Childhood Asthma: Diagnosis and Treatment

Table 6

Asthma treatment in children older than 6 years according to the GINA guideline [1].

Step 1	Step 2	Step 3	Step 4	Step 5
Asthma education. Environmental control
(If step-up treatment is being considered for poor symptom, first check inhaler technique, check adherence, and confirm that symptoms are due to asthma.)
As needed rapid-acting 𝛽2 agonist
	Select one	Select one	To step 3 treatment; Select one or more	To step 4 treatment; add either
Controller options	Low dose ICS	Low dose ICS+ long-acting; 𝛽2  agonist	Medium- or high-dose ICS+ long-acting 𝛽2  agonist	Oral glucocorticosteroid (lowest dose)
		Medium- or high-dose ICS; Low-dose ICS + leukotriene modifier	leukotriene modifier; sustained release theophylline	Anti-IgE treatment
		Low-dose ICS + sustained release theophylline

ICS: inhaled corticosteroids. Italic and Bold words refer to the recommended treatment. Alternative reliever treatments include inhaled anticholinergics, short-acting oral 𝛽₂ agonist, some long-acting 𝛽₂ agonist, and short-acting theophiline. Regular using of short- and long-acting 𝛽₂ agonist is not advised unless accompanied by ICS.