Asthma Children -2016

Diagnosis and assessment-Consider monitored initiation of treatment with very low-to low-dose ICS.Infrequent , short lived wheeze

Asthma diagnosed-Evaluation ○ assess symptoms , measure lung function , check inhaler technique and adherence
○ adjust dose ○ update self – management plan ○ move up and down as appropriate.


Regular preventer Very low 
( paediatric dose ICS )

( or LTRA < 5 yrs )-
Initial add-on preventer.Very low 
( paediatric dose ICS ) Plus Children > 5 yrs – add inhaled LABA Children < 5 yrs – add LTRA-
Additional add-on therapies

No reponse to LABA-stop LABA and ↑ dose of ICS to low dose



If benefit from LABA but control still inadequate – continue LABA and ↑ ICS to low dose



If benefit from LABA but control still inadequate- continue LABA and ICS and consider trial of other therapy – LTRA

High dose therapies





Consider trials of :

Increasing ICS upto medium dose


Addition of a fourth drug- SR theophylline Refer patient for specialist care.Continous or frequent use of oral steroids




Use daily steroid tablet in the lowest dose providing adequate control


Maintain medium-dose ICS

Consider other treatments to minimize use of steroid tablet Refer patient for specialist care. Short acting Beta 2 agonist as required- consider moving up if using three doses a week or more.In children with an intermediate probablity of asthma who cannot perform spirometry consider watchful waiting if the child is asymptomatic offer carefully monitored trial if the child is symptomatic


Reference
British guideline on the management of asthma- BTS SIGN September 2016