Asthma Pathway - Summary of Stepwise Pharmacological Management in Children Aged 5-15 Years
STEP 1: Mild Asthma
Inhaled short acting β2 agonist as required
STEP 2: Regular Preventer Therapy
Add inhaled steroid 100-200mcg/twice daily Beclomethasone or Budesonide, or 50 - 100mcg/twice daily Fluticasone – use the higher dose with greater severity
STEP 3: Add on Therapy
- Add inhaled long acting β2 agonist (LABA)2
- Assess response to LABA
- Good response to LABA ------- continue LABA
Some benefit from LABA in maximum dose 3 but control still inadequate, increase inhaled steroid to 100-200mcg/twice daily Beclomethasone or Budesonide, or 50-100mcg/twice daily Fluticasone
(if not already on this dose)
STEP 4: Persistent Poor Control
Increase inhaled steroid to 300-400 mcg/twice daily Beclomethasone or Budesonide, or 125 - 250 mcg/twice daily Fluticasone4 Continue to review add on therapy Refer to pediatrician if not improving
STEP 5: Continued Poor Control
Refer to paediatrician
Maintain high dose inhaled steroid
Consider steroid tablet in lowest dose providing adequate control.
- The only New Zealand Registered Leukotriene Receptor Antagonist, montelukast, is currently on the Pharmaceutical Schedule.
- The current Special Authority criteria of the Pharmaceutical schedule allows LABA to be introduced at the higher threshold of 400mcg/day BDP or BUD, or 200mcg/day.
- Maximum recommended dose of eformoterol is 12mcg bd, and salmeterol 50mcg bd
- These levels of ICS are greater than usually required to achieve optimal control and do not hesitate to seek advice from a paediatrician
n.b. SMART® treatment is not currently recommended in childhood asthma
Last updated : Thursday, May 18, 2017
Next review date : Friday, May 18,2018
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