Stepwise approach to managing Asthma

Intermittent (Step 1) — 
Symptoms — <2 days a week, <2x nighttime awakenings/month, SABA use <2 days/week
Preferred: SABA prn

Mild persistent (Step 2) —
Symptoms Preferred:— >2 days a week, 3-4x nighttime awakenings/month, SABA use >2 days/week
 Preferred: low dose ICS Alternative:
Alternative: Cromolyn, LRTA, Nedocromil, Theophylline

Moderate persistent (Step 3) —
Symptoms Preferred:— Daily, >1x nighttime awakenings/week, SABA use daily
Preferred: Low dose ICS + LABA OR Medium dose ICS Alternative:
Alternative: Low-dose ICS + either LTRA, theophylline, or Zileuton 

Severe persistent (Step 4) — 
Symptoms Preferred:— Throughout the day, Often 7x nighttime awakenings/week, SABA use several times daily
Preferred: Medium dose ICS + LABA Alternative:
Alternative: Medium dose ICS + either LTRA, Theophylline, or Zileuton

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

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