Mount Carmel Health Partners Clinical Guidelines Asthma | Page 7
Table 2: Stepwise approach for managing asthma in children ages 5 to 11
INTERMITTENT
ASTHMA
PERSISTENT ASTHMA (Daily Medication)
Consult with asthma specialist if Step 4 care or higher is required.
Consider consultation at Step 3.
Step 6
Step 5
Step 4
Step 3
Step 2
Preferred:
Low-dose ICS
Step 1
Preferred:
SABA prn
Alternative:
cromolyn, LTRA,
nedocromil or
theophylline
Preferred:
Either low-dose ICS +
(either LABA, LTRA or
theophylline)
or
medium-dose ICS
Preferred:
Medium-dose ICS +
LABA
Alternative:
Medium-dose ICS
+ either LTRA or
theophylline
Preferred:
High-dose ICS
+ LABA
Alternative:
High-dose ICS
+ either LTRA or
theophylline
Preferred:
High-dose ICS
+ LABA +
oral systemic
corticosteroid
Alternative:
High-dose ICS
+ either LTRA or
theophylline
+ oral systemic
corticosteroid
Assess control: check adherence, inhaler technique, environmental control, and comorbid conditions.
Step up if needed and step down if possible (if well-controlled at least three months).
Each Step: Patient/parent education, environmental control, and management of comorbidities.
Steps 2 through 4: Consider subcutaneous allergen immunotherapy for patients who have allergic asthma (see notes).
KEY (alphabetical order)
ICS = inhaled corticosteroid
LABA = inhaled long-acting beta 2 -agonist
LTRA = leukotriene receptor agonist
SABA = inhaled short-acting beta 2 -agonist
QUICK RELIEF MEDICATION (all patients)
SABA as needed for symptoms; intensity of treatment depends on
severity of symptoms; up to three treatments at 20-minute
intervals as needed.
Use of SABA more than two days a week for symptom relief–not
prevention of EIB–generally indicates inadequate control and the
need to step up treatment.
NOTES
This approach is meant to assist, not replace, the clinical decision making required to meet individual patient needs.
If an alternative treatment is used and the response is inadequate, discontinue it and use the preferred treatment before stepping up.
Theophylline is a less desirable alternative due to the need to monitor serum concentration levels.
Step 1 and Step 2 medications are based on Evidence A. Step 3 ICS + adjunctive therapy and ICS are based on Evidence B for efficacy of each
treatment and extrapolation from comparator trials in older children and adults (comparator trials are not available for this age group);
Steps 4 through 6 are based on expert opinion and extrapolation from studies in older children and adults.
Immunotherapy for Steps 2 through 4 is based on Evidence B for house-dust mites, animal dander and pollens; evidence is weak or lacking
for molds and cockroaches. Evidence is strongest for immunotherapy with single allergens. The role of allergy in asthma is greater in children
than in adults. Clinicians who administer immunotherapy should be prepared and equipped to identify and treat anaphylaxis should it occur.
Source: Adapted from the National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and
Management of Asthma, Full Report 2007.
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