Steps of Asthma Management*

1 (starting point for intermittent asthma)

Short-acting beta-2 agonist as needed†

—

2 (starting point for mild persistent asthma)

Daily low-dose inhaled corticosteroid and as-needed short-acting beta-2 agonist

or

For ages 12 years and older, as-needed use of concomitant inhaled corticosteroid and short-acting beta-2 agonist

Mast cell stabilizer, leukotriene receptor antagonist, theophylline, or zileuton (for ages 12 and older), either with as-needed (rescue) short-acting beta-2 agonist therapy

3 (starting point for moderate persistent asthma)

Daily and as-needed combination therapy with low-dose inhaled corticosteroid plus formoterol‡

Daily medium-dose inhaled corticosteroid and as-needed (rescue) short-acting beta-2 agonist

or

Daily low-dose inhaled corticosteroid plus one of the following:

• Long-acting beta-2 agonist

• Leukotriene receptor antagonist

• Theophylline

Each with as-needed (rescue) short-acting beta-2 agonist therapy

or

For ages 12 years and older, daily low-dose inhaled corticosteroid plus a long-acting muscarinic antagonist or zileuton, either with as-needed (rescue) short-acting beta-2 agonist therapy

4

Daily and as-needed combination therapy with medium-dose inhaled corticosteroid- formoterol‡

Daily medium-dose inhaled corticosteroid plus long-acting beta-2 agonist with as-needed (rescue) short-acting beta-2 agonist therapy

or

For ages 12 years and older, daily medium-dose inhaled corticosteroid plus long-acting muscarinic antagonist with as-needed (rescue) short-acting beta-2 agonist therapy

or

Daily medium-dose inhaled corticosteroid plus one of the following:

• Leukotriene receptor antagonist

• Theophylline

• Zileuton (ages 12 and older)

Each with as-needed (rescue) short-acting beta-2 agonist therapy

5 (starting point for severe persistent asthma)

For ages 5–11 years, daily high-dose inhaled corticosteroid–long-acting beta-2 agonist combination therapy with as-needed short-acting beta-2 agonist therapy

or

For ages 12 and older, daily medium-high dose inhaled corticosteroid–long-acting beta-2 agonist combination with long-acting muscarinic antagonist and as-needed short-acting beta-2 agonist therapy

and

Consider adding asthma biologics (includes anti-IgE, anti-IL5, anti-IL5R, anti-IL4/IL13)

For ages 5–11 years, daily high-dose inhaled corticosteroid plus leukotriene receptor antagonist or daily high-dose inhaled corticosteroid plus theophylline, either with as-needed (rescue) short-acting beta-2 agonist therapy

or

For ages 12 and older, daily medium- to high-dose inhaled corticosteroid plus long-acting beta-2 agonist or daily high-dose inhaled corticosteroid plus leukotriene receptor antagonist, either with as-needed (rescue) short-acting beta-2 agonist therapy

and

Consider adding asthma biologics (includes anti-IgE, anti-IL5, anti-IL5R, anti-IL-4/IL13)

6

Daily high-dose inhaled corticosteroid plus long-acting beta-2 agonist plus oral corticosteroid with as-needed short-acting beta-2 agonist therapy

and

Consider adding asthma biologics (includes anti-IgE, anti-IL5, anti-IL5R, anti-IL4/IL13)

For ages 5–11 years, daily high-dose inhaled corticosteroid plus leukotriene receptor antagonist and oral systemic corticosteroid or daily high-dose inhaled corticosteroid plus theophylline plus oral corticosteroid, either with as-needed (rescue) short-acting beta-2 agonist therapy

and

Consider adding asthma biologics (includes anti-IgE, anti-IL5, anti-IL5R, anti-IL4/IL13)