Stepwise approach for managing asthma in youths greater than 12 years of age and adults as recommended by the Expert Panel 3 of the National Asthma Education and Prevention Program(4)

Therapy should be increased to the next step if symptoms are not well controlled or poorly controlled, as indicated by the use of short-acting β2-agonists or the presence of asthma symptoms more than 2 days per week, nighttime awakenings due to asthma symptoms at least once per week, some interference with normal activities, or a reduction in FEV1 or peak flow below 80% of predicted or personal best. Allergen immunotherapy may be considered for patients at steps 2 – 4, especially those with single allergies to house-dust mites, animal danders or pollens. Health care providers should be prepared to identify and treat anaphylaxis that can be associated with immunotherapy and omalizumab. All patients should receive education, environmental control and management of co-morbidities. If asthma is well controlled for at least 3 months, then therapy should be decreased downward to the next step. Abbreviations are as follows: ICS (inhaled corticosteroids), LABA (long-acting β2-agonists), LTRA (leukotriene receptor antagonists), and SABA (short-acting β2-agonists).

Ann Intern Med. 2010 Feb 16;152(4):232-7

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