Table 3. Consensus management recommendations, split by REALISE Asia attitudinal cohort including cluster-specific qualifiers.

Recommendationsa	Attitudinal–Control Cluster
	Well-adjusted	Rejectors	Endurer	Lost	Worrier
Optimised GINA Step-wise Management	✓ If well controlled: consider step down If control could be improved: consider simplified treatment regimen	✓ As usage/adherence is likely intermittent: encourage a regular maintenance regimen (e.g., fixed dose combination ICS/LABA)	✓ Taking into consideration specific approaches for optimising adherence and targeting inflammation throughout the airways (e.g., extra-fine particle ICS)	✓ Take individual patient's attitudes and beliefs into consideration and consider aggressive management’ (i.e trial of higher-step therapy to demonstrate efficacy and build confidence)	✓ Where symptoms are the result of uncontrolled asthma, consider: •simplified treatment regimen to help optimise adherence •‘aggressive management’ to demonstrate efficacy and build confidence (e.g., ICS/LABA±LAMA or±LTRA)
Reduced or Non-ICS alternatives	×	✓ If steroid avoidance is identified as a barrier to ICS containing	×	×	×
Avoid therapies that may causes anxiety	×	×	×	✓ e.g., excess bronchodilator use	✓ Where symptom are not the result of uncontrolled asthma
Comorbidity Management	×	×	×	×	✓ Where symptoms are not the result of uncontrolled asthma
Education, cluster-specific recommendations	✓ •Trigger avoidance (e.g., lifestyle; domestic and occupational irritants) •Inhaler technique assessment and training •Benefits of Medication adherence	✓ •Tailored to patient’s perception of their condition (i.e., they do not accept they have ‘asthma’) •Trigger avoidance (e.g., lifestyle; domestic and occupational irritants)	✓ •Benefits of Medication adherence	✓ Tailored to patient’s literacy, health literacy and personal circumstances	✓ •Trigger avoidance (e.g., lifestyle; domestic and occupational irritants) •Benefits of Medication adherence
Self-management (to empower and build confidence)	✓ Key cohort to decide on the best/lowest dose of ICS that keeps them symptom free	×	✓ Self-selecting self-managers. Management approaches include: asthma risk plan and ‘innovative’ (e.g., digital) solutions	✓ Using objective-monitoring tools to help patient’s perception of their ability to monitor and self-manage	✓ Individualised symptom management and risk management plan
Risk management	×	✓ Not labelled as ‘asthma management plan’ (as they do not accept they have asthma)	✓ To ensure timely and appropriate access to healthcare	×	✓
Follow-up: remote or less intensive	✓	✓	×	×	×
Follow-up: more frequent	×	×	×	×	✓
Improve expectations of treatment	×	×	✓	✓	✓
Psychological approach	×	✓ •Tailor management style to specific patient characteristics •Motivational interviewing •Non-judgmental consultation style •Possible referral to specialist or psychologist	×	✓ •Address concerns and low confidence in healthcare	✓ •Possible referral to specialist or psychologist
Social Support	×	✓ •Engage support from family, friend Group support & shared experiences (to help with de-stigmatisation)	×	✓ •Engage support from family, friend •Group support & shared experiences (to help with de-stigmatisation	✓ •Engage support from family, friend •Group support & shared experiences (to help with de-stigmatisation
Evaluate/manage comorbidities	×	×	×	✓	✓
Breathing exercises	×	×	×	×	✓ Where symptoms are not the result of uncontrolled asthma

✓, specifically recommended for this patient group by the expert panel.

×, not specifically recommended for this patient group by the expert panel.

^aSome recommendations/recommendation categories are relevant across all attitudinal–control clusters. However, the table summarises those highlighted by the panel as deserving particular attention in specific patient subgroups/clusters.