EVAL
Book a demo
Book a demo

Identify Current Asthma Treatment Step

Determine your patient's current asthma treatment step based on current medications.

Jennifer Glen

Provided by EVAL Foundation
Play

ICS: Inhaled Corticosteroid

 

0%

Usage

For patients currently taking asthma medications. A provider can determine which asthma step the patient is currently on based on the asthma medication regimen.

.

Summary

2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group details how to assess the current asthma treatment step based on the patient's current medications. Identifying the patient's current treatment step will assist the provider in determining the next therapy step up or down based on the patient's level of control.

 

Decision rules follow the EPR-4 asthma treatment steps:

 

To assess the patient's level of asthma control in patients taking asthma medications refer the Assess Asthma Control & Adjust Therapy tool.

 

Refer to the Classify Asthma Severity tool for: 

  • patients not currently treated for asthma or 

  • the patient's treatment plan is unknown or 

  • the patient is not taking asthma controller medications as prescribed for at least three months. 

.

All questions & possible results

Need Help?Title not visible
Need help determining if the ICS medication dosage is low, medium or high strength?

ICS: Inhaled Corticosteroid

 

Select one option:

  • Yes (I do NOT know the ICS strength)
  • No (I already know the ICS strength)
Identify Current StepTitle not visible
Enter the patient's age

Select one option:

  • 0-3
  • 4
  • 5-11
  • 12+
Which asthma medication is the patient taking (Ages 0-3)?

Medication look up: ICS Dosing Reference (Age 0-4)

ICS: Inhaled Corticosteroid

LABA: Long-Acting Beta-2 Agonist

RTI: Respiratory Tract Infection

Combo: Combination Inhaler

 

Select one option:

  • Not taking any as needed or daily ICS
  • Short course of daily ICS at the start of an RTI
  • Daily low-dose ICS
  • Daily medium-dose ICS
  • Daily high-dose ICS
  • Daily medium-dose ICS - LABA (combo)
  • Daily high-dose ICS - LABA (combo)
  • Unlisted ICS or ICS combo
Which asthma medication is the patient taking (Age 4)?

Medication look up: ICS Dosing Reference (Age 0-4)

ICS: Inhaled Corticosteroid

LABA: Long-Acting Beta-2 Agonist

RTI: Respiratory Tract Infection

SMART: Single Maintenance & Reliever Therapy (**limited to single-inhaler ICS-formoterol Symbicort & Dulera)

Combo: Combination Inhaler

 

Select one option:

  • Not taking any as needed or daily ICS
  • Short course of daily ICS at the start of an RTI
  • Daily low-dose ICS
  • Daily medium-dose ICS
  • Daily high-dose ICS
  • Daily low-dose ICS - LABA (combo)
  • Daily medium-dose ICS - LABA (combo)
  • Daily high-dose ICS - LABA (combo)
  • Daily & Rescue SMART Therapy: LOW-dose ICS - LABA (formoterol combination inhaler)
  • Daily & Rescue SMART Therapy: MEDIUM-dose ICS - LABA (formoterol combination inhaler)
  • Unlisted ICS or ICS combo
Which asthma medication is the patient taking (Ages 5-11)?

Medication look up: ICS Dosing Reference (Age 5-11)

ICS: Inhaled Corticosteroid

LABA: Long-Acting Beta-2 Agonist

SMART: Single Maintenance & Reliever Therapy (**limited to single-inhaler ICS-formoterol Symbicort & Dulera)

 Combo: Combination Inhaler

Select one option:

  • Not taking any as needed or daily ICS
  • Daily low-dose ICS
  • Daily medium-dose ICS
  • Daily high-dose ICS
  • Daily low-dose ICS - LABA (combo)
  • Daily medium-dose ICS - LABA (combo)
  • Daily high-dose ICS - LABA (combo)
  • Daily & Rescue SMART Therapy: LOW-dose ICS - LABA (formoterol combination inhaler)
  • Daily & Rescue SMART Therapy: MEDIUM-dose ICS - LABA (formoterol combination inhaler)
  • Unlisted ICS or ICS combo
Which asthma medication is the patient taking (Ages 12+)?

Medication look up: ICS Dosing Reference (Age 12+)

ICS: Inhaled Corticosteroid

LABA: Long-Acting Beta-2 Agonist

LAMA: Long-Acting Muscarinic Antagonist (Respimat - tiotropium bromide)

SMART: Single Maintenance & Reliever Therapy (**limited to single-inhaler ICS-formoterol Symbicort & Dulera)

Combo: Combination Inhaler

 

 

Select one option:

  • Not taking any as needed or daily ICS
  • Rescue Concomitant low-dose ICS & SABA
  • Daily low-dose ICS
  • Daily medium-dose ICS
  • Daily high-dose ICS
  • Daily low-dose ICS - LABA (combo)
  • Daily medium-dose ICS - LABA (combo)
  • Daily high-dose ICS - LABA (combo)
  • Daily & Rescue SMART Therapy: LOW-dose ICS - LABA (formoterol combination inhaler)
  • Daily & Rescue SMART Therapy: MEDIUM-dose ICS - LABA (formoterol combination inhaler)
  • Daily low-dose ICS + daily LAMA
  • Daily medium-dose ICS + daily LAMA
  • Daily medium-dose ICS - LABA (combo) + daily LAMA
  • Daily high-dose ICS - LABA (combo) + daily LAMA
  • Unlisted ICS or ICS combo
Which asthma therapy plan matches the patient's asthma medication plan (not taking any as needed or daily ICS)?

Select one option:

  • 1. Daily LTRA (&) 2. Rescue SABA
  • Rescue SABA only
  • Unlisted or custom plan
Which asthma therapy plan matches the patient's asthma medication plan (short course ICS with RTI)?

Select one option:

  • No daily controller medication. As needed meds include: 1. A short course of ICS at the start of a RTI (&) 2. Rescue SABA
  • Unlisted or custom plan
Which asthma therapy plan matches the patient's asthma medication plan when using a low-dose ICS?

Select one option:

  • 1. Daily low-dose ICS (&) 2. Rescue SABA
  • 1. Daily low-dose ICS (&) 2. Daily LTRA (&) 3. Rescue SABA
  • Unlisted or custom plan
Which asthma therapy plan matches the patient's asthma medication plan when using a medium-dose ICS?

Select one option:

  • 1. Daily medium-dose ICS (&) 2. Rescue SABA
  • 1. Daily medium-dose ICS (&) 2. Daily LTRA (&) 3. Rescue SABA
  • Unlisted or custom plan
Which asthma therapy plan matches the patient's asthma medication plan when using a high - dose ICS?

Select one option:

  • 1. Daily high - dose ICS (&) 2. Daily LTRA (&) 3. Rescue SABA
  • 1. Daily high - dose ICS (&) 2. Daily LTRA (&) 3. Daily oral corticosteroid (&) 4. Rescue SABA
  • Unlisted or custom plan
Which asthma therapy plan matches the patient's asthma medication plan when using a low-dose ICS - LABA combo?

Select one option:

  • 1. Daily low-dose ICS - LABA combo (&) 2. Rescue SABA
  • Unlisted or custom plan
Which asthma therapy plan matches the patient's asthma medication plan when using a medium-dose ICS - LABA combo?

Select one option:

  • 1. Daily medium-dose ICS - LABA combo (&) 2. Rescue SABA
  • Unlisted or custom plan
Which asthma therapy plan matches the patient's asthma medication plan when using a high-dose ICS - LABA combo?

Select one option:

  • 1. Daily high-dose ICS - LABA combo (&) 2. Rescue SABA
  • 1. Daily high-dose ICS - LABA (&) 2. Daily oral corticosteroid (&) 3. Rescue SABA
  • Unlisted or custom plan
Which asthma therapy plan matches the patient's asthma medication plan when using a low-dose ICS + LAMA?

Select one option:

  • 1. Daily low-dose ICS (&) 2. Daily LAMA (&) 3. Rescue SABA
  • Unlisted or custom plan
Which asthma therapy plan matches the patient's asthma medication plan when using a medium-dose ICS + LAMA?

Select one option:

  • 1. Daily medium-dose ICS (&) 2. Daily LAMA (&) 3. Rescue SABA
  • Unlisted or custom plan
Which asthma therapy plan matches the patient's asthma medication plan when using a medium-dose ICS - LABA combo + LAMA?

Select one option:

  • 1. Daily medium-dose ICS - LABA (combo) (&) 2. Daily LAMA (&) 3. Rescue SABA
  • Unlisted or custom plan
Which asthma therapy plan matches the patient's asthma medication plan when using a high-dose ICS - LABA combo + LAMA?

Select one option:

  • 1. Daily high-dose ICS - LABA (combo) (&) 2. Daily LAMA (&) 3. Rescue SABA
  • Unlisted or custom plan
Taking asthma medications as prescribed?

Select one option:

  • Yes
  • No
  • Cannot determine
Default SectionTitle not visible
Select age group

Select one option:

  • 0-3
  • 4
  • 5-11
  • 12+
Look up medication by

Select one option:

  • Brand Name
  • Generic Name
Select Medication by generic name (12+)

Includes ICS & ICS-LABA combination inhalers

ICS: Inhaled corticosteroid

LABA: Long-Acting Beta-2 Agonist

 

Select one option:

  • beclomethasone (QVAR MDI)
  • budesonide (Pulmicort DPI)
  • budesonide - formoterol combination (Symbicort MDI)
  • ciclesonide (Alvesco MDI)
  • flunisolide (Aerospan MDI)
  • fluticasone (ArmonAir, Arnuity & Flovent)
  • fluticasone - salmeterol combination (Advair & AirDuo)
  • fluticasone - vilanterol combination (Breo Ellipta DPI)
  • mometasone (Asmanex DPI & MDI)
  • mometasone - formoterol combination (Dulera MDI)
  • Unlisted
Select Medication Brand (12+)

Includes ICS & ICS-LABA combination inhalers

ICS: Inhaled corticosteroid

LABA: Long-Acting Beta-2 Agonist

 

Select one option:

  • Advair MDI & Diskus (fluticasone - salmeterol)
  • Aerospan MDI (flunisolide)
  • AirDuo RespiClick DPI (fluticasone - salmeterol)
  • Alvesco MDI (ciclesonide)
  • ArmonAir RespiClick DPI (fluticasone)
  • Arnuity DPI (fluticasone)
  • Asmanex DPI & MDI (mometasone)
  • Breo Ellipta DPI (fluticasone - vilanterol)
  • Dulera MDI (mometasone - formoterol)
  • Flovent MDI & Diskus (fluticasone)
  • Pulmicort DPI (budesonide)
  • Symbicort MDI (budesonide - formoterol)
  • QVAR MDI (beclomethasone)
  • Unlisted
Select Medication by generic name (5-11)

Includes ICS & ICS-LABA combination inhalers

ICS: Inhaled corticosteroid

LABA: Long-Acting Beta-2 Agonist

 

Select one option:

  • beclomethasone (QVAR MDI)
  • budesonide (Pulmicort Nebules)
  • budesonide - formoterol combination (Symbicort MDI)
  • ciclesonide (Alvesco MDI)
  • fluticasone (Flovent MDI & Diskus)
  • fluticasone - salmeterol combination (Advair MDI & Diskus)
  • fluticasone - vilanterol combination (Breo Ellipta DPI)
  • mometasone (Asmanex DPI & MDI)
  • mometasone - formoterol combination (Dulera MDI)
  • Unlisted
Select Medication Brand (5-11)

Includes ICS & ICS-LABA combination inhalers

ICS: Inhaled corticosteroid

LABA: Long-Acting Beta-2 Agonist

 

Select one option:

  • Advair MDI & Diskus (fluticasone - salmeterol)
  • Alvesco MDI (ciclesonide)
  • Asmanex DPI & MDI (mometasone)
  • Breo Ellipta DPI (fluticasone - vilanterol)
  • Dulera MDI (mometasone - formoterol)
  • Flovent MDI & Diskus (fluticasone)
  • Pulmicort Nebules (budesonide)
  • Symbicort MDI (budesonide - formoterol)
  • QVAR MDI (beclomethasone)
  • Unlisted
Select Medication by generic name (0-4)

Includes ICS & ICS-LABA combination inhalers

ICS: Inhaled corticosteroid

LABA: Long-Acting Beta-2 Agonist

 

Select one option:

  • beclomethasone (QVAR MDI)
  • budesonide (Pulmicort Nebules)
  • budesonide - formoterol combination (Symbicort MDI)
  • fluticasone (Flovent MDI)
  • fluticasone - salmeterol combination (Advair MDI)
  • mometasone (Asmanex MDI)
  • mometasone - formoterol combination (Dulera MDI)
  • Unlisted
Select Medication Brand (0-4)

Includes ICS & ICS-LABA combination inhalers

ICS: Inhaled corticosteroid

LABA: Long-Acting Beta-2 Agonist

 

Select one option:

  • Advair MDI (fluticasone - salmeterol)
  • Asmanex MDI (mometasone)
  • Dulera MDI (mometasone - formoterol)
  • Flovent MDI (fluticasone)
  • Pulmicort Nebules (budesonide)
  • Symbicort MDI (budesonide - formoterol)
  • QVAR MDI (beclomethasone)
  • Unlisted
Select delivery inhaler type

DPI: Dry Powder Inhaler (includes Diskus)

MDI: Metered Dose Inhaler

Inhaler Examples

 

Select one option:

  • MDI
  • DPI (includes Diskus)
Select fluticasone DPI strength options by brand

Select one option:

  • 50 / 100 / 250 mcg (Flovent Diskus)
  • 100 / 200 mcg (Arnuity DPI)
  • 55 / 113 / 232 mcg (ArmonAir RespiClick DPI)
  • Unlisted
Select fluticasone - salmeterol combination DPI strength options by brand

Select one option:

  • 100/50 or 250/50 or 500/50 mcg (Advair combo Diskus)
  • 55/14 or 113/14 or 232/14 mcg (AirDuo RespiClick combo DPI)
  • Unlisted
Select QVAR (beclomethasone) strength and dose (12+)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • QVAR MDI 40 mcg inhale 2-6 puffs/day (total dose range 80-240 mcg per day) - Low Dose
  • QVAR MDI 40 mcg inhale 8-12 puffs/day (total dose range >240-480 mcg per day) - Medium Dose
  • QVAR MDI 80 mcg inhale 1-2 puffs/day (total dose range 80-240 mcg per day) - Low Dose
  • QVAR MDI 80 mcg inhale 4-6 puffs/day (total dose range >240-480 mcg per day) - Medium Dose
  • QVAR MDI 80 mcg inhale 8 puffs/day (total dose range >480 mcg per day) - High Dose
  • Unlisted
Select Alvesco (ciclesonide) strength and dose (12+)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Alvesco MDI 80 mcg inhale 2-4 puffs/day (total dose range 160-320 mcg per day) - Low Dose
  • Alvesco MDI 80 mcg inhale 6-8 puffs/day (total dose range >320-640 mcg per day) - Medium Dose
  • Alvesco MDI 160 mcg inhale 1-2 puffs/day (total dose range 160-320 mcg per day) - Low Dose
  • Alvesco MDI 160 mcg inhale 4 puffs/day (total dose range >320-640 mcg per day) - Medium Dose
  • Alvesco MDI 160 mcg inhale 6 puffs/day (total dose range >640 mcg per day) - High Dose
  • Unlisted
Select Pulmicort (budesonide) strength and dose (12+)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Pulmicort DPI 90 mcg inhale 2-6 puffs/day (total dose range 180-540 mcg per day) - Low Dose
  • Pulmicort DPI 180 mcg inhale 1-2 puffs/day (total dose range 180-540 mcg per day) - Low Dose
  • Pulmicort DPI 180 mcg inhale 4-6 puffs/day (total dose range >540-1080 mcg per day) - Medium Dose
  • Pulmicort DPI 180 mcg inhale 8 puffs/day (total dose range >1080 mcg per day) - High Dose
  • Unlisted
Select Aerospan (flunisolide) strength and dose (12+)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Aerospan MDI 80 mcg inhale 2 puffs/day (total dose range 320 mcg per day) - Low Dose
  • Aerospan MDI 80 mcg inhale 6-8 puffs/day (total dose range >320-640 mcg per day) - Medium Dose
  • Unlisted
Select Flovent (fluticasone) MDI strength and dose (12+)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Flovent MDI 44 mcg inhale 2-6 puffs/day (total dose range 88-264 mcg per day) - Low Dose
  • Flovent MDI 110 mcg inhale 1-2 puffs/day (total dose range 88-264 mcg per day) - Low Dose
  • Flovent MDI 110 mcg inhale 4 puffs/day (total dose range >264-440 mcg per day) - Medium Dose
  • Flovent MDI 110 mcg inhale 6 puffs/day (total dose range >440 mcg per day) - High Dose
  • Flovent MDI 220 mcg inhale 1 puffs/day (total dose range 88-264 mcg per day) - Low Dose
  • Flovent MDI 220 mcg inhale 2 puffs/day (total dose range >264-440 mcg per day) - Medium Dose
  • Flovent MDI 220 mcg inhale 4-6 puffs/day (total dose range >440 mcg per day) - High Dose
  • Unlisted
Select Flovent (fluticasone) Diskus strength and dose (12+)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Flovent Diskus 50 mcg inhale 2-6 puffs/day (total dose range 100-300 mcg per day) - Low Dose
  • Flovent Diskus 100 mcg inhale 1-3 puffs/day (total dose range 100-300 mcg per day) - Low Dose
  • Flovent Diskus 100 mcg inhale 4 puffs/day (total dose range >300-500 mcg per day) - Medium Dose
  • Flovent Diskus 100 mcg inhale 6 puffs/day (total dose range >500 mcg per day) - High Dose
  • Flovent Diskus 250 mcg inhale 1 puffs/day (total dose range 100-300 mcg per day) - Low Dose
  • Flovent Diskus 250 mcg inhale 2 puffs/day (total dose range >300-500 mcg per day) - Medium Dose
  • Flovent Diskus 250 mcg inhale 4-6 puffs/day (total dose range >500 mcg per day) - High Dose
  • Unlisted
Select Asmanex (mometasone) DPI strength and dose (12+)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Asmanex DPI 110 mcg inhale 1-2 puffs/day (total dose range 110-220 mcg per day) - Low Dose
  • Asmanex DPI 110 mcg inhale 4 puffs/day (total dose range >220-440 mcg per day) - Medium Dose
  • Asmanex DPI 110 mcg inhale 6 puffs/day (total dose range >440 mcg per day) - High Dose
  • Asmanex DPI 220 mcg inhale 1 puffs/day (total dose range 110-220 mcg per day) - Low Dose
  • Asmanex DPI 220 mcg inhale 2 puffs/day (total dose range >220-440 mcg per day) - Medium Dose
  • Asmanex DPI 220 mcg inhale 3 puffs/day (total dose range >440 mcg per day) - High Dose
  • Unlisted
Select Asmanex (mometasone) MDI strength and dose (12+)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Asmanex MDI 100 mcg inhale 1-2 puffs/day - Low Dose
  • Asmanex MDI 100 mcg inhale 4 puffs/day - Medium Dose
  • Asmanex MDI 100 mcg inhale 6 puffs/day - High Dose
  • Asmanex MDI 200 mcg inhale 1 puffs/day - Low Dose
  • Asmanex MDI 200 mcg inhale 2 puffs/day - Medium Dose
  • Asmanex MDI 200 mcg inhale 3-4 puffs/day - High Dose
  • Unlisted
Select Arnuity (fluticasone) DPI strength and dose (12+)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.

 

Select one option:

  • Arnuity DPI 100 mcg inhale 1 puffs/day - Medium Dose
  • Arnuity DPI 200 mcg inhale 1 puffs/day - High Dose
  • Unlisted
Select ArmonAir RespiClick (fluticasone) DPI strength and dose (12+)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • ArmonAir RespiClick DPI 55 mcg inhale 2 puffs/day (total dose range 100-250 mcg per day) - Low Dose
  • ArmonAir RespiClick DPI 113 mcg inhale 1-2 puffs/day (total dose range 100-250 mcg per day) - Low Dose
  • ArmonAir RespiClick DPI 113 mcg inhale 2 puffs/day (total dose range 250-500 mcg per day) - Medium Dose
  • ArmonAir RespiClick DPI 232 mcg inhale 1 puffs/day (total dose range 100-250 mcg per day) - Low Dose
  • ArmonAir RespiClick DPI 232 mcg inhale 2 puffs/day (total dose range 250-500 mcg per day) - Medium Dose
  • Unlisted
Select Advair (fluticasone - Salmeterol) combo Diskus strength and dose (12+)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Advair combo Diskus 100/50 mcg inhale 2 puffs/day (total dose range 100-300 mcg per day) - Low Dose
  • Advair combo Diskus 250/50 mcg inhale 1 puffs/day (total dose range 100-300 mcg per day) - Low Dose
  • Advair combo Diskus 250/50 mcg inhale 2 puffs/day (total dose range >300-500 mcg per day) - Medium Dose
  • Advair combo Diskus 500/50 mcg inhale 1 puffs/day (total dose range >300-500 mcg per day) - Medium Dose
  • Advair combo Diskus 500/50 mcg inhale 2 puffs/day (total dose range >500 mcg per day) - High Dose
  • Unlisted
Select Advair (fluticasone - Salmeterol) combo MDI strength and dose (12+)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Advair combo MDI 45/21 mcg inhale 2-4 puffs/day (total dose range 88-264 mcg per day) - Low Dose
  • Advair combo MDI 115/21 mcg inhale 2 puffs/day (total dose range 88-264 mcg per day) - Low Dose
  • Advair combo MDI 115/21 mcg inhale 4 puffs/day (total dose range >264-440 mcg per day) - Medium Dose
  • Advair combo MDI 230/21 mcg inhale 1 puffs/day (total dose range 88-264 mcg per day) - Low Dose
  • Advair combo MDI 230/21 mcg inhale 2 puffs/day (total dose range >264-440 mcg per day) - Medium Dose
  • Advair combo MDI 230/21 mcg inhale 4 puffs/day (total dose range >440 mcg per day) - High Dose
  • Unlisted
Select Symbicort (budesonide - formoterol) combo MDI strength and dose (12+)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Symbicort combo MDI 80/4.5 mcg inhale 4 puffs/day (total dose range 180-540 mcg per day) - Low Dose
  • Symbicort combo MDI 160/4.5 mcg inhale 2 puffs/day (total dose range 180-540 mcg per day) - Low Dose
  • Symbicort combo MDI 160/4.5 mcg inhale 4 puffs/day (total dose range >540-1080 mcg per day) - Medium Dose
  • Unlisted
Select Dulera (mometasone - formoterol) combo MDI strength and dose (12+)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Dulera combo MDI 100/5 mcg inhale 2 puffs/day (total dose range 110-220 mcg per day) - Low Dose
  • Dulera combo MDI 100/5 mcg inhale 4 puffs/day (total dose range >220-440 mcg per day) - Medium Dose
  • Dulera combo MDI 200/5 mcg inhale 2 puffs/day (total dose range >220-440 mcg per day) - Medium Dose
  • Dulera combo MDI 200/5 mcg inhale 4 puffs/day (total dose range >440 mcg per day) - High Dose
  • Unlisted
Select Breo Ellipta (fluticasone - vilanterol) combo DPI strength and dose (12+)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Breo Ellipta combo DPI 100/25 mcg inhale 1 puffs/day (total dose 100 mcg per day) - Medium Dose
  • Breo Ellipta combo DPI 200/25 mcg inhale 1 puffs/day (total dose 200 mcg per day) - High Dose
  • Unlisted
Select AirDuo RespiClick (fluticasone - salmeterol) combo DPI strength and dose (12+)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • AirDuo RespiClick combo DPI 55/14 mcg inhale 2 puffs/day (total dose range 100-250 mcg per day) - Low Dose
  • AirDuo RespiClick combo DPI 113/14 mcg inhale 1-2 puffs/day (total dose range 100-250 mcg per day) - Low Dose
  • AirDuo RespiClick combo DPI 113/14 mcg inhale 2 puffs/day (total dose range 250-500 mcg per day) - Medium Dose
  • AirDuo RespiClick combo DPI 232/14 mcg inhale 1 puffs/day (total dose range 100-250 mcg per day) - Low Dose
  • AirDuo RespiClick combo DPI 232/14 mcg inhale 2 puffs/day (total dose range 250-500 mcg per day) - Medium Dose
  • Unlisted
Select QVAR (beclomethasone) strength and dose (5-11)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • QVAR MDI 40 mcg inhale 2-4 puffs/day (total dose range 80-160 mcg per day) - Low Dose
  • QVAR MDI 40 mcg inhale 6 puffs/day (total dose range >160-320 mcg per day) - Medium Dose
  • QVAR MDI 80 mcg inhale 1-2 puffs/day (total dose range 80-160 mcg per day) - Low Dose
  • QVAR MDI 80 mcg inhale 4 puffs/day (total dose range >160-320 mcg per day) - Medium Dose
  • QVAR MDI 80 mcg inhale 6 puffs/day (total dose range >320 mcg per day) - High Dose
  • Unlisted
Select Alvesco (ciclesonide) strength and dose (5-11)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Alvesco MDI 80 mcg inhale 1-2 puffs/day (total dose range 80-160 mcg per day) - Low Dose
  • Alvesco MDI 80 mcg inhale 3-4 puffs/day (total dose range >160-320 mcg per day) - Medium Dose
  • Alvesco MDI 80 mcg inhale 6 puffs/day (total dose range >320 mcg per day) - High Dose
  • Alvesco MDI 160 mcg inhale 1 puffs/day (total dose range 80-160 mcg per day) - Low Dose
  • Alvesco MDI 160 mcg inhale 2 puffs/day (total dose range >160-320 mcg per day) - Medium Dose
  • Alvesco MDI 160 mcg inhale 4 puffs/day (total dose range >320 mcg per day) - High Dose
  • Unlisted
Select Pulmicort (budesonide) strength and dose (5-11)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Pulmicort Nebules 0.25 mg inhale 2 nebs/day (total dose 0.5 mg per day) - Low Dose
  • Pulmicort Nebules 0.5 mg inhale 1 nebs/day (total dose 0.5 mg per day) - Low Dose
  • Pulmicort Nebules 0.5 mg inhale 2 nebs/day (total dose 1.0 mg per day) - Medium Dose
  • Pulmicort Nebules 1.0 mg inhale 1 nebs/day (total dose 1.0 mg per day) - Medium Dose
  • Pulmicort Nebules 1.0 mg inhale 2 nebs/day (total dose 2.0 mg per day) - High Dose
  • Unlisted
Select Flovent (fluticasone) MDI strength and dose (5-11)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Flovent MDI 44 mcg inhale 2-4 puffs/day (total dose range 88-176 mcg per day) - Low Dose
  • Flovent MDI 44 mcg inhale 6 puffs/day (total dose range >176-352 mcg per day) - Medium Dose
  • Flovent MDI 110 mcg inhale 1 puffs/day (total dose range 88-176 mcg per day) - Low Dose
  • Flovent MDI 110 mcg inhale 2 puffs/day (total dose range >176-352 mcg per day) - Medium Dose
  • Flovent MDI 110 mcg inhale 4 puffs/day (total dose range >352 mcg per day) - High Dose
  • Flovent MDI 220 mcg inhale 1 puffs/day (total dose range >176-352 mcg per day) - Medium Dose
  • Flovent MDI 220 mcg inhale 2 puffs/day (total dose range >352 mcg per day) - High Dose
  • Unlisted
Select Flovent (fluticasone) Diskus strength and dose (5-11)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Flovent Diskus 50 mcg inhale 2-4 puffs/day (total dose range 100-200 mcg per day) - Low Dose
  • Flovent Diskus 50 mcg inhale 6 puffs/day (total dose range >200-400 mcg per day) - Medium Dose
  • Flovent Diskus 100 mcg inhale 1-2 puffs/day (total dose range 100-200 mcg per day) - Low Dose
  • Flovent Diskus 100 mcg inhale 4 puffs/day (total dose range >200-400 mcg per day) - Medium Dose
  • Flovent Diskus 100 mcg inhale 6 puffs/day (total dose range >400 mcg per day) - High Dose
  • Flovent Diskus 250 mcg inhale 1 puffs/day (total dose range >200-400 mcg per day) - Medium Dose
  • Flovent Diskus 250 mcg inhale 2 puffs/day (total dose range >400 mcg per day) - High Dose
  • Unlisted
Select Asmanex (mometasone) DPI strength and dose (5-11)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Asmanex DPI (Twisthaler) 110 mcg inhale 1 puffs/day (total dose range 110 mcg per day) - Low Dose
  • Asmanex DPI (Twisthaler) 110 mcg inhale 2-4 puffs/day (total dose range 220-440 mcg per day) - Medium Dose
  • Asmanex DPI (Twisthaler) 110 mcg inhale 6 puffs/day (total dose range >440 mcg per day) - High Dose
  • Asmanex DPI (Twisthaler) 220 mcg inhale 1-2 puffs/day (total dose range 220-140 mcg per day) - Medium Dose
  • Asmanex DPI (Twisthaler) 220 mcg inhale 3 puffs/day (total dose range >440 mcg per day) - High Dose
  • Unlisted
Select Asmanex (mometasone) MDI strength and dose (5-11)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Asmanex MDI 100 mcg inhale 1 puffs/day - Low Dose
  • Asmanex MDI 100 mcg inhale 2 puffs/day - Medium Dose
  • Asmanex MDI 100 mcg inhale 4 puffs/day - High Dose
  • Asmanex MDI 200 mcg inhale 1-2 puffs/day - Medium Dose
  • Asmanex MDI 200 mcg inhale 3-4 puffs/day - High Dose
  • Unlisted
Select Advair (fluticasone - Salmeterol) combo Diskus strength and dose (5-11)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Advair combo Diskus 100/50 mcg inhale 1-2 puffs/day (total dose range 100-200 mcg per day) - Low Dose
  • Advair combo Diskus 250/50 mcg inhale 1-2 puffs/day (total dose range >200-400 mcg per day) - Medium Dose
  • Advair combo Diskus 250/50 mcg inhale 2 puffs/day (total dose range >400 mcg per day) - High Dose
  • Advair combo Diskus 500/50 mcg inhale 1-2 puffs/day (total dose range >400 mcg per day) - High Dose
  • Unlisted
Select Advair (fluticasone - Salmeterol) combo MDI strength and dose (5-11)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Advair combo MDI 45/21 mcg inhale 2-4 puffs/day (total dose range 88-176 mcg per day) - Low Dose
  • Advair combo MDI 115/21 mcg inhale 1 puffs/day (total dose range 88-176 mcg per day) - Low Dose
  • Advair combo MDI 115/21 mcg inhale 2 puffs/day (total dose range >176-352 mcg per day) - Medium Dose
  • Advair combo MDI 115/21 mcg inhale 4 puffs/day (total dose range >352 mcg per day) - High Dose
  • Advair combo MDI 230/21 mcg inhale 1 puffs/day (total dose range >176-352 mcg per day) - Medium Dose
  • Advair combo MDI 230/21 mcg inhale 2-4 puffs/day (total dose range >352 mcg per day) - High Dose
  • Unlisted
Select Symbicort (budesonide - formoterol) combo MDI strength and dose (5-11)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Symbicort combo MDI 80/4.5 mcg inhale 2-4 puffs/day (total dose range 180-360 mcg per day) - Low Dose
  • Symbicort combo MDI 80/4.5 mcg inhale 4 puffs/day (total dose range >360-720 mcg per day) - Medium Dose
  • Symbicort combo MDI 160/4.5 mcg inhale 1 puffs/day (total dose range 180-360 mcg per day) - Low Dose
  • Symbicort combo MDI 160/4.5 mcg inhale 2-4 puffs/day (total dose range >360-720 mcg per day) - Medium Dose
  • Symbicort combo MDI 160/4.5 mcg inhale 4 puffs/day (total dose range >720 mcg per day) - High Dose
  • Unlisted
Select Dulera (mometasone - formoterol) combo MDI strength and dose (5-11)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Dulera combo MDI 100/5 mcg inhale 1 puffs/day (total dose 110 mcg per day) - Low Dose
  • Dulera combo MDI 100/5 mcg inhale 2-4 puffs/day (total dose range 220-440 mcg per day) - Medium Dose
  • Dulera combo MDI 100/5 mcg inhale 4 puffs/day (total dose range >440 mcg per day) - High Dose
  • Dulera combo MDI 200/5 mcg inhale 2 puffs/day (total dose range 220-440 mcg per day) - Medium Dose
  • Dulera combo MDI 200/5 mcg inhale 2-4 puffs/day (total dose range >440 mcg per day) - High Dose
  • Unlisted
Select Breo Ellipta (fluticasone - vilanterol) combo DPI strength and dose (5-11)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Breo Ellipta combo DPI 200/25 mcg inhale 1 puffs/day (total 200 mcg per day) - High Dose
  • Unlisted
Select QVAR (beclomethasone) strength and dose (0-4)

While dosing is typically based on NHLIB/GINA guidelines, QVAR MDI is not indicated in the guidelines but included because of common local practice.

  • Choices are total puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • QVAR MDI 40 mcg inhale 4 puffs/day (total dose 160 mcg per day) - Low Dose
  • QVAR MDI 80 mcg inhale 2 puffs/day (total dose 160 mcg per day) - Low Dose
  • QVAR MDI 80 mcg inhale 4 puffs/day (total dose 320 mcg per day) - Medium Dose
  • QVAR MDI 80 mcg inhale 6 puffs/day (total dose 480 mcg per day) - High Dose
  • Unlisted
Select Pulmicort (budesonide) strength and dose (0-4)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID. 
  • RTI: Respiratory Tract Infection

 

Select one option:

  • Pulmicort Nebules 0.25 mg inhale 1-2 nebs/day (total dose range 0.25-0.5 mg per day) - Low Dose
  • Pulmicort Nebules 0.5 mg inhale 1 nebs/day (total dose 0.25-0.5 mg per day) - Low Dose
  • Pulmicort Nebules 0.5 mg inhale 2 nebs/day (total dose range >0.5-1.0 mg per day) - Medium Dose
  • Pulmicort Nebules 0.5 mg inhale 3 nebs x 7 days RTI (total dose >1.0 mg per day) - High Dose
  • Pulmicort Nebules 1.0 mg inhale 1 nebs/day (total dose range >0.5-1.0 mg per day) - Medium Dose
  • Pulmicort Nebules 1.0 mg inhale 2 nebs x 7 days RTI (total dose range > 1.0 mg per day) - High Dose
  • Unlisted
Select Flovent (fluticasone) MDI strength and dose (0-4)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.
  • All MDI doses administered by facemask with spacer.
  • Therefore, higher doses recommended per guidelines.
  • RTI: Respiratory Tract Infection

 

Select one option:

  • Flovent MDI 44 mcg inhale 4 puffs/day (total dose 176 mcg per day) - Low Dose
  • Flovent MDI 44 mcg inhale 6 puffs/day (total dose range >176-352 mcg per day) - Medium Dose
  • Flovent MDI 110 mcg inhale 2 puffs/day (total dose range >176-352 mcg per day) - Medium Dose
  • Flovent MDI 110 mcg inhale 4 nebs x 7 days RTI (total dose range >352 mcg per day) - High Dose
  • Flovent MDI 220 mcg inhale 1 puffs/day (total dose range >176-352 mcg per day) - Medium Dose
  • Flovent MDI 220 mcg inhale 2 nebs x 7 days RTI (total dose range >352 mcg per day) - High Dose
  • Unlisted
Select Asmanex (mometasone) MDI strength and dose (0-4)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.
  • All MDI doses administered by facemask with spacer.
  • Therefore, higher doses recommended per guidelines.

 

Select one option:

  • Asmanex MDI 100 mcg inhale 2 puffs/day - Medium Dose
  • Asmanex MDI 100 mcg inhale 4 puffs/day - High Dose
  • Asmanex MDI 200 mcg inhale 1 puffs/day - Medium Dose
  • Asmanex MDI 200 mcg inhale 2 puffs/day - High Dose
  • Unlisted
Select Advair (fluticasone - Salmeterol) combo MDI strength and dose (0-4)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.

 

Select one option:

  • Advair combo MDI 45/21 mcg inhale 2 puffs/day (total dose 176 mcg per day) - Low Dose
  • Advair combo MDI 45/21 mcg inhale 4 puffs/day (total dose range >176-352 mcg per day) - Medium Dose
  • Advair combo MDI 115/21 mcg inhale 2 puffs/day (total dose range >176-352 mcg per day) - Medium Dose
  • Advair combo MDI 115/21 mcg inhale 4 puffs/day (total dose range >352 mcg per day) - High Dose
  • Advair combo MDI 230/21 mcg inhale 2 puffs/day (total dose range >352 mcg per day) - High Dose
  • Unlisted
Select Symbicort (budesonide - formoterol) combo MDI strength and dose (0-4)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.
  • Dosing is based on relative ICS potency to fluticasone. Higher dose indicated because it is delivered with  a face mask and spacer.

 

Select one option:

  • Symbicort combo MDI 80/4.5 mcg inhale 2-4 puffs/day (total dose range 180-360 mcg per day) - Low Dose
  • Symbicort combo MDI 80/4.5 mcg inhale 4 puffs/day (total dose range >360-720 mcg per day) - Medium Dose
  • Symbicort combo MDI 160/4.5 mcg inhale 1 puffs/day (total dose range 180-360 mcg per day) - Low Dose
  • Symbicort combo MDI 160/4.5 mcg inhale 2 puffs/day (total dose range >360-720 mcg per day) - Medium Dose
  • Symbicort combo MDI 160/4.5 mcg inhale 4 puffs/day (total dose range >720 mcg per day) - High Dose
  • Unlisted
Select Dulera (mometasone - formoterol) combo MDI strength and dose (0-4)

All doses are based on NHLIB/GINA guidelines.

  • Choices are puffs per day.
  • Most clinical dosing is BID. 
  • Therefore, divide total dose by 2 and administer BID.
  • Dosing is based on relative ICS potency to fluticasone. Higher dose indicated because it is delivered with  a face mask and spacer.

 

Select one option:

  • Dulera combo MDI 100/5 mcg inhale 1 puffs/day (total dose 110 mcg per day) - Low Dose
  • Dulera combo MDI 100/5 mcg inhale 2 puffs/day (total dose range 220-440 mcg per day) - Medium Dose
  • Dulera combo MDI 100/5 mcg inhale 4 puffs/day (total dose range >440 mcg per day) - High Dose
  • Dulera combo MDI 200/5 mcg inhale 1 puffs/day (total dose range 220-440 mcg per day) - Medium Dose
  • Dulera combo MDI 200/5 mcg inhale 2 puffs/day (total dose range >440 mcg per day) - High Dose
  • Unlisted
Possible results
Step Six (Alternative): 1. Daily high-dose ICS (&) 2. Daily LTRA (&) 3. Daily oral corticosteroid (&) 4. Rescue SABA (Ages 0-4)
  • Daily Controllers: 
    • High-dose inhaled corticosteroid (ICS) &
    • Leukotriene receptor agonist (LTRA) & 
    • Oral corticosteroid &
  • Rescue Medication: As needed short-acting beta 2 agonist (SABA)
Step Two (Alternative): 1. Daily LTRA (&) 2. Rescue SABA (Ages 5-11)

Daily Controller: Leukotriene receptor agonist (LTRA) &

Rescue Medication: As needed short-acting beta 2 agonist (SABA)

Seek Asthma Specialist Consultation (Ages 5 years and older)

In ages 5 years and older, consult with an asthma specialist if step 4 care or higher is required.

Step Four (Alternative): 1. Daily medium-dose ICS (&) 2. Daily LTRA (&) 3. Rescue SABA (Ages 12+)
  • Daily Controllers: 
    • Medium-dose inhaled corticosteroid (ICS) & 
    • Leukotriene receptor agonist (LTRA) &
  • Rescue Medication: 
    • As needed short-acting beta 2 agonist (SABA)
Step Five (Alternative): 1. Daily high-dose ICS - LABA combo (&) 2. Rescue SABA (Ages 12+)

Daily Controller: Combination high-dose inhaled corticosteroid (ICS) - long-acting beta 2 agonist (LABA) &

Rescue Medication: As needed short-acting beta 2 agonist (SABA)

No match to an asthma guideline therapy step. If asthma uncontrolled, consider following recommendations in the asthma severity algorithm or starting a guideline step with a similar medication profile.

EPR-4 Guidelines

  • EPR-4 Guideline Step Summary (Ages 0-4)
  • EPR-4 Guideline Step Summary (Ages 5-11)
  • EPR-4 Guideline Step Summary (Ages 12+)
Step Four (Alternative): 1. Daily medium-dose ICS - LABA combo (&) 2. Rescue SABA (Ages 12+)

Daily Controller: Combination medium-dose inhaled corticosteroid (ICS) - long-acting beta 2 agonist (LABA) &

Rescue Medication: As needed short-acting beta 2 agonist (SABA)

Step Three (Alternative): 1. Daily low-dose ICS - LABA combo (&) 2. Rescue SABA (Ages 4-11)

Daily Controller: Combination low-dose inhaled corticosteroid (ICS) & long-acting beta 2 agonist (LABA) & 

Rescue Medication: As needed short-acting beta 2 agonist (SABA)

Consider Asthma Specialist Consultation (Ages 0-4)

In ages 0-4 years, consider consultation with an asthma specialist if step 2 care or higher is required

Step Five (Preferred): Daily high-dose ICS - LABA combo (&) 2. Rescue SABA (Ages 0-4)
  • Daily Controller: Combination high-dose inhaled corticosteroid (ICS) - long-acting beta 2 agonist (LABA) &
  • Rescue Medication: As needed short-acting beta 2 agonist (SABA)
Step Four (Alternative): 1. Daily medium-dose ICS (&) 2. Daily LAMA (&) 3. Rescue SABA (Ages 12+)
  • Daily Controllers: 
    • Medium-dose inhaled corticosteroid (ICS) & 
    • Long-acting muscarinic agonist (LAMA) &
  • Rescue Medication:
    • As needed short-acting beta 2 agonist (SABA)
Step Three (Alternative): 1. Daily medium-dose ICS (&) 2. Rescue SABA (Ages 4-11)

Daily Controller: Medium-dose inhaled corticosteroid (ICS) &

Rescue Medication: As needed short-acting beta 2 agonist (SABA)

Step Two (Preferred): 1. Daily low-dose ICS (&) 2. Rescue SABA (Ages 12+)

Daily Controller: Low-dose ICS &

Rescue Medication: As needed short-acting beta 2 agonist (SABA)

Step Five (Alternative): 1. Daily high-dose ICS (&) 2. Daily LTRA (&) 3. Rescue SABA (Ages 5-11)

Daily Controller: High-dose inhaled corticosteroid (ICS) & leukotriene receptor agonist (LTRA) &

Rescue Medication: As needed short-acting beta 2 agonist (SABA)

Step Four (Alternative): 1. Daily medium-dose ICS (&) 2. Daily LTRA (&) Rescue SABA (Ages 4-11)

Daily Controller: Medium-dose inhaled corticosteroid (ICS) & leukotriene receptor agonist (LTRA) &

Rescue Medication: As needed short-acting beta 2 agonist (SABA)

Step Three (Alternative): 1. Daily low-dose ICS - LABA combo (&) 2. Rescue SABA (Ages 12+)

Daily Controller: Combination low-dose inhaled corticosteroid (ICS) & long-acting beta 2 agonist (LABA) &

Rescue Medication: As needed short-acting beta 2 agonist (SABA)

Step Five (Alternative): 1. Daily high-dose ICS (&) 2. Daily LTRA (&) 3. Rescue SABA (Ages 0-4)
  • Daily Controller: High-dose inhaled corticosteroid (ICS) & leukotriene receptor agonist (LTRA) &
  • Rescue Medication: As needed short-acting beta 2 agonist (SABA)
At Risk: Poor Medication Compliance

Review adherence to medication, inhaler technique, environmental control, and comorbid conditions. 

 

 

Step Three (Alternative): 1. Daily low-dose ICS (&) 2. Daily LTRA (&) 3. Rescue SABA (Ages 4-11)

Daily Controller: Low-dose inhaled corticosteroid (ICS) & leukotriene receptor agonist (LTRA) 

Rescue Medication: As needed short-acting beta 2 agonist (SABA)

Step One: No daily controller medication. Rescue SABA is indicated. (Ages 5-11)
  • No daily controller medication indicated 
  • Rescue medication: As needed short-acting beta 2 agonist (SABA)
Good Medication Compliance

Review environmental triggers.

Step Two (Preferred): 1. Daily low-dose ICS (&) 2. Rescue SABA (Ages 5-11)

Daily Controller: Low-dose ICS &

Rescue Medication: As needed short-acting beta 2 agonist (SABA)

Step Three (Alternative): 1. Daily low-dose ICS (&) 2. Daily LTRA (&) 3. Rescue SABA (Ages 12+)
  • Daily Controllers: 
    • Low-dose inhaled corticosteroid (ICS) &
    • Leukotriene receptor agonist (LTRA) &
  • Rescue Medication: 
    • As needed short-acting beta 2 agonist (SABA)
Step One: No daily controller medication. Rescue SABA is indicated. (Ages 12+)
  • No daily controller medication indicated  
  • Rescue Medication: As needed short-acting beta 2 agonist (SABA)
Step Two (Alternative): 1. Daily LTRA (&) 2. Rescue SABA (Ages 12+)

Daily Controller: Leukotriene receptor agonist (LTRA) &

Rescue Medication: As needed short-acting beta 2 agonist (SABA)

Step Four (Preferred): 1. Daily SMART MEDIUM-dose ICS - LABA as formoterol combo (Symbicort & Dulera only) (&) 2. Rescue SMART MEDIUM-dose ICS - LABA as formoterol combo (Ages 4-11)

Daily Controller: SMART combination medium-dose inhaled corticosteroid (ICS) - long-acting beta 2 agonist (LABA) as formoterol

Rescue Medication: As needed SMART combination medium-dose inhaled corticosteroid (ICS) - long-acting beta 2 agonist (LABA) as formoterol

Step Six: 1. Daily high-dose ICS - LABA combo (&) 2. Daily oral corticosteroid (&) 3. Rescue SABA (Ages 12+)
  • Daily Controllers: 
    • Combination high-dose inhaled corticosteroid (ICS) - long-acting beta 2 agonist (LABA) & 
    • Oral corticosteroid &
  • Rescue Medication: 
    • As needed short-acting beta 2 agonist (SABA)
Step Five (Preferred): 1. Daily high-dose ICS - LABA combo (&) 2. Daily LAMA (&) 3. Rescue SABA (Ages 12+)
  • Daily Controllers: 
    • Combination high-dose inhaled corticosteroid (ICS) & long-acting beta 2 agonist (LABA) & 
    • Long-acting muscarinic agonist (LAMA) &
  • Rescue Medication: 
    • As needed short-acting beta 2 agonist (SABA)
Step Five (Alternative): 1. Daily high-dose ICS (&) 2. Daily LTRA (&) 3. rescue SABA (Ages 12+)
  • Daily Controllers: 
    • High-dose inhaled corticosteroid (ICS) & 
    • Leukotriene receptor agonist (LTRA) &
  • Rescue Medication: 
    • As needed short-acting beta 2 agonist (SABA)
Step Five (Preferred): 1. Daily medium-dose ICS - LABA combo (&) 2. Daily LAMA (&) 3. Rescue SABA (Ages 12+)
  • Daily Controllers: 
    • Combination medium-dose inhaled corticosteroid (ICS) & long-acting beta 2 agonist (LABA) & 
    • Long-acting muscarinic agonist (LAMA) &
  • Rescue Medication: 
    • As needed short-acting beta 2 agonist (SABA)
Step Six (Preferred): 1. Daily high-dose ICS - LABA combo (&) 2. Daily oral corticosteroid (&) 3. Rescue SABA (Ages 5-11)
  • Daily Controllers: 
    • Combination high-dose inhaled corticosteroid (ICS) - long-acting beta 2 agonist (LABA) & 
    • Oral corticosteroid &
  • Rescue Medication: 
    • As needed short-acting beta 2 agonist (SABA)
Seek Asthma Specialist Consultation (Ages 0-4 years)
  • In ages 0-4 years, consult with an asthma specialist if step 3 care or higher is required.
Step Three: 1. Daily medium-dose ICS (&) 2. Rescue SABA (Ages 0-3)
  • Daily Controller: Medium-dose inhaled corticosteroid (ICS) &
  • Rescue Medication: As needed short-acting beta 2 agonist (SABA)
Step Four (Alternative): 1. Daily medium-dose ICS (&) 2. Daily LTRA (&) 3. Rescue SABA (Ages 0-3)
  • Daily Controller: Medium-dose inhaled corticosteroid (ICS) & daily leukotriene receptor agonist (LTRA) &
  • Rescue Medication: As needed short-acting beta 2 agonist (SABA)
Step Two (Alternative): 1. Daily LTRA (&) 2. Rescue SABA (Ages 0-4)
  • Daily Controller: Leukotriene receptor agonist (LTRA) &
  • Rescue Medication: As needed short-acting beta 2 agonist (SABA)
Step One: No daily controller medication. As needed meds include: 1. A short course of ICS at the start of a RTI (&) 2. Rescue SABA (Ages 0-4)
  • No daily controller medication indicated
  • Rescue medications include:
    • As needed short-acting beta 2 agonist (SABA) &
    • A short course of daily inhaled corticosteroid (ICS) at the start of a respiratory tract infection (RTI)
Step Four (Preferred): 1. Daily SMART MEDIUM-dose ICS - LABA as formoterol combo (Symbicort & Dulera only) (&) 2. Rescue SMART MEDIUM-dose ICS - LABA as formoterol combo (Ages 12+)

Daily Controller: SMART combination medium-dose inhaled corticosteroid (ICS) - long-acting beta 2 agonist (LABA) as formoterol

Rescue Medication: As needed SMART combination medium-dose inhaled corticosteroid (ICS) - long-acting beta 2 agonist (LABA) as formoterol

Step Four (Preferred): 1. Daily medium-dose ICS - LABA combo (&) 2. Rescue SABA (Ages 0-3)
  • Daily Controller: Combination medium-dose inhaled corticosteroid (ICS) & long-acting beta 2 agonist (LABA) &
  • Rescue Medication: As needed short-acting beta 2 agonist (SABA)
Step Six (Preferred): 1. Daily high-dose ICS - LABA combo (&) 2. Daily oral corticosteroid (&) 3. Rescue SABA (Ages 0-4)
  • Daily Controllers: 
    • Combination high-dose inhaled corticosteroid (ICS) - long-acting beta 2 agonist (LABA) &
    • Oral corticosteroid & 
  • Rescue Medication: As needed short-acting beta 2 agonist (SABA)
Consider Asthma Specialist Consultation (Ages 5 years and older)

In ages 5 years or older, consider consultation with an asthma specialist if step 3 care or higher is required

Step Four (Alternative): 1. Daily medium-dose ICS - LABA combo (&) 2. Rescue SABA (Ages 4-11)

Daily Controller: Combination medium-dose inhaled corticosteroid (ICS) - long-acting beta 2 agonist (LABA) &

Rescue Medication: As needed short-acting beta 2 agonist (SABA)

Step Six (Alternative): 1. Daily high-dose ICS (&) 2. Daily LTRA (&) 3. Daily oral corticosteroid (&) 4. Rescue SABA (Ages 5-11)
  • Daily Controllers:
    • High-dose inhaled corticosteroid (ICS) & 
    • Leukotriene receptor agonist (LTRA) & 
    • Oral corticosteroid 
  • Rescue Medication:
    • As needed short-acting beta 2 agonist (SABA)
Step Three (Alternative): 1. Daily low-dose ICS (&) 2. Daily LAMA (&) 3. Rescue SABA (Ages 12+)
  • Daily Controllers: 
    • Low-dose inhaled corticosteroid (ICS) & 
    • Long-acting muscarinic agonist (LAMA) &
  • Rescue Medication: 
    • As needed short-acting beta 2 agonist (SABA)
Step Three (Preferred): 1. Daily SMART LOW-dose ICS - LABA as formoterol combo (Symbicort & Dulera only) (&) 2. Rescue SMART LOW-dose ICS - LABA as formoterol combo (Ages 12+)

Daily Controller: SMART combination low-dose inhaled corticosteroid (ICS) - long-acting beta 2 agonist (LABA) as formoterol

 

Rescue Medication: As needed SMART combination low-dose inhaled corticosteroid (ICS) - long-acting beta 2 agonist (LABA) as formoterol

Step Three (Alternative): 1. Daily medium-dose ICS (&) 2. Rescue SABA (Ages 12+)

Daily Controller: Medium-dose inhaled corticosteroid (ICS) &

Rescue Medication: As needed short-acting beta 2 agonist (SABA)

Step Two (Preferred): 1. Daily low-dose ICS (&) 2. Rescue SABA (Ages 0-4)
  • Daily Controller: Low-dose ICS &
  • Rescue Medication: As needed short-acting beta 2 agonist (SABA)
Step Three (Preferred): 1. Daily SMART LOW-dose ICS - LABA as formoterol combo (Symbicort & Dulera only) (&) 2. Rescue SMART LOW-dose ICS - LABA as formoterol combo (Ages 4-11)

Daily Controller: SMART combination low-dose inhaled corticosteroid (ICS) - long-acting beta 2 agonist (LABA) as formoterol

Rescue Medication: As needed SMART combination low-dose inhaled corticosteroid (ICS) - long-acting beta 2 agonist (LABA) as formoterol

Step Five (Preferred): 1. Daily high-dose ICS - LABA combo (&) 2. Rescue SABA (Ages 5-11)

Daily Controller: Combination high-dose inhaled corticosteroid (ICS) - long-acting beta 2 agonist (LABA) &

Rescue Medication: As needed short-acting beta 2 agonist (SABA)

Step Two (Preferred): No daily controller medication. 1. Rescue Concomitant low-dose ICS (&) 2. Rescue SABA (Ages 12+)
  • No daily controller medication 
  • Rescue Medication: PRN concomitant Low-dose Inhaled Corticosteroid (ICS) & Short-acting Beta 2 Agonist (SABA)
Low-dose ICS: Used in Step 2 (Pref) & Step 3 - Ages 5-11
High-dose ICS: Used in Steps 5 & 6 - Ages 5-11
High-dose ICS: Used in Steps 5 & 6 - Ages 0-4
High-dose ICS: Used in Steps 5 & 6 - Ages 12+
Low-dose ICS: Used in Step 2 (Pref) & Step 3 (Alt) - Ages 12+
Medium-dose ICS: Used in Step 3 (Alt) & Step 4 (Alt) - Ages 12+
ICS medication unlisted: Consider pharmacist consultation
Medium-dose ICS: Used in Step 3 (Alt) & Step 4 - Ages 5-11
Low-dose ICS: Used in Step 2 (Ages 0-4) & Step 3 (Age 4)
Medium-dose ICS: Used in Step 3 & Step 4 - Ages 0-4

Literature

Related evaluations

Also from EVAL Foundation

Alcohol Use Disorders Identification Test - C (AUDIT-C)

A 3-item tool to screen for unhealthy alcohol use in patients who may not be alcohol-dependent.

Alcohol Use Disorders Identification Test (AUDIT)

A 10-item tool to screen for hazardous alcohol use, harmful use, and alcohol dependence.

American Shoulder and Elbow Surgeons (ASES) Shoulder Score

15-item assessment of shoulder pain and functional limitations in activities of daily living.

Behavioral Activity Rating Scale (BARS)

A 1-item rating scale to quantify a patient's level of agitation in acute care or psychiatric settings.

Drug Abuse Screening Test (DAST-10)

A patient self-report questionnaire to screen for problematic drug use (excluding alcohol/tobacco).

Foot and Ankle Ability Measure (FAAM)

Assesses functional limitations and disability related to foot and ankle conditions in daily activities and sports.

Foot and Ankle Disability Index (FADI)

Assess functional limitations of those with a variety of foot and ankle conditions

General Anxiety Disorder (GAD-7)

Measure severity of anxiety

Browse all evaluations