New Perspectives in the Management of Mild to Moderate Asthma in Children

Figures & data

Table 1 New Recommendations in the Treatment of Mild to Moderate Asthma According to the GINA and NHLBI Guidelines

		GINA	NHLBI
Step 1	Teens	As-needed low dose ICS-formoterol*	No new recommendations
		Low dose ICS taken whenever SABA taken^#
	6–11 years old	Low dose ICS taken whenever SABA taken^#	No new recommendations
	Preschool age	No new recommendations	As-needed SABA and add short course daily ICS at the start of RTI
Step 2	Teens	As-needed low dose ICS-formoterol^†	Low dose ICS taken whenever SABA taken ^†
			**SCIT as adjunct treatment to standard pharmacotherapy
	6–11 years old	Low dose ICS taken whenever SABA taken^#	**SCIT as adjunct treatment to standard pharmacotherapy
	Preschool age	No new recommendations	No new recommendations
Step 3	Teens	Daily and as-needed low-dose ICS-formoterol^‡	Daily and as-needed low-dose ICS-formoterol^‡
		**Consider adding HDM SLIT for sensitized patients with allergic rhinitis and FEV>70%	**SCIT as adjunct treatment to standard pharmacotherapy
	6–11 years old	No new recommendations	Daily and as-needed low-dose ICS-formoterol*
			**SCIT as adjunct treatment to standard pharmacotherapy (for 5–11 year olds)
	Preschool age	No new recommendations	Low dose ICS-LABA and as-needed SABA (for ≤3 years old)*
			Daily and as-needed low dose ICS-formoterol (for 4 years old)*

Notes: *Preferred controller and reliever treatment option in this age group. ^#Other controller option in this age group. ^†Second preferred controller and reliever treatment option in this age group. ^‡Low dose ICS-formoterol is the reliever only for patients prescribed budesonide-formoterol maintenance and reliever therapy. **Conditional recommendation. Data from Global Initiative for Asthma (GINA)^1,9 and National Asthma Education and National Heart, Lung, and Blood Institute, National Institutes of Health.¹⁰

Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting beta₂-agonist; SABA, short-acting beta₂-agonist; RTI, respiratory tract infection; SCIT, subcutaneous allergen immunotherapy; SLIT, sublingual allergen immunotherapy; HDM, house dust mite.

Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention (Updated 2020). Available from: www.ginasthma.org. Accessed March 10, 2021.

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Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention (Updated 2019). Avaliable from: www.ginasthma.org. Accessed March 10, 2021.

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A report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. 2020 Focused Updates to The Asthma Management Guidelines. National Heart, Lung, and Blood Institute, National Institutes of Health; 2020 Available from: www.nhlbi.nih.gov. Accessed March 10, 2021.

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