Asthma management (stepwise)

NAEPP / NHLBI2020

Ages 4 and up, Steps 3 to 4: preferred SMART, single ICS-formoterol inhaler for daily maintenance plus as-needed reliever (low dose step 3, medium dose step 4). Ages 12 and up, Step 2: conditional option of as-needed ICS plus SABA. Add-on LAMA to ICS-LABA at Steps 4 to 5 if not controlled.

GINA2026

Adults and adolescents, Track 1 (preferred): as-needed low-dose ICS-formoterol is the reliever at every step. Steps 1 to 2 as-needed only; Step 3 low-dose MART; Step 4 medium-dose MART. Track 2 alternative uses daily ICS or ICS-LABA with as-needed SABA or ICS-SABA (AIR reliever now offered across all steps). Step 5: add LAMA (triple ICS-LABA-LAMA), refer for phenotyping and biologic.

NAEPP / NHLBI2020Grade Conditional recommendations

Ages 0 to 4 with recurrent wheezing only during respiratory infections: start a short course of daily ICS at the onset of each infection, plus as-needed SABA (high certainty). Ages 4 and up with mild to moderate persistent asthma on daily ICS: do not simply increase the ICS dose short term for worsening symptoms. Ages 5 and up with uncertain diagnosis: FeNO can be added as an adjunct to spirometry.