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Patient handout

Asthma (chronic stepwise + acute exacerbation)

PRODUCTION

1. Your condition

This handout is for asthma (chronic stepwise + acute exacerbation). Your care team identified this based on: episodic wheeze, cough, chest tightness, dyspnea (gina 2026 box 1-2).

Other reasons your team may use this plan: nocturnal awakening from cough/wheeze (gina 2026 control assessment); severe acute exacerbation (pef <50%, accessory muscles, silent chest) — bts/sign 2024 severity classification; spirometry: reduced fev1/fvc with bronchodilator reversibility ≥12% (gina 2026 box 1-2; ats/ers 2022 spirometry standards).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

MedicationStarting doseHowWhenWhat it does
budesonide-formoterol200/6 µginhaled1 puff PRN for symptomsGINA 2026 Track 1 AIR — replaces SABA-only. SYGMA-1 (PMID 29768149): as-needed budesonide-formoterol superior to as-needed SABA for severe exacerbations; SYGMA-2 (PMID 29768147): as-needed bud-form non-inferior to maintenance budesonide for severe exac at ≈1/4 the inhaled steroid dose; Novel START (PMID 31112386): bud-form lower severe-exac risk vs SABA. RxCUI 1246304 = budesonide/formoterol SCD (RxNav-validated 2026-05-24)

Plan: GINA 2026 Track 1 — ICS-formoterol-based stepwise (Steps 1–5)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Doing well — PEF 80–100% personal best
If you have:
  • No cough, wheeze, chest tightness, or shortness of breath (GINA 2026 Box 4-2 green zone)
  • Can do all usual activities (GINA 2026 control criteria)
  • No night waking from asthma (GINA 2026 control criteria)
  • peak flow ≥80% personal best (GINA 2026 Box 4-2)
Do this:
  • Take controller as prescribed every day — do not skip even if feeling well (GINA 2026 §3)
  • Use reliever (controller inhaler-formoterol or rescue inhaler) only as needed (GINA 2026 Track 1)
  • Continue trigger avoidance (GINA 2026 §3)
  • Keep follow-up appointments (GINA 2026 §4)
YELLOW — Caution — PEF 50–79% personal best OR symptoms increasing
If you have:
  • Cough, wheeze, chest tightness, or breathlessness (GINA 2026 Box 4-2 yellow zone)
  • Waking at night with asthma (GINA 2026 control assessment)
  • Reliever needed more than usual (GINA 2026 Box 4-2)
  • peak flow 50–79% personal best (GINA 2026 Box 4-2)
Do this:
  • Increase controller inhaler-formoterol PRN reliever as needed — max 12 puffs/day total (GINA 2026 Track 1)
  • If on MART: continue maintenance + use additional puffs as reliever (GINA 2026 MART protocol)
  • If not improving in 24–48 h or worsening: start prednisone 40–50 mg PO daily x 5–7 days per pre-prescribed action plan (GINA 2026 Box 4-2)
  • Contact your provider within 24 h (GINA 2026 Box 4-2)
Call your provider if:
  • Symptoms not improving after 48 h of increased reliever (GINA 2026 Box 4-2)
  • Any decline in peak flow below 50% best (GINA 2026 yellow→red zone boundary)
  • Need to use reliever more often than every 4 h (GINA 2026)
RED — Medical alert — PEF <50% personal best OR severe symptoms
If you have:
  • Very short of breath, cannot speak in full sentences (BTS/SIGN 2024 severe criteria)
  • Reliever not helping (GINA 2026 Box 4-2 red zone)
  • peak flow <50% personal best (GINA 2026 Box 4-2 red zone)
  • Lips or fingertips blue — cyanosis (BTS/SIGN 2024 life-threatening criteria)
  • Confusion or extreme drowsiness (BTS/SIGN 2024 life-threatening criteria)
Do this:
  • Use reliever right now — controller inhaler-formoterol 4 puffs OR rescue inhaler 4–8 puffs — repeat every 20 min while seeking help (GINA 2026 Box 4-2)
  • Take prednisone 40–50 mg PO now if available (GINA 2026 Box 4-2)
  • Call 911 / emergency services immediately (GINA 2026 Box 4-2)
  • Sit upright; do not lie down (BTS/SIGN 2024)
Call your provider if:
  • Any red zone symptom — go to ED now, do not wait (GINA 2026 Box 4-2)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

  • peak flow <50% personal best after first-hour rescue inhaler + ipratropium + systemic steroid (BTS/SIGN 2024 severe criteria)
  • Silent chest, altered mental status, exhaustion, or pulsus paradoxus >25 mmHg (BTS/SIGN 2024 life-threatening criteria)(life-threatening)
  • PaCO2 rising or normalising in tachypnoeic severe asthma — PaCO2 should be LOW from hyperventilation (BTS/SIGN 2024 near-fatal criteria)(life-threatening)
  • Severe exacerbation in pregnant patient (GINA 2026 §3 pregnancy)
  • Acute severe wheeze — is it asthma or a mimic? §5.5.2 acute differential: anaphylaxis (urticaria/angioedema/hypotension + exposure + tryptase) → epinephrine NOW; tension/simple pneumothorax (sudden pleuritic + unilateral ↓breath sounds, CXR/POCUS); PE (disproportionate hypoxia, pleuritic, VTE risk, no sputum change → Wells/D-dimer/CTPA); ADHF/cardiac asthma (orthopnea/JVD/S3/natural marker of fluid overload (NT-proBNP)↑↑/echo/CXR edema); foreign body (sudden onset, focal monophonic wheeze, asymmetric exam — bronchoscopy)

5. Follow-up

Written asthma action plan (GINA 2026 Box 4-2), vaccinations — flu, pneumococcal, COVID, RSV (ACIP 2026), smoking cessation, weight, allergen control, controller refill, technique re-audit, follow-up within 1 week of any ED/admission per GINA 2026

6. Sources

Guideline: GINA 2026 Strategy Report (released May 2026) + ATS/ERS 2024 Severe Asthma Guidelines + NAEPP 2020 Focused Update + BTS/SIGN 2024

  1. pubmed.ncbi.nlm.nih.gov/29768149
  2. pubmed.ncbi.nlm.nih.gov/29768147
  3. pubmed.ncbi.nlm.nih.gov/31112386