Stepwise Approach for Management of Asthma
Abbreviations#
EIB = exercise-induced bronchoconstriction
ICS = inhaled corticosteroids
LABA = long-acting beta2-agonist(s)
LAMA = long-acting muscarinic antagonist
SABA = short-acting beta2-agonist(s)
RTL = repiratory tract infection
PRN = as needed
Ages 0-4 years old#
| Intermittent asthma | Management of persistent asthma in individuals ages 0-4 years | |||||
|---|---|---|---|---|---|---|
| Treatment | Step 1 | Step 2 | Step 3 | Step 4 | Step 5 | Step 6 |
| Preferred | PRN SABA and at the start of RTI: add short course daily ICS | Daily low-dose ICS and PRN SABA | Daily low-dose ICS-LABA and PRN SABA or Daily low-dose ICS + montelukast or Daily medium-dose ICS, and PRN SABA | Daily medium-dose ICS-LABA and PRN SABA | Daily high-dose ICS-LABA and PRN SABA | Daily high-dose ICS-LABA + oral systemic corticosteroid and PRN SABA |
| Alternative | Daily montelukast or Cromolyn, and PRN SAB | Daily medium-dose ICS + montelukast and PRN SABA | Daily high-dose ICS + montelukast and PRN SABA | Daily high-dose ICS + montelukast+ oral systemic corticosteroid and PRN SABA | ||
Quick relief medications#
- Use SABA as needed for symptoms. The intensity of treatment depends on severity of symptoms: up to 3 treatments at 20-minute intervals as needed.
- Caution: Increasing use of SABA or use >2 days a week for symptom relief (not prevention of EIB) generally indicates inadequate control and may require a step up in treatment.
- Consider short course of oral systemic corticosteroid if exacerbation is severe or individual has a history of severe exacerbation.
Ages 5-11 years#
| Intermittent asthma | Management of persistent asthma in individuals ages 5-11 years | |||||
|---|---|---|---|---|---|---|
| Treatment | Step 1 | Step 2 | Step 3 | Step 4 | Step 5 | Step 6 |
| Preferred | PRN SABA | Daily low-dose ICS and PRN SABA | Daily and PRN combination low-dose ICS-formoterol | Daily and PRN combination medium-dose ICS-formoterol | Daily high-dose ICS-LABA and PRN SABA | Daily high-dose ICS-LABA + oral systemic corticosteroid and PRN SABA |
| Alternative | Daily LTRA, or Cromolyn, or Nedocromil, or Theophylline, and PRN SABA | Daily medium-dose ICS and PRN SABA or Daily low-dose ICS-LABA, or daily low-dose ICS + LTRA, or daily low-dose ICS + Theophylline, and PRN SABA | Daily medium-dose ICS-LABA and PRN SABA or Daily medium-dose ICS + LTRA* or daily medium[1]dose ICS + Theophylline, and PRN SABA | Daily high-dose ICS + LTRA* or daily high-dose ICS + Theophylline, and PRN SABA | Daily high-dose ICS + LTRA + oral systemic corticosteroid or daily high-dose ICS + Theophylline + oral systemic corticosteroid, and PRN SABA | |
Quick relief medications#
- Use SABA as needed for symptoms. The intensity of treatment depends on severity of symptoms: up to 3 treatments at 20-minute intervals as needed.
- In Steps 3 and 4, the preferred option includes the use of ICS-formoterol 1 to 2 puffs as needed up to a maximum total daily maintenance and rescue dose of 8 puffs.
- Caution: Increasing use of SABA or use >2 days a week for symptom relief (not prevention of EIB) generally indicates inadequate control and may require a step up in treatment.
Ages 12+ years#
| Intermittent asthma | Management of persistent asthma in individuals ages 12+ years | |||||
|---|---|---|---|---|---|---|
| Treatment | Step 1 | Step 2 | Step 3 | Step 4 | Step 5 | Step 6 |
| Preferred | PRN SABA | Daily low-dose ICS and PRN SABA or PRN concomitant ICS and SABA | Daily and PRN combination low-dose ICS-formoterol | Daily and PRN combination medium-dose ICS-formoterol | Daily medium-high dose ICS-LABA and PRN SABA | Daily high-dose ICS-LABA + oral systemic corticosteroid and PRN SABA |
| Alternative | Daily LTRA and PRN SABA or Cromolyn, or Nedocromil, or Zileuton, or Theophylline, and PRN SABA | Daily medium-dose ICS and PRN SABA or Daily low-dose ICS-LABA, or daily low-dose ICS + LAMA, or daily low-dose ICS + LTRA, and PRN SABA or Daily low-dose ICS + Theophylline* or Zileuton,* and PRN SABA | Daily medium-dose ICS-LABA or daily medium-dose ICS + LAMA, and PRN SABA or Daily medium-dose ICS + LTRA, or daily medium-dose ICS + Theophylline, or daily medium-dose ICS + Zileuton, and PRN SABA | Daily medium-high dose ICS-LABA or daily high-dose ICS + LTRA, and PRN SABA | ||
Quick relief medications#
- Use SABA as needed for symptoms. The intensity of treatment depends on severity of symptoms: up to 3 treatments at 20-minute intervals as needed.
- In Steps 3 and 4, the preferred option includes the use of ICS-formoterol 1 to 2 puffs as needed up to a maximum total daily maintenance and rescue dose of 8 puffs.
- Caution: Increasing use of SABA or use >2 days a week for symptom relief (not prevention of EIB) generally indicates inadequate control and may require a step up in treatment.