6.4. Long-term management
Over the long-term follow-up, level of asthma control in patients should be assessed according to the criteria stated above.
In all patients, asthma control should be achieved and maintained by escalating or de-escalating to proper treatment steps.
Down-stepping of treatment regimens may be considered only after maintenance of asthma control for at least 3 months. Consider stepping-up for failed control of asthma or onset of acute exacerbation until asthma control is achieved.
A follow-up visit is generally scheduled every 1 to 3 months for patients even though with achieved asthma control; but for those who have a recent exacerbation, every 2 to 4 weeks. During the visits, data on home PEF measurement and symptom records, acquired skills for inhalation, risk factors, and the level of asthma control should be collected. Patients should be encouraged to keep an asthma diary which includes daily symptoms, twice-daily measurements of PEF, and outcomes of asthma control test (ACT) which is performed once every 4 weeks. In addition, the patients should be followed up for maintenance of asthma control, prompt adjustment of treatment regimens and the need to reduce dosing of controllers