Scientifica / 2012 / Article / Tab 6

Review Article

Childhood Asthma: Diagnosis and Treatment

Table 6

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

Step 1Step 2Step 3Step 4Step 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 agonist

Select oneSelect oneTo step 3 treatment
Select one or more
To step 4 treatment
add either
Controller optionsLow dose ICS Low dose ICS+ long-acting
Medium- or high-dose ICS+ long-acting   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 agonist, some long-acting agonist, and short-acting theophiline. Regular using of short- and long-acting agonist is not advised unless accompanied by ICS.