The Clinical Times
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Asthma management (stepwise)

What the major U.S. guidelines recommend, with a link to verify each at the source. A quick-reference summary for clinicians, not medical advice.

NAEPP / NHLBI · 2020

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.

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GINA · 2025

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. Step 5: add LAMA, refer for phenotyping and biologic.

Verify at GINA →

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