Asthma: Diagnosis and Management ____________________________________________________________
STEPWISE APPROACH FOR MANAGING ASTHMA IN PATIENTS 12 YEARS OF AGE AND OLDER Treatment Step Preferred Treatment Alternative Treatment Considerations Step 1 SABA —
Use SABA as needed for symptoms in any step (as indicated), up to three treatments at 20-minute intervals depending on severity of symptoms. Caution: Increasing use of SABA or use >2 days a week for symptom relief generally indicates inadequate control and may require a step up in treatment. Steps 2–4: Conditionally recommend subcutaneous allergen immunotherapy
Daily LTRA a and SABA OR
Step 2
Daily low-dose ICS and SABA OR Concomitant ICS and SABA
Cromolyn a ; or nedocromil a ; or zileuton a ; or theophylline a ; and SABA Daily medium-dose ICS and SABA OR Daily low-dose ICS/LABA; or daily low-dose ICS + LAMA; or daily low-dose ICS + LTRA a ; and SABA OR Daily low-dose ICS + theophylline a or zileuton a ; and SABA Daily medium-dose ICS/ LABA; or daily medium-dose ICS + LAMA; and SABA OR Daily medium-dose ICS + LTRA a ; or daily medium-dose ICS + theophylline a ; or daily medium-dose ICS + zileuton a ; and SABA Daily medium-high dose ICS/LABA and SABA OR Daily high-dose ICS + LTRA a and SABA
as an adjunct treatment to standard therapy in
individuals 5 years of age and older with asthma controlled at initiation, build up, and maintenance phases of immunotherapy Steps 3–4: Preferred use of ICS/formoterol is 1 to 2 puffs as needed up to a maximum total daily maintenance and rescue dose of 12 puffs (54 mcg)
Step 3
Daily and as needed combination low-dose ICS/ formoterol
Step 4
Daily and as needed combination medium-dose ICS/formoterol
Step 5
Daily medium-high dose ICS/ LABA + LAMA and SABA
Steps 5–6: Consider adding asthma biologics (e.g., anti- IgE, anti-IL5, anti-IL5R, anti-IL4/IL13)
Step 6
Daily high-dose ICS/LABA + oral systemic corticosteroids + SABA
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MDVT1726
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