Management of Asthma in Children
 Use the least expensive product that is suitable for the individual patient, within its marketing authorisation Before starting a new therapy practitioners should check concordance and inhaler technique with existing therapy Patients should start treatment at the step most appropriate to the initial severity of asthma symptoms following reconsideration and review of the diagnosis Step up to improve control and step down to find and maintain lowest controlling step |
| Step 1: Mild intermittent asthma | Step 2: Regular preventer therapy | Step 3: Initial add-on therapy | Step 4: Persistent poor control | Step 5: Continuous or frequent use of oral steroids |
| Inhaled short acting B2-agonist Prescribe inhalers only after the patient has received training in the use of the device and has demonstrated satisfactory technique 0-5 years pMDI and spacer are preferred delivery system. |
Add inhaled corticosteroid (ICS) 200-400mcg/day (BDP or equivalent)
Start dose of inhaled corticosteroid appropriate to severity of disease. 200mcg/day is an appropriate dose for most children Special instructions for under 5 years Use a leukotriene receptor antagonist (LTRA) if inhaled corticosteroid cannot be used |
Special instructions for under 5 years In the under 5 years and those already taking inhaled corticosteroids consider adding LTRA. In those already taking LTRA consider adding ICS 200-400mcg/day (BDP or equivalent). |
Special instructions for under 5 years Refer to paediatrician |
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| Special instructions for 5-12 years Add inhaled long-acting B2-agonist (LABA) and assess response. If response good - continue. Consider combination inhalers in those for whom LABA are effective at controlling symptoms. If response poor, discontinue and increase ICS to 400mcg/day (BDP or equivalent). If response still poor, add other therapies. |
Special instructions for 5-12 years Increase inhaled corticosteroid up to 800mcg/day (BDP or equivalent) Consider referral to paediatrician |
Special instructions for 5-12 years Use daily steroid tablet in lowest dose to provide adequate control Maintain high-dose ICS at 800mcg (BDP or equivalent) per day Refer to paediatrician |