- Mild Intermittent (Step 1): No daily (preventative) medications.
- Mild Persistent (Step 2): Daily use (even if the child is not having any asthma symptoms) of low-dose inhaled corticosteroid (with nebulizer or MDI with holding chamber with or without a face mask or DPI). Alternative treatments include cromolyn (nebulizer is preferred or MDI with holding chamber) or leukotriene receptor antagonist. In children over 5 years of age, alternative treatments may include cromolyn, leukotriene modifier, nedocromil, or sustained release theophylline to serum concentrations of 5-15 mcg/ml.
- Moderate Persistent (Step 3): In children under age 5 years, daily use of low-dose inhaled corticosteroids and long-acting inhaled beta2-agonists or Medium-dose inhaled corticosteroids. Alternative treatments including low-dose inhaled corticosteroids and either leukotriene receptor antagonist or theophylline. If needed (particularly in patients with recurring severe exacerbations), the preferred treatment is a medium-dose inhaled corticosteroids and long-acting beta2-agonists. If needed, alternative treatments can include medium-dose inhaled corticosteroids and either leukotriene receptor antagonists or theophylline.
In children under over 5 years, the preferred treatment of moderate persistent asthma is the daily use of low-to-medium dose inhaled corticosteroids and long-acting inhaled beta2-agonists or Medium-dose inhaled corticosteroids. Alternative treatments include an increasing the dose of inhaled corticosteroids within the medium-dose range or low-to-medium dose inhaled corticosteroids and either leukotriene receptor antagonist or theophylline. If needed (particularly in patients with recurring severe exacerbations), the preferred treatment includes an increasing dose of inhaled corticosteroids within the medium-dose range and adding a long-acting beta2-agonist. If needed, alternative treatments can include an increasing dose of inhaled corticosteroids within the medium-dose range and adding either a leukotriene modifier or theophylline. - Severe Persistent (Step 4): Daily use of high-dose inhaled corticosteroids and long-acting inhaled beta2-agonists and if needed, corticosteroid tablets or syrup long term (2mg/kg/day, generally do not exceed 60 mg per day), with repeated attempts to reduce systemic corticosteroids and maintain control with high-dose inhaled corticosteroids.
The new guidelines also state that:
- Antibiotics offer no benefit for asthma exacerbations, except as needed for those patients with fever and purulent sputum, evidence of pneumonia, or suspected bacterial sinusitis.
- Patients should continue to receive and use a written asthma action plan to help control their asthma symptoms.
- Patients with moderate or severe persistent asthma should continue to use peak flow monitoring and should have written asthma action plans based on their peak flows.
- In children under age 5 years, consultation with an asthma specialist is recommended for patients with moderate or severe persistent asthma. Consider consultation for patients with mild persistent asthma.
- In children over age 5 years and adults, you should get a referral to an asthma specialist if there are difficulties controlling asthma or if step 4 care is required. Referral may be considered if step 3 care is required.
- Is your child meeting the goals of the National Asthma Education and Prevention Program?
- Does his treatment follow those mentioned in the updated Guidelines for the Diagnosis and Management of Asthma? Is he using a preferred treatment? This is especially important if his asthma isn't under good control.
- Do you have a written asthma action plan?
