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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
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Stepwise asthma management in children 4 to 11 years old

Stepwise asthma management in children 4 to 11 years old
NAEPP*
(5 to 11 years old)		 GINA
(6 to 11 years old)		 Our approach
(4 to 11 years old)
Asthma symptoms/impact Therapy Asthma symptoms Therapy
(all steps include SABA as needed)		 Therapy
Intermittent:
  • Daytime symptoms ≤2 days/week
  • Nocturnal awakenings ≤2/month
  • No interference with activities
  • Normal FEV1 and FEV1/FVC
  • Exacerbations ≤1/year
 Step 1
  • SABA as needed
  • Infrequent asthma symptoms (eg, <2 times/month)

Step 1

Preferred:

  • Low-dose ICS whenever SABA is used

Alternatives:

  • Daily low-dose ICS

Step 1

Preferred:

  • SABA as needed

Alternatives:

  • Low-dose ICS whenever SABA used
Mild persistent:
  • Daytime symptoms >2 but <7 days/week
  • Nocturnal awakenings 3 to 4/month
  • Minor interference with activities
  • Normal FEV1 and FEV1/FVC
  • Exacerbations ≥2/year

Step 2

Preferred:

  • Daily low-dose ICS and SABA as needed

Alternative:

  • Daily LTRA and SABA as needed
  • Asthma symptoms or need for reliever inhaler ≥2 times/month

Step 2

Preferred:

  • Daily low-dose ICS

Alternatives:

  • Daily LTRA

or

  • Low-dose ICS whenever SABA is used

Step 2

Preferred (includes SABA as needed):

  • Daily low-dose ICS

Alternatives (includes SABA as needed):

  • Daily LTRA

or

  • Low-dose ICS whenever SABA used
Moderate persistent:
  • Daily symptoms
  • Nocturnal awakenings >1/week but not daily
  • Daily SABA use
  • Some activity limitation
  • FEV1 60 to 80% predicted; FEV1/FVC below normal
  • Exacerbations ≥2/year

Step 3

Preferred:

  • Daily and as needed low-dose ICS-formoterol

Alternative:

  • Daily medium-dose ICS and as needed SABA

or

  • Daily low-dose ICS-LABA or low-dose ICS plus LTRA and as needed SABA
  • Troublesome asthma symptoms most days
or
  • Waking due to asthma ≥1 time/month (also assess risk factors for exacerbations)

Step 3

Preferred:

  • Daily low-dose ICS-LABA

or

  • Daily medium-dose ICS

Alternative:

  • Daily low-dose ICS plus LTRA

Step 3

Preferred:

  • Daily and as- needed low-dose ICS-formoterol (fast-onset LABA)

Alternatives (includes SABA as needed):

  • Daily low-dose ICS-LABA (slower- onset LABA)

or

  • Daily medium-dose ICS

or

  • Daily low-dose ICS plus LTRA
Severe persistent:
  • Symptoms throughout the day
  • Nocturnal awakenings most nights
  • Need for SABA several times/day
  • Extreme limitation in activity
  • FEV1 <60% predicted; FEV1/FVC below normal
  • Exacerbations ≥2/year

Step 4

Preferred:

  • Daily and as needed medium-dose ICS-formoterol

Alternative:

  • Daily medium-dose ICS-LABA and as needed SABA

or

  • Daily medium-dose ICS plus LTRA and as needed SABA
  • Severe asthma

Step 4

Preferred:

  • Daily medium-dose ICS-LABA

or

  • Daily low-dose ICS plus LTRA

Alternatives:

  • Daily medium-dose ICS-LABA and add-on tiotropium or LTRA

Step 4

Preferred:

  • Daily and as needed medium-dose ICS-formoterol (fast-onset LABA)

Alternatives (includes SABA as needed):

  • Daily medium-dose ICS-LABA (slower- onset LABA)

or

  • Daily high-dose ICS

or

  • Daily medium-dose ICS plus LTRA

or

  • Daily medium-dose ICS-LABA and add-on tiotropium or LTRA
  • Step-up therapy for severe asthma that is poorly controlled

Step 5

Preferred:

  • Daily high-dose ICS-LABA and as needed SABA

Alternative:

  • Daily high-dose ICS plus LTRA and as needed SABA

Add-on therapy:

  • A biologic agent (eg, omalizumab, mepolizumab) is an additional option for patients ≥6 years of age
  • Step-up therapy for severe asthma that is poorly controlled

Step 5

Preferred:

  • Daily medium-dose ICS-LABA and assess for possible high-dose ICS-LABA or add-on therapy (anti-IgE or anti-IL4R)

Alternative add-on therapies:

  • Anti-IL-5R; low-dose OCS only as last resort

Step 5

Preferred (includes SABA as needed):

  • Daily medium-dose ICS-LABA and tiotropium (in children ≥6 years of age)

or

  • Daily high-dose ICS-LABA (in children 4 to <6 years of age)

Alternatives (includes SABA as needed):

  • Daily medium-dose ICS-LABA and LTRA

or

  • Daily high-dose ICS-LABA

or

  • Daily high-dose ICS plus LTRA

Add-on therapy:

  • A biologic agent (eg, omalizumab [anti-IgE], dupilumab [anti-IL-4R], or mepolizumab [anti-IL-5R]) is an additional option for patients ≥6 years of age

Step 6

Preferred:

  • Daily high-dose ICS-LABA plus OCS and as needed SABA

Alternative:

  • Daily high-dose ICS plus LTRA and OCS and as needed SABA

Add-on therapy:

  • A biologic agent (eg, omalizumab, mepolizumab) is an additional option for patients ≥6 years of age
   Step 6
  • One of the above options plus OCS
  • A biologic agent (eg, omalizumab, dupilumab, or mepolizumab) is an additional option for patients ≥6 years of age
Initial therapies are noted above. A higher level of initial therapy, with concurrent use of OCS in some cases, may be chosen if the patient presents with an acute exacerbation. Treatment may be stepped down if asthma is well controlled for at least 3 months and is stepped up 1 or 2 steps if asthma is not well controlled or is very poorly controlled.

NAEPP: National Asthma Education and Prevention Program; GINA: Global Initiative for Asthma; SABA: short-acting beta agonist; FEV1: forced expiratory volume in 1 second; FVC: forced vital capacity; ICS: inhaled corticosteroid (glucocorticoid); LTRA: leukotriene receptor antagonist; LABA: long-acting beta agonist; OCS: oral corticosteroid (glucocorticoid); IgE: immunoglobulin E; IL-5R: interleukin 5 receptor.

* Theophylline, cromolyn, and nedocromil were not included in table even though they were included in NAEPP. They are rarely used due availability of more effective options.

¶ Subcutaneous allergen immunotherapy is suggested as adjunctive treatment in patients with well-controlled asthma and environmental allergies.
References:
  1. National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. 2020 Focused updates to the asthma management guidelines. National Heart, Lung, and Blood Institute, 2007. Available at: https://www.nhlbi.nih.gov/health-topics/all-publications-and-resources/2020-focused-updates-asthma-management-guidelines (Accessed on December 16, 2020).
  2. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. Available at: www.ginasthma.org (Accessed on October 27, 2022).
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