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All age groups
Infants
Older children r1
Acute asthma exacerbation
Chronic asthma
Multiple resources are available to assist with treatment decisions including:
Daily dose | Aged 0 to 4 years | Aged 5 to 11 years | Aged 12 years or older | ||||||
---|---|---|---|---|---|---|---|---|---|
Low | Medium* | High* | Low | Medium* | High* | Low | Medium* | High* | |
Medication | |||||||||
Beclomethasone MDI | N/A | N/A | N/A | 80 to 160 mcg | Greater than 160 to 320 mcg | Greater than 320 mcg | 80 to 240 mcg | Greater than 240 to 480 mcg | Greater than 480 mcg |
40 mcg/puff | N/A | N/A | N/A | 1 to 2 puffs twice daily | 3 to 4 puffs twice daily | 1 to 3 puffs twice daily | 4 to 6 puffs twice daily | ||
80 mcg/puff | N/A | N/A | N/A | 1 puff twice daily | 2 puffs twice daily | 3 or more puffs twice daily | 1 puff AM, 2 puffs PM | 2 to 3 puffs twice daily | 4 or more puffs twice daily |
Budesonide DPI | N/A | N/A | N/A | 180 to 360 mcg | Greater than 360 to 720 mcg | Greater than 720 mcg | 180 to 540 mcg | Greater than 540 to 1080 mcg | Greater than 1080 mcg |
90 mcg/inhalation | N/A | N/A | N/A | 1 to 2 inhalations twice daily | 3 to 4 inhalations twice daily | 1 to 3 inhalations twice daily | |||
180 mcg/inhalation | N/A | N/A | N/A | 2 inhalations twice daily | 3 or more inhalations twice daily | 1 inhalation AM, 2 inhalations PM | 2 to 3 inhalations twice daily | 4 or more inhalations twice daily | |
Budesonide nebules | 0.25 to 0.5 mg | Greater than 0.5 to 1 mg | Greater than 1 mg | 0.5 mg | 1 mg | 2 mg | N/A | N/A | N/A |
0.25 mg | 1 to 2 nebules/day | 1 nebule twice daily | N/A | N/A | N/A | ||||
0.5 mg | 1 nebule/day | 2 nebules/day | 3 nebules/day | 1 nebule/day | 1 nebule twice daily | N/A | N/A | N/A | |
1 mg | 1 nebule/day | 2 nebules/day | 1 nebule/day | 1 nebule twice daily | N/A | N/A | N/A | ||
Ciclesonide MDI | N/A | N/A | N/A | 80 to 160 mcg | Greater than 160 to 320 mcg | Greater than 320 mcg | 160 to 320 mcg | Greater than 320 to 640 mcg | Greater than 640 mcg |
80 mcg/puff | N/A | N/A | N/A | 1 to 2 puffs/day | 1 puff AM, 2 puffs PM to 2 puffs twice daily | 3 or more puffs twice daily | 1 to 2 puffs twice daily | 3 to 4 puffs twice daily | |
160 mcg/puff | N/A | N/A | N/A | 1 puff/day | 1 puff twice daily | 2 or more puffs twice daily | 2 puffs twice daily | 3 or more puffs twice daily | |
Flunisolide MDI | N/A | N/A | N/A | 160 mcg | 320 to 480 mcg | 480 mcg or more | 320 mcg | Greater than 320 to 640 mcg | Greater than 640 mcg |
80 mcg/puff | N/A | N/A | N/A | 1 puff twice daily | 2 to 3 puffs twice daily | 4 or more puffs twice daily | 2 puffs twice daily | 3 to 4 puffs twice daily | 5 or more puffs twice daily |
Fluticasone MDI | 176 mcg | Greater than 176 to 352 mcg | Greater than 352 mcg | 88 to 176 mcg | Greater than 175 to 352 mcg | Greater than 352 mcg | 88 to 264 mcg | Greater than 264 to 440 mcg | Greater than 440 mcg |
44 mcg/puff | 2 puffs twice daily | 3 to 4 puffs twice daily | 1 to 2 puffs twice daily | 3 to 4 puffs twice daily | 1 to 3 puffs twice daily | ||||
110 mcg/puff | 1 puff twice daily | 2 or more puffs twice daily | 1 puff twice daily | 2 or more puffs twice daily | 2 puffs twice daily | 3 puffs twice daily | |||
220 mcg/puff | 1 puff twice daily | 2 or more puffs twice daily | |||||||
Fluticasone DPI | N/A | N/A | N/A | 100 to 200 mcg | Greater than 200 to 400 mcg | Greater than 400 mcg | 100 to 300 mcg | Greater than 300 to 500 mcg | Greater than 500 mcg |
50 mcg/inhalation | N/A | N/A | N/A | 1 to 2 inhalations twice daily | 3 to 4 inhalations twice daily | 1 to 3 inhalations twice daily | |||
100 mcg/inhalation | N/A | N/A | N/A | 1 inhalation twice daily | 2 inhalations twice daily | More than 2 inhalations twice daily | 2 inhalations twice daily | 3 or more inhalations twice daily | |
250 mcg/inhalation | N/A | N/A | N/A | 1 inhalation twice daily | 1 inhalation twice daily | 2 or more inhalations twice daily | |||
Mometasone DPI | N/A | N/A | N/A | 110 mcg | 220 to 440 mcg | Greater than 440 mcg | 110 to 220 mcg | Greater than 220 to 440 mcg | Greater than 440 mcg |
110 mcg/inhalation | N/A | N/A | N/A | 1 inhalation/day | 1 to 2 inhalations twice daily | 3 or more inhalations twice daily | 1 to 2 inhalations PM | 3 to 4 inhalations PM or 2 inhalations twice daily | 3 or more inhalations twice daily |
220 mcg/inhalation | N/A | N/A | N/A | 1 to 2 inhalations/day | 3 or more inhalations divided in 2 doses | 1 inhalation PM | 1 inhalation twice daily or 2 inhalations PM | 3 or more inhalations divided in 2 doses |
Daily dose | Aged 0 to 4 years | Aged 5 to 11 years | Aged 12 years or older | ||||||
---|---|---|---|---|---|---|---|---|---|
Low | Medium* | High* | Low | Medium* | High* | Low | Medium* | High* | |
Medication | |||||||||
Beclomethasone MDI | N/A | N/A | N/A | 80 to 160 mcg | Greater than 160 to 320 mcg | Greater than 320 mcg | 80 to 240 mcg | Greater than 240 to 480 mcg | Greater than 480 mcg |
40 mcg/puff | N/A | N/A | N/A | 1 to 2 puffs twice daily | 3 to 4 puffs twice daily | 1 to 3 puffs twice daily | 4 to 6 puffs twice daily | ||
80 mcg/puff | N/A | N/A | N/A | 1 puff twice daily | 2 puffs twice daily | 3 or more puffs twice daily | 1 puff AM, 2 puffs PM | 2 to 3 puffs twice daily | 4 or more puffs twice daily |
Budesonide DPI | N/A | N/A | N/A | 180 to 360 mcg | Greater than 360 to 720 mcg | Greater than 720 mcg | 180 to 540 mcg | Greater than 540 to 1080 mcg | Greater than 1080 mcg |
90 mcg/inhalation | N/A | N/A | N/A | 1 to 2 inhalations twice daily | 3 to 4 inhalations twice daily | 1 to 3 inhalations twice daily | |||
180 mcg/inhalation | N/A | N/A | N/A | 2 inhalations twice daily | 3 or more inhalations twice daily | 1 inhalation AM, 2 inhalations PM | 2 to 3 inhalations twice daily | 4 or more inhalations twice daily | |
Budesonide nebules | 0.25 to 0.5 mg | Greater than 0.5 to 1 mg | Greater than 1 mg | 0.5 mg | 1 mg | 2 mg | N/A | N/A | N/A |
0.25 mg | 1 to 2 nebules/day | 1 nebule twice daily | N/A | N/A | N/A | ||||
0.5 mg | 1 nebule/day | 2 nebules/day | 3 nebules/day | 1 nebule/day | 1 nebule twice daily | N/A | N/A | N/A | |
1 mg | 1 nebule/day | 2 nebules/day | 1 nebule/day | 1 nebule twice daily | N/A | N/A | N/A | ||
Ciclesonide MDI | N/A | N/A | N/A | 80 to 160 mcg | Greater than 160 to 320 mcg | Greater than 320 mcg | 160 to 320 mcg | Greater than 320 to 640 mcg | Greater than 640 mcg |
80 mcg/puff | N/A | N/A | N/A | 1 to 2 puffs/day | 1 puff AM, 2 puffs PM to 2 puffs twice daily | 3 or more puffs twice daily | 1 to 2 puffs twice daily | 3 to 4 puffs twice daily | |
160 mcg/puff | N/A | N/A | N/A | 1 puff/day | 1 puff twice daily | 2 or more puffs twice daily | 2 puffs twice daily | 3 or more puffs twice daily | |
Flunisolide MDI | N/A | N/A | N/A | 160 mcg | 320 to 480 mcg | 480 mcg or more | 320 mcg | Greater than 320 to 640 mcg | Greater than 640 mcg |
80 mcg/puff | N/A | N/A | N/A | 1 puff twice daily | 2 to 3 puffs twice daily | 4 or more puffs twice daily | 2 puffs twice daily | 3 to 4 puffs twice daily | 5 or more puffs twice daily |
Fluticasone MDI | 176 mcg | Greater than 176 to 352 mcg | Greater than 352 mcg | 88 to 176 mcg | Greater than 175 to 352 mcg | Greater than 352 mcg | 88 to 264 mcg | Greater than 264 to 440 mcg | Greater than 440 mcg |
44 mcg/puff | 2 puffs twice daily | 3 to 4 puffs twice daily | 1 to 2 puffs twice daily | 3 to 4 puffs twice daily | 1 to 3 puffs twice daily | ||||
110 mcg/puff | 1 puff twice daily | 2 or more puffs twice daily | 1 puff twice daily | 2 or more puffs twice daily | 2 puffs twice daily | 3 puffs twice daily | |||
220 mcg/puff | 1 puff twice daily | 2 or more puffs twice daily | |||||||
Fluticasone DPI | N/A | N/A | N/A | 100 to 200 mcg | Greater than 200 to 400 mcg | Greater than 400 mcg | 100 to 300 mcg | Greater than 300 to 500 mcg | Greater than 500 mcg |
50 mcg/inhalation | N/A | N/A | N/A | 1 to 2 inhalations twice daily | 3 to 4 inhalations twice daily | 1 to 3 inhalations twice daily | |||
100 mcg/inhalation | N/A | N/A | N/A | 1 inhalation twice daily | 2 inhalations twice daily | More than 2 inhalations twice daily | 2 inhalations twice daily | 3 or more inhalations twice daily | |
250 mcg/inhalation | N/A | N/A | N/A | 1 inhalation twice daily | 1 inhalation twice daily | 2 or more inhalations twice daily | |||
Mometasone DPI | N/A | N/A | N/A | 110 mcg | 220 to 440 mcg | Greater than 440 mcg | 110 to 220 mcg | Greater than 220 to 440 mcg | Greater than 440 mcg |
110 mcg/inhalation | N/A | N/A | N/A | 1 inhalation/day | 1 to 2 inhalations twice daily | 3 or more inhalations twice daily | 1 to 2 inhalations PM | 3 to 4 inhalations PM or 2 inhalations twice daily | 3 or more inhalations twice daily |
220 mcg/inhalation | N/A | N/A | N/A | 1 to 2 inhalations/day | 3 or more inhalations divided in 2 doses | 1 inhalation PM | 1 inhalation twice daily or 2 inhalations PM | 3 or more inhalations divided in 2 doses |
Medication | Aged 0 to 4 years | Aged 5 to 11 years | Aged 12 years or older |
---|---|---|---|
Combined medication (inhaled corticosteroid + long-acting β₂-agonist) | |||
Fluticasone-salmeterol | |||
DPI: 100 mcg/50 mcg, 250 mcg/50 mcg, or 500 mcg/50 mcg | N/A | 1 inhalation twice daily; dose depends on level of severity or control | 1 inhalation twice daily; dose depends on level of severity or control |
MDI: 45 mcg/21 mcg, 115 mcg/21 mcg, or 230 mcg/21 mcg | N/A | 1 inhalation twice daily; dose depends on level of severity or control | 1 inhalation twice daily; dose depends on level of severity or control |
Budesonide-formoterol | |||
MDI: 80 mcg/4.5 mcg or 160 mcg/4.5 mcg | N/A | 2 puffs twice daily; dose depends on level of severity or control | 2 puffs twice daily; dose depends on level of severity or control |
Mometasone-formoterol | |||
MDI: 100 mcg/5 mcg | N/A | N/A | 2 inhalations twice daily; dose depends on severity of asthma |
Leukotriene modifiers | |||
Leukotriene receptor antagonist: montelukast | |||
Leukotriene receptor antagonist: zafirlukast | |||
4- or 5-mg chewable tablet, 4-mg granule packets, 10-mg tablet | 4 mg every night at bedtime (age 1 to 5 years) | 5 mg every night at bedtime (age 6 to 14 years) | 10 mg every night at bedtime |
10- or 20-mg tablet (Take at least 1 hour before or 2 hours after a meal. Monitor liver function.) | N/A | 10 mg twice daily (age 7 to 11 years) | 40 mg daily (20-mg tablet twice daily) |
5-lipoxygenase inhibitor: zileuton | |||
600-mg tablet (Monitor liver function.) | N/A | N/A | 2400 mg daily (give 1 tablet 4 times daily) |
Immunomodulators | |||
Omalizumab (anti-IgE) | |||
Subcutaneous injection, 150 mg/1.2 mL after reconstitution with 1.4-mL sterile water for injection (Monitor patients after injections; be prepared to treat anaphylaxis that may occur.) | N/A | N/A | 150- to 375-mg subcutaneous injection every 2 to 4 weeks, depending on body weight and pretreatment serum IgE level |
Cromolyn | |||
Cromolyn | |||
Nebulizer: 20 mg/ampule | 1 ampule 4 times daily, N/A in children younger than 2 years | 1 ampule 4 times daily | 1 ampule 4 times daily |
Methylxanthines | |||
Theophylline | |||
Liquids, sustained-release tablets, and capsules (Monitor serum concentration levels.) | Starting dose 10 mg/kg/ day; usual maximum: | Starting dose 10 mg/ kg/day; usual maximum: 16 mg/kg/day | Starting dose 10 mg/kg/day up to 300 mg maximum; usual maximum: 800 mg/day |
Infants younger than 1 year: 0.2 (age in weeks) + 5 = mg/kg/day | |||
Infants or children aged 1 year or older: 16 mg/kg/day | |||
Inhaled long-acting β₂-agonists (used in conjunction with inhaled corticosteroids for long-term control; long-acting β₂-agonists are NOT to be used as monotherapy) | |||
Salmeterol | |||
DPI: 50 mcg/blister | N/A | 1 blister every 12 hours | 1 blister every 12 hours |
Oral systemic corticosteroids | |||
Methylprednisolone | |||
2-, 4-, 8-, 16-, 32-mg tablets | 0.25 to 2 mg/kg daily in single dose in AM or every other day as needed for control | 0.25 to 2 mg/kg daily in single dose in AM or every other day as needed for control | 7.5 to 60 mg daily in single dose in AM or every other day as needed for control |
Short course "burst": 1 to 2 mg/kg/day; max: 60 mg/day for 3 to 10 days | Short course "burst": 1 to 2 mg/kg/day; Max: 60 mg/day for 3 to 10 days | Short course "burst": to achieve control, 40 to 60 mg/day as single dose or 2 divided doses for 3 to 10 days | |
Prednisone | |||
1-, 2.5-, 5-, 10-, 20-, 50-mg tablets; 5 mg/mL, 5 mg/5 mL | 0.25 to 2 mg/kg daily in single dose in AM or every other day as needed for control | 0.25 to 2 mg/kg daily in single dose in AM or every other day as needed for control | 7.5 to 60 mg daily in single dose in AM or every other day as needed for control |
Short course "burst": 1 to 2 mg/kg/day; max: 60 mg/day for 3 to 10 days | Short course "burst": 1 to 2 mg/kg/day; max: 60 mg/day for 3 to 10 days | Short course "burst": to achieve control, 40 to 60 mg/day as single dose or 2 divided doses for 3 to 10 days | |
Prednisolone | |||
5-mg tablets; 5 mg/5 mL, 15 mg/5 mL | 0.25 to 2 mg/kg daily in single dose in AM or every other day as needed for control | 0.25 to 2 mg/kg daily in single dose in AM or every other day as needed for control | 7.5 to 60 mg daily in single dose in AM or every other day as needed for control |
Short course "burst": 1 to 2 mg/kg/day; max: 60 mg/day for 3 to 10 days | Short course "burst": 1 to 2 mg/kg/day; max: 60 mg/day for 3 to 10 days | Short course "burst": to achieve control, 40 to 60 mg/day as single dose or 2 divided doses for 3 to 10 days |
Asthma self-management (home management)
Promote active participation in physical activities, exercise, and sports r1c195c196c197
Reduce exposure to allergen, irritant, and air pollution triggers c198
Avoid using β-blockers and NSAIDs (including aspirin) in patients with asthma because they have potential to exacerbate symptoms c199c200
Multidisciplinary case management may be needed for patients with severe, difficult-to-treat disease c201