NAEPP¶ (≤4 years old) | GINA (≤5 years old) | Our approach (<4 years old) | ||
Asthma symptoms/impact | Therapy (all steps include SABA as needed) | Asthma symptoms | Therapy (all steps include SABA as needed) | Therapy (all steps include SABA as needed) |
Intermittent:
| Step 1
|
| Step 1 Preferred:
Alternative:
| Step 1 Preferred:
Alternative:
|
Mild persistent:
| Step 2 Preferred:
Alternative:
|
| Step 2 Preferred:
Alternatives:
or
| Step 2 Preferred:
Alternatives:
or
|
Moderate persistent:
| Step 3◊
or
or
|
| Step 3§ Preferred:
Alternative:
| Step 3§ Preferred:
or
Alternative:
|
Severe persistent:
| Step 4◊ Preferred:
Alternative:
|
| Step 4§ Preferred:
and
Alternatives:
or
or
| Step 4 Preferred:
Alternative:
|
| Step 5 Preferred:
Alternative:
| Step 5 Preferred:
Alternative:
| ||
Step 6 Preferred:
Alternative:
| Step 6 Preferred:
Alternative:
|
NAEPP: National Asthma Education and Prevention Program; GINA: Global Initiative for Asthma; SABA: short-acting beta agonist; OCS: oral corticosteroid (glucocorticoid); ICS: inhaled corticosteroid (glucocorticoid); LTRA: leukotriene receptor antagonist; LABA: long-acting beta agonist.
* Dosing is reviewed in other UpToDate topics and tables on the management of asthma in children.
¶ Theophylline, nedocromil, and cromolyn are not included in the table even though they were included in NAEPP. They are rarely used due to the availability of more effective options.
Δ In these patients, a 3-month trial of therapy is reasonable and will help confirm or refute the diagnosis of asthma.
◊ For children 4 years of age, refer to steps 3 and 4 in the UpToDate table for stepwise asthma management in children aged 5 to 11.
§ Step-up therapy.Do you want to add Medilib to your home screen?