# Bronchial asthma - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: GINA Asthma Strategy 2023 · Egyptian National Drug Formulary - Respiratory System 2026 (montelukast monograph) · Symbicort Turbohaler 200/6 SmPC section 4.2 (eMC product 1327) · SIGN 158 / BTS British guideline on the management of asthma (2019), section 9.3.3 · SIGN 158 / BTS British guideline on the management of asthma (2019), section 9.8.4 · Goldin J, Cataletto ME. Asthma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: May 3, 2024. - Verified date: 2026-08 ## Verified against - GINA Asthma Strategy 2023 - Egyptian National Drug Formulary - Respiratory System 2026 (montelukast monograph) - Symbicort Turbohaler 200/6 SmPC section 4.2 (eMC product 1327) - SIGN 158 / BTS British guideline on the management of asthma (2019), section 9.3.3 - SIGN 158 / BTS British guideline on the management of asthma (2019), section 9.8.4 ## Treatment metadata - Salbutamol — 0.1 mg — oral.inhalation - Budesonide — 0.2 mg — oral.inhalation - Budesonide + formoterol — 0.2 mg — oral.inhalation - Salmeterol + Fluticasone — 0.25 mg — oral.inhalation - Montelukast — 10 mg — oral.solid - Prednisolone — 5 mg — oral.solid ## Complete treatment card ```text BRONCHIAL ASTHMA Sources: GINA Asthma Strategy 2023 · Egyptian National Drug Formulary - Respiratory System 2026 (montelukast monograph) · Symbicort Turbohaler 200/6 SmPC section 4.2 (eMC product 1327) · SIGN 158 / BTS British guideline on the management of asthma (2019), section 9.3.3 · SIGN 158 / BTS British guideline on the management of asthma (2019), section 9.8.4 · Goldin J, Cataletto ME. Asthma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: May 3, 2024. Review status: REVIEWED against 5 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (8) - The four cardinal symptoms are wheeze, cough that is often worse at night, breathlessness and chest tightness [breathlessness · chest pain · cough · night-time symptoms · wheeze] - Symptoms come and go over hours to days, and settle when the trigger goes or treatment is given - Waking at night, or symptoms set off by exercise, cold air or an allergen, points to asthma - Exercise-induced asthma begins about 15 minutes into activity and eases 30 to 60 minutes after stopping - Ordinary exertional breathlessness behaves differently - it starts soon after effort begins and clears within 5 minutes [breathlessness] - Ask about eczema and hay fever - other forms of atopy support the diagnosis [allergic rhinitis] - Ask what sets it off at home: dust, animals, and infestation with rodents or cockroaches - Symptoms that track the working week suggest an occupational cause SIGNS - what you find (8) - Widespread high-pitched wheeze is the characteristic finding [wheeze] - Wheeze is neither specific to asthma nor usually present between attacks [wheeze] - A severe attack: fast breathing, fast pulse, long expiratory phase, poor air entry, unable to finish a sentence [reduced air entry · tachypnoea] - Accessory muscle use on inspiration and pulsus paradoxus also mark a severe attack [chest recession] - Look outside the chest: pale boggy nasal lining, cobblestoning of the posterior pharynx, polyps, eczema [allergic rhinitis · polyp] - Nasal polyps should prompt asking about lost sense of smell, chronic sinusitis and aspirin sensitivity [loss of smell · nasal polyps] - Polyps in a child with lower airway disease mean testing for cystic fibrosis [polyp] - Clubbing is not a feature of asthma and should send you hunting another diagnosis [finger clubbing] TESTS (12) - Confirming asthma means showing variable airflow limitation, usually on spirometry, and excluding other causes - Asthma gives an obstructive pattern - the ratio of FEV1 to FVC is reduced - Give two to four puffs of a reliever inhaler, then repeat the spirometry a quarter of an hour later - GINA counts the response as significant at a rise in FEV1 of 12 percent, or 200 mL - Challenge testing is positive if FEV1 drops 20 percent with methacholine, or 15 percent with mannitol or hypertonic saline - Exhaled nitric oxide over 40 to 50 ppb helps confirm the diagnosis - Spirometry may read normal between attacks or in cough-variant asthma - False negatives come from controller therapy, airway remodelling, few symptoms on the day, or a recent inhaler - Peak flow is for monitoring known asthma rather than making the diagnosis, and depends heavily on effort - A falling oxygen saturation is a late sign - by then the patient is heading for arrest - In a severe attack check the blood count for eosinophils and for anaemia, which can itself explain breathlessness - Chest film if aged 40 or over with new moderate-to-severe asthma, to exclude a mediastinal mass or heart failure IF NOT THIS - what else fits (12) - COPD, or bronchiectasis and bronchiolitis - Cystic fibrosis, or chronic sinusitis driving the cough - An inhaled foreign body, or heart failure - Reflux disease, or tracheomalacia - Pulmonary embolism - Vocal cord dysfunction - Cough caused by an ACE inhibitor - Whooping cough - Cough after a virus, or eosinophilic bronchitis - Carcinoma of the bronchus - Aspergillosis, or anaphylaxis brought on by exercise - Eosinophilic granulomatosis with polyangiitis Source StatPearls "Asthma" - disease-level clinical article Status traced to the source above Rx: Reliever | Preventer | Combination inhaler | Add-on | Asthma attack RELIEVER 1. SALBUTAMOL [1st line] Adult 100-200 mcg (1-2 puffs of 100 mcg/puff) as needed for acute symptom relief - as-needed Peds 100-200 mcg as needed via spacer in children Source GINA Asthma Strategy 2023 Why Short-acting beta-agonist that relaxes bronchial smooth muscle for quick relief of acute asthma symptoms; a reliever only, and never to be used without a concomitant inhaled corticosteroid, since reliever-only treatment is what leads to fatal exacerbations. Caution Never on its own. NICE NG245 1.6.3 is a flat prohibition: do not prescribe a short- acting beta 2 agonist, at any age, to a person with asthma unless an ICS is prescribed with it. Reliever-only treatment is what kills asthmatics. Overuse (>2 canisters/year) indicates poor asthma control. May cause tremor and tachycardia at high doses. Use with spacer device in young children. Egypt AEROLIN 100MCG/DOSE INHALER EIPICO > 3M H... 7.30 EGP BUTALIN 100MCG/ACTUATION 200 DOSES JULPHAR 12.00 EGP VENTAL INHALER 100 MCG/DOSE 200 DOSES ARAB DRUG COMPANY (ADCO) 72.00 EGP VIASALMOL 100MCG 200 ACTUATION INHALER MDI PHARMA 72.00 EGP VENTOLIN EVOHALER 100MCG/ACTUATION INHALER GLAXO SMITHKLINE 86.00 EGP OPICHESTAL SYRUP 120ML EL-OBOUR 2.00 EGP -> ? strength differs, ? different route - not oral.inhalation SALBUTAMOL 2MG/5ML SYRUP 120ML SEDICO 3.50 EGP -> ? strength differs, ? different route - not oral.inhalation PREVENTER - choose one 2. BUDESONIDE [1st line] Adult 200-400 mcg (1-2 puffs of 200 mcg/puff) BID regular maintenance - long-term Peds 100-200 mcg BID maintenance in children Source GINA Asthma Strategy 2023 Why Inhaled corticosteroid that reduces the chronic airway inflammation underlying asthma; a regular controller taken to prevent symptoms rather than to relieve an acute attack. Caution Rinse mouth after inhalation to prevent candidiasis. Counsel on daily compliance even when asymptomatic. Budesonide is not for acute relief of bronchospasm. Egypt BUDECORT 200MCG/DOSE INHALER CIPLA LTD. - ... 55.00 EGP PULMICORT 200MCG/DOSE TURBOHALER ASTRA ZENECA 110.00 EGP 3. SALMETEROL + FLUTICASONE [2nd line] Adult 1 puff (50/250 mcg per puff) BID - long-term Peds Specialist referral for ICS-LABA in children under 12 Source GINA Asthma Strategy 2023 Why Combination long-acting beta-agonist and inhaled corticosteroid used as a step-up controller when inhaled corticosteroid alone does not achieve control; the long-acting bronchodilator is not for acute relief and is always paired here with the steroid component. Caution Do not use for acute symptom relief. Rinse mouth after each dose to avoid oral thrush. Step down therapy once controlled for 3 months. Egypt SEROFLO 100/50MCG PD. FOR INH. 30 BLISTERS CIPLA LTD. - INDIA > STAR INT... 52.50 EGP -> ? strength differs SEROFLO 250/50MCG PD. FOR INH. 30 BLISTERS CIPLA LTD. - INDIA > STAR INT... 63.00 EGP -> ? strength differs SEROFLO 500/50MCG PD. FOR INH. 30 BLISTERS CIPLA LTD. - INDIA > STAR INT... 77.00 EGP -> ? strength differs METRICASON 125/25 MCG 120 METERED ACTUATIONS MDI PHARMA 121.00 EGP -> ? strength differs SERETIDE EVOHALER 50/25MCG 120 METERED ACTUATIONS GLAXO SMITHKLINE > MOD... 198.00 EGP -> ? strength differs SERETIDE DISKUS 100/50MCG 60 DOSES GLAXO SMITHKLINE > MODERN PHARMA 244.00 EGP -> ? strength differs SERETIDE DISKUS 250/50MCG 60 DOSES GLAXO SMITHKLINE > MODERN PHARMA 335.00 EGP -> ? strength differs SERETIDE DISKUS 500/50MCG 60 DOSES GLAXO SMITHKLINE > MODERN PHARMA 411.00 EGP -> ? strength differs COMBINATION INHALER 4. BUDESONIDE + FORMOTEROL [1st line] Adult 200/6 mcg per inhalation. As-needed AIR: 1 inhalation whenever symptoms occur, no regular dose. As MART: 1 inhalation morning and evening plus 1 extra whenever symptoms occur; not more than 6 on any single occasion and not normally more than 8 in a day - long-term Peds The AIR and MART recommendations apply from 12 years. The SmPC states reliever therapy with this product is not recommended under 12 years; a younger child needs the paediatric pathway and a separate ICS. Source Symbicort Turbohaler 200/6 SmPC section 4.2 (eMC product 1327) Why NG245 makes a low-dose ICS/formoterol inhaler the first thing written for newly diagnosed asthma in anyone 12 and over. The condition currently starts with a plain salbutamol reliever, which the same guideline says must never be prescribed without an inhaled steroid. This is the single biggest gap in the asthma card. Caution The whole point of this inhaler is that the steroid travels with the reliever. If the patient is given a separate salbutamol as well, they will use that instead and the steroid stops being taken. AIR and MART are two different prescriptions. AIR is as-needed only. MART is one puff twice a day plus as-needed. Write which one you mean on the Roschetta. Rinse the mouth after every inhalation to prevent oral thrush. Using more than 8 inhalations a day means the asthma is not controlled - review, do not just refill. Formoterol is a long-acting beta agonist. Never combine this with a separate LABA inhaler. Egypt MDICORVAL 200MCG/6MCG 120 METERED ACTUATIONS MDI PHARMA 198.00 EGP ADD-ON 5. MONTELUKAST [2nd line] Adult 10 mg once daily in the evening - long-term Peds 6 months to 5 years: 4 mg once daily in the evening 6 to 14 years: 5 mg once daily in the evening 15 to 17 years: 10 mg once daily in the evening (4 mg (6 mos-5 yrs) or 5 mg (6-14 yrs) or 10 mg (15-17 yrs) once daily in evening) Source Egyptian National Drug Formulary - Respiratory System 2026 (montelukast monograph) Why Leukotriene receptor antagonist used as an add-on or alternative oral controller when inhaled corticosteroid therapy needs to be stepped up; less effective than inhaled corticosteroids as monotherapy, as the cautions note. Caution Monitor for mood and behavior changes. Montelukast carries an FDA warning for neuropsychiatric events. Montelukast is less effective than ICS as monotherapy. Egypt PIRONTAGONIST 10MG 20 F.C. TABS. EGPI > ADVANC... 60.00 EGP (3.00/unit) ASMALAIR 10MG 10 TAB. HI-PHARM 40.00 EGP (4.00/unit) MONTEKAL 10MG 10 TAB. EUROPEAN EGYP... 40.00 EGP (4.00/unit) INLETAIR 10 MG 10 F.C.TAB. ORGANOPHARMA 47.00 EGP (4.70/unit) MONTELOSAB 10 MG 14 F.C. TABS. P&C > VERCURE 82.00 EGP (5.86/unit) LELIPEL 10 MG 20 F.C. TABS. EGPI > GLOBE ... 120.00 EGP (6.00/unit) OPIKAST 10 MG 14 SCORED F.C. TABS. EL-OBOUR 22.20 EGP STATUKAST 10 MG 10 SCORED F.C. TABS. ADWIA 41.50 EGP ASTHMA ATTACK - give alongside 6. PREDNISOLONE [add-on - not a substitute] Adult 40-50 mg once daily in the morning - until recovery, minimum 5 days, then stop without tapering Peds Under 2 years: 10 mg once daily 2 to 5 years: 20 mg once daily Over 5 years: 30 to 40 mg once daily. Larger doses give no advantage and the course does not need tapering. (Fixed doses by age band, not mg/kg: 10 mg under 2 years, 20 mg for 2-5 years, 30-40 mg over 5 years, once daily. Larger doses give no advantage and the course does not need tapering.) Source SIGN 158 / BTS British guideline on the management of asthma (2019), section 9.8.4 Why The asthmatic who walks in wheezing needs a steroid course as well as the inhalers, and the condition had nothing for the attack. NG245 deliberately does not cover acute attacks, so the dose comes from the BTS/SIGN guideline that does. Caution Give it early - the guideline states the earlier steroids are given in the attack the better the outcome. Do not stop the inhaled corticosteroid while the tablets are running. No taper after a short course, provided the patient is on an inhaled steroid. A patient needing repeated courses has uncontrolled asthma and needs the maintenance treatment stepped up, not more prednisolone. Raises blood glucose - warn the diabetic patient. Egypt HOSTACORTIN H 5MG 30 TAB. SANOFI 12.00 EGP (0.40/unit) PREDNISOLONE 5 MG 20 TABS. ARAB DRUG COM... 24.00 EGP (1.20/unit) PREDILONE 5MG 10 TAB. (25 STRIPS PACK) KAHIRA 250.00 EGP (25.00/unit) EPICOPRED 5 MG 30 ORODISPERSIBLE TABS. EIPICO 69.00 EGP PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS. EVA PHARMA 79.50 EGP DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS. ANDALOUS PHARMA 84.00 EGP SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS. SANOFI WINTHROP > SANOFI 84.00 EGP ACETASEE 1% EYE DROPS (SUSP.) 5 ML RAMEDA 7.50 EGP -> ? strength differs, ? different route - not oral solid PREDNIS 5MG/5ML SYRUP 100 ML PHAROPHARMA 9.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)