Table 1.
The 2016 stepwise approach to asthma treatment1
| Asthma step | As-needed SABA | Low-dose ICS preferred controller | Medium/high-dose ICS/LABA | LTRA or Theo | Tiotropium | Alternative |
|---|---|---|---|---|---|---|
| Step 1 | + | + | ||||
| Step 2 | + | + | + | |||
| Step 3 | +a | +b | +b | + | +c | |
| Step 4 | +a | + | + | +d | +e | |
| Step 5 | +a | + | + | +d | +f |
Notes: Adapted from GINA 2016.1
May also include a single low-dose ICS/formoterol as a reliever medication for patients prescribed low-dose BUD/F for maintenance or low-dose BEC/F for those patients using BEC/F for maintenance.
Preferred step 3 maintenance for children aged 6–11 years is medium-dose ICS; adolescent/adults, low-dose ICS/LABA option.
Medium/high-dose ICS, low-dose ICS + LTRA, low-dose ICS + Theo are alternate options.
Tiotropium (LAMA) by spring-driven mist (not indicated in children aged <12 years).
Tiotropium (LAMA) by spring-driven mist, high-dose ICS and LTRA or Theo are alternate options.
Refer to asthma specialist for add-on treatment options including tiotropium (LAMA), omalizumab, mepolizumab and/or oral corticosteroids.
Abbreviations: BEC/F, beclomethasone dipropionate/formoterol; BUD/F, budesonide/formoterol; GINA, Global Initiative for Asthma; ICS, inhaled corticosteroids; LABA, long-acting beta2 agonist; LAMA, long-acting muscarinic antagonist; LTRA, leukotriene receptor antagonist; SABA, short-acting beta2 agonist; Theo, theophylline.