chronic

Bronchial asthma

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources6 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 against5 documents

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

Verified date2026-08

Presentation reference

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

SourceStatPearls "Asthma" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Reliever | Preventer | Combination inhaler | Add-on | Asthma attack

RELIEVER

SALBUTAMOL

Reliever

1st line

Strength0.1 mg

Formoral.inhalation

Adult dose and duration

100-200 mcg (1-2 puffs of 100 mcg/puff) as needed for acute symptom relief - as-needed

Paediatric dose

100-200 mcg as needed via spacer in children

Dose 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.

Cautions

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
AEROLIN 100MCG/DOSE INHALER	EIPICO > 3M HEALTH CARE-U.K.	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? strength differs? different route - not oral.inhalation	EL-OBOUR	2.00 EGP
SALBUTAMOL 2MG/5ML SYRUP 120ML? strength differs? different route - not oral.inhalation	SEDICO	3.50 EGP

PREVENTER - choose one

BUDESONIDE

Preventer

1st line

Strength0.2 mg

Formoral.inhalation

Adult dose and duration

200-400 mcg (1-2 puffs of 200 mcg/puff) BID regular maintenance - long-term

Paediatric dose

100-200 mcg BID maintenance in children

Dose 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.

Cautions

Rinse mouth after inhalation to prevent candidiasis.
Counsel on daily compliance even when asymptomatic.
Budesonide is not for acute relief of bronchospasm.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
BUDECORT 200MCG/DOSE INHALER	CIPLA LTD. - INDIA > STAR INTERNATIONAL COMPANY	55.00 EGP
PULMICORT 200MCG/DOSE TURBOHALER	ASTRA ZENECA	110.00 EGP

SALMETEROL + FLUTICASONE

Preventer

2nd line

Strength0.25 mg

Formoral.inhalation

Adult dose and duration

1 puff (50/250 mcg per puff) BID - long-term

Paediatric dose

Specialist referral for ICS-LABA in children under 12

Dose 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.

Cautions

Do not use for acute symptom relief.
Rinse mouth after each dose to avoid oral thrush.
Step down therapy once controlled for 3 months.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
SEROFLO 100/50MCG PD. FOR INH. 30 BLISTERS? strength differs	CIPLA LTD. - INDIA > STAR INTERNATIONAL COMPANY	52.50 EGP
SEROFLO 250/50MCG PD. FOR INH. 30 BLISTERS? strength differs	CIPLA LTD. - INDIA > STAR INTERNATIONAL COMPANY	63.00 EGP
SEROFLO 500/50MCG PD. FOR INH. 30 BLISTERS? strength differs	CIPLA LTD. - INDIA > STAR INTERNATIONAL COMPANY	77.00 EGP
METRICASON 125/25 MCG 120 METERED ACTUATIONS? strength differs	MDI PHARMA	121.00 EGP
SERETIDE EVOHALER 50/25MCG 120 METERED ACTUATIONS? strength differs	GLAXO SMITHKLINE > MODERN PHARMA	198.00 EGP
SERETIDE DISKUS 100/50MCG 60 DOSES? strength differs	GLAXO SMITHKLINE > MODERN PHARMA	244.00 EGP
SERETIDE DISKUS 250/50MCG 60 DOSES? strength differs	GLAXO SMITHKLINE > MODERN PHARMA	335.00 EGP
SERETIDE DISKUS 500/50MCG 60 DOSES? strength differs	GLAXO SMITHKLINE > MODERN PHARMA	411.00 EGP

COMBINATION INHALER

BUDESONIDE + FORMOTEROL

Combination inhaler

1st line

Strength0.2 mg

Formoral.inhalation

Adult dose and duration

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

Paediatric dose

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.

Dose 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.

Cautions

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
MDICORVAL 200MCG/6MCG 120 METERED ACTUATIONS	MDI PHARMA	198.00 EGP

ADD-ON

MONTELUKAST

Add-on

2nd line

Strength10 mg

Formoral.solid

Adult dose and duration

10 mg once daily in the evening - long-term

Paediatric dose

(4 mg (6 mos-5 yrs) or 5 mg (6-14 yrs) or 10 mg (15-17 yrs) once daily in evening)

Dose by age
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

Dose 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.

Cautions

Monitor for mood and behavior changes.
Montelukast carries an FDA warning for neuropsychiatric events.
Montelukast is less effective than ICS as monotherapy.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
PIRONTAGONIST 10MG 20 F.C. TABS.	EGPI > ADVANCE PHARMA	60.00 EGP (3.00/unit)
ASMALAIR 10MG 10 TAB.	HI-PHARM	40.00 EGP (4.00/unit)
MONTEKAL 10MG 10 TAB.	EUROPEAN EGYPTIAN PHARM. IND.	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 INTERNATIONAL PHARMACEUTICALS	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

PREDNISOLONE

Asthma attack

add-on - not a substitute

Strength5 mg

Formoral.solid

Adult dose and duration

40-50 mg once daily in the morning - until recovery, minimum 5 days, then stop without tapering

Paediatric dose

(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.)

Dose by age
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.

Dose 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.

Cautions

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
HOSTACORTIN H 5MG 30 TAB.	SANOFI	12.00 EGP (0.40/unit)
PREDNISOLONE 5 MG 20 TABS.	ARAB DRUG COMPANY (ADCO)	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? strength differs? different route - not oral solid	RAMEDA	7.50 EGP
PREDNIS 5MG/5ML SYRUP 100 ML? strength differs? different route - not oral solid	PHAROPHARMA	9.50 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.