National Asthma Education and Prevention Program: Expert Panel Working Group[1,2] | Global Initiative for Asthma (GINA)[3] | ||
Asthma symptoms/lung function | Therapy* | Asthma symptoms | Therapy |
Step 1 | Step 1 | ||
All of the following:
|
|
|
|
Step 2 | Step 2 | ||
Any of the following:
|
Alternative option(s)
|
|
Other options
|
Step 3 | Step 3 | ||
Any of the following:
|
Alternative option(s)
|
|
Other options
|
Step 4 | Step 4 | ||
Any of the following:
|
Alternative option(s)
| Severely uncontrolled asthma with ≥3 of the following:
|
Other options
|
DPI: dry powder inhaler; FEV1: forced expiratory volume in one second; ICS: inhaled corticosteroid (glucocorticoid); IgE: immunoglobulin E; IL: interleukin; LABA: long-acting beta-agonist; LAMA: long-acting muscarinic antagonist; LTRA: leukotriene receptor antagonist; MDI: metered-dose inhaler; SABA: short-acting beta-agonist.
* Theophylline and cromolyn are not included in the table even though they were included in NAEPP-EPR 3 (2007), and theophylline is included in NAEPP (2020). These agents are rarely used now, due to availability of more effective options.
¶ Risk factors for exacerbations include: frequent asthma symptoms, prior asthma exacerbations, smoking, allergen exposure if sensitized, previous intubation or intensive care unit stay for asthma, low FEV1 (especially <60% predicted), obesity, food allergy, chronic rhinosinusitis, and poor adherence/inhaler technique. Please refer to UpToDate asthma treatment content and separate graphic on risk factors for asthma exacerbation.
Δ When prescribed for use as-needed for acute asthma symptoms, ICS-formoterol, ICS-SABA, and concomitant ICS and SABA are referred to as anti-inflammatory reliever therapy (AIR). Compared with SABA relievers, use of AIR has demonstrated decreased exacerbation risk in patients with all degrees of asthma severity. Choice of therapy is also guided by patient preference, cost, and medication availability.
◊ ICS-formoterol prescribed for use as both maintenance therapy and for acute relief of symptoms is referred to as Maintenance and Reliever Therapy (MART). MART has been shown to be more effective in terms of exacerbation reduction and symptom relief compared with ICS-formoterol and SABA alone as reliever therapy. Choice of therapy is also guided by patient preference, cost, and medication availability.Do you want to add Medilib to your home screen?