Child Health  |  Asthma Pathway - Summary of Stepwise Pharmacological Management in Children Aged 5-15 Years

Child Health

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

  1. Add inhaled long acting β2 agonist (LABA)2
  2. Assess response to LABA


  • Good response to LABA ------- continue LABA
  • Some benefit from LABA in maximum dose  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.

  1. The only New Zealand Registered Leukotriene Receptor Antagonist, montelukast, is currently on the Pharmaceutical Schedule.
  2. 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.
  3. Maximum recommended dose of eformoterol is 12mcg bd, and salmeterol 50mcg bd
  4. 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

Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.