may be considered in low-resource countries or as part of tailoring treatment. The two options for reliever
medication are shown, i.e. SABA, or low dose ICS/formoterol for patients prescribed maintenance and
reliever regimens. In the 2015 GINA update, add-on tiotropium by soft-mist inhaler is included in Step 4
and Step 5 as an “other controller option” for adults (⩾18 years) with exacerbations, following regulatory
approval for this indication. Key clinical messages are included beneath the stepwise figure, to ensure that
it is complete in itself if the figure is viewed in isolation from the surrounding text.