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Table 1 Summary of the stepwise approach for managing asthma in children less than 5 years of age according to different guidelines

From: Treatment of asthma in young children: evidence-based recommendations

  NAEPP [31] British [32] GINA [33] Canadian [34]
Step 1 SABA prn SABA prn SABA prn SABA prn
Step 2 Pref: Low-dose ICS Pref: ICS 200–400 μg /daya,b Pref: Daily low-dose ICS Pref: Daily low-dose ICS
Alter: cromolyn or LTRA Alter: LTRA Alter: LTRA or intermittent ICS Alter: LTRA
Step 3 Medium-dose ICS ICS + LTRA Pref: Double low-dose ICS Medium-dose ICS
Alter: Low-dose ICS + LTRA
Step 4 Medium-dose ICS + either LABA or LTRA Refer to respiratory pediatrician Pref: Continue controller & refer for specialist assessment Referral to asthma specialist
Alter: Add LTRA, increase ICS frequency, intermittent ICS.
Step 5 High-dose ICS + either LABA or LTRA    
Step 6 High-dose ICS + either LABA or LTRA    
Consider OCS
  1. Alter alternative, GINA Global Initiative for Asthma, ICS inhaled corticosteroids, LABA long active beta-2 agonists, LTRA leukotriene receptor antagonist, NAEPP National Asthma Education and Prevention Program, OCS oral corticosteroids, Pref preferred, prn pro re nata, SABA short active beta-2 agonist
  2. abeclometasona dipropionate or equivalent doses
  3. bHigher nominal doses may be required if drug delivery is difficult