Stepwise approach to managing Asthma

Intermittent (Step 1) — SABA prn

Mild persistent (Step 2) — Preferred: low dose ICS Alternative: Cromolyn, LRTA, Nedocromil, Theophylline

Moderate persistent (Step 3) — Preferred: Low dose ICS + LABA OR Medium dose ICS Alternative: Low-dose ICS + either LTRA, theophylline, or Zileuton

Severe persistent (Step 4) — Preferred: Medium dose ICS + LABA Alternative: Medium dose ICS + either LTRA, Theophylline, or Zileuton

(Step 5) — Preferred: High-dose ICS + LABA AND Consider Omalizumab for patients who have allergies

(Step 6) — Preferred: High-dose ICS + LABA + oral corticosteroid AND Consider Omalizumab for patients who have allergies