Tiotropium as an add-on Tx

for uncontrolled asthma

despite ICS LABA
Step

STEP 5

Step4
STEP

Preferred
Controller
Other
Controller

STEP
Step1

STEP 2

low dose ICS

Consider low
dose ICS

Reliever
www.ginasthma.org

Step

Leukotriene receptor antagonists

(LTRA) Low dose theophylline*

As-needed short-acting beta2-agonist (SABA)

SABA

Tiotripium for Asthma

STEP
Step3

4
Med/high

low dose

ICS/LABA

Refer for
add-on Tx
e.g.

anti-IgE

ICS/LABA
Med/high dose ICS Add tiotropium
Low dose ICS+LTRA High dose ICS
+ LTRA
(or + theoph)
(or + theoph)

Add
tiotropium#
Add low
dose OCS

Add tiotropium

As-needed SABA or

SABA
ICS/Form
low
dose or
ICS/formoterol**
4

GINA 2015