STEP5 : Refer for expert investigation and add-on treatment
Add –on treatment include anti-IgE (omalizumab) for severe allergic asthma. Sputum-guided treatment, if available, improves outcome. Other option: Add-on tiotropium by soft-mist inhaler for adults ( >18 yrears) with a history of exacerbation. Some patients may benefit from low dose OCS but long-term systemic side-effects occur.