Table 1 Summary of treatment recommendations for childhood asthma according to 2005 Global Initiative for Asthma (GINA) guidelines [9] and 2005 British Thoracic Society (BTS) guidelines [7]
2005 GINA Guidelines for adults & children > 5 years old* | 2005 BTS Guidelines for children 5-12 years old* | ||
|---|---|---|---|
GINA Step 1 Intermittent asthma | No controller medication necessary Short acting β2 agonist as needed | BTS Step 1 Mild intermittent asthma | Short acting β2 agonist as required |
GINA Step 2 Mild persistent asthma | Low-dose ICS (or SR-theophylline; cromone; or leukotriene modifier) | BTS Step 2 Regular preventer therapy | ICS 200-400 μg/d†: 200 μg/d is a reasonable starting dose [for those < 5 y, use LTRA if cannot use ICS] |
GINA Step 3 Moderate persistent asthma | Low- to medium-dose ICS plus inhaled LABA (or medium-dose ICS plus SR-theophylline, plus oral LABA, or plus leukotriene modifier; OR high-dose ICS) [for those ≤ 5 y, medium-dose ICS] | BTS Step 3 Add-on therapy | Add inhaled LABA; if poor response try ICS 400 μg/d; if poor response, add LTRA or SR-theophylline (ICS dose up to 400 μg/d) [for those 2-5 y, trial of LTRA] |
GINA Step 4 Severe persistent asthma | High-dose ICS plus LABA plus 1 or more of the following if needed: SR-theophylline, leukotriene modifier, oral LABA, oral steroid, anti-IgE [for those ≤ 5 y, high-dose ICS plus add-on Rx if needed] | BTS Step 4 Persistent poor control | Increase ICS dose to 800 μg/d Consider adding the following if needed: LTRA, theophylline, SR-β2 agonist tablets [for those < 5 y, refer to respiratory paediatrician] |
-- | -- | BTS Step 5 Continuous or frequent use of oral steroids | Use daily steroid tablet in lowest dose; maintain high-dose ICS; refer to respiratory paediatrician |