In asthma management, which step of the GINA stepwise approach is characterized by the use of low-dose ICS/LABA combination therapy?

Explanation

## GINA Stepwise Asthma Management — Step 3 **Key Point:** Step 3 of the GINA asthma management ladder involves low-dose ICS/LABA combination therapy, used for patients with mild-to-moderate persistent asthma not controlled on Step 2 monotherapy. ### GINA Stepwise Treatment Algorithm ```mermaid flowchart TD A[Asthma Diagnosis]:::outcome --> B{Symptom Control?}:::decision B -->|Intermittent symptoms| C[Step 1: SABA PRN]:::action B -->|Mild persistent| D[Step 2: Low-dose ICS]:::action D --> E{Controlled?}:::decision E -->|No| F[Step 3: Low-dose ICS/LABA]:::action F --> G{Controlled?}:::decision G -->|No| H[Step 4: Medium/High-dose ICS/LABA ± LTRA/LAMA]:::action G -->|Yes| I[Maintain Step 3]:::outcome H --> J{Controlled?}:::decision J -->|No| K[Step 5: High-dose ICS/LABA + oral corticosteroid ± biologic]:::action J -->|Yes| L[Maintain Step 4]:::outcome ``` ### Step-by-Step Breakdown | Step | Therapy | Indication | |------|---------|------------| | 1 | SABA as needed | Intermittent asthma | | **2** | **Low-dose ICS** | **Mild persistent asthma** | | **3** | **Low-dose ICS/LABA** | **Mild-to-moderate persistent; inadequate control on Step 2** | | 4 | Medium/high-dose ICS/LABA ± LTRA/LAMA | Moderate-to-severe persistent | | 5 | High-dose ICS/LABA + OCS ± biologic | Severe asthma; inadequate control on Step 4 | **High-Yield:** The transition from Step 2 to Step 3 is triggered by inadequate control on low-dose ICS monotherapy, not by symptom severity alone. **Mnemonic:** **GINA Steps 1–5 = SABA → ICS → ICS/LABA → ICS/LABA+ → OCS/Biologic** **Clinical Pearl:** Step 3 is the most commonly used maintenance regimen in primary care for mild-to-moderate persistent asthma; it balances efficacy and safety.