___________________________________________________________ Asthma: Diagnosis and Management
STEPWISE APPROACH FOR MANAGING ASTHMA IN PATIENTS 5 TO 11 YEARS OF AGE
Treatment Step
Preferred Treatment
Alternative Treatment
Considerations
Step 1 Step 2
SABA
—
Daily low-dose ICS and SABA Daily LTRA a ; or cromol y na; or nedocromil a , or theophylline a ; and SABA
Steps 2–4: Conditionally recommend subcutaneous allergen immunotherapy as an adjunct treatment to standard therapy in individuals 5 to 11 years of age and older with asthma controlled at initiation, build up, and maintenance phases of immunotherapy Steps 3–4: 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 (36 mcg).
Step 3
Daily and as needed combination low-dose ICS/ formoterol
Daily medium-dose ICS and SABA OR Daily low--dose ICS/LABA; or daily low-dose ICS + LTRA a ; or daily low-dose ICS + theophylline a ; and SABA Daily medium-dose ICS/ LABA and SABA OR Daily medium-dose ICS +LTRA a ; or daily medium- dose ICS + theophylline a ; and SABA Daily high-dose ICS + LTRA a ; or daily high-dose ICS + theophylline a ; and SABA Daily high-dose ICS + LTRA* + oral systemic corticosteroid; or daily high-dose ICS + theophylline + oral systemic corticosteroid; and SABA
Step 4
Daily and as needed combination medium-dose ICS/formoterol
Step 5
Daily high-dose ICS/LABA and SABA
Steps 5–6: Consider omalizumab
Step 6
Daily high-dose ICS/LABA + oral systemic corticosteroid and SABA
Steps 1–6 In each step, assess environmental factors, provide patient education, and manage comorbidities a Cromolyn and montelukast were not considered in the 2022 update of the NAEPP guidelines, have limited availability for use in the United States, and/or have an increased risk of adverse consequences and need for monitoring that make their use less desirable. The FDA issued a boxed warning for montelukast in March 2020 due to the risk for serious neuropsychiatric events, including suicide. Medications linked with a slash (/) indicate combination formulations in a single inhaler.
Source: [9; 10]
Table 5
In school-aged children (5 to 11 years of age), it is recom- mended that the same stepwise treatment and management principles established for adults be followed, with some modi- fication [9]. Healthcare providers should prepare and make available a written asthma plan for pediatric patients, not only for the patient and the patient’s caretaker(s), but also for the child’s school. This plan should detail any medications that may be appropriate (both short- and long-term medications),
identify any known asthma triggers, and establish an action plan (including preferred or required medication usages) for any asthma attack [9; 10]. Additionally, if the use of a broncho- dilator prior to outdoor exercise or activity, especially in cold weather, is indicated, this should be noted in the action plan. Annual influenza and pneumococcal vaccination, particularly in pandemic years, can assist in preventing respiratory inflam- mation in an already compromised system.
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MDVT1726
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