Figure 11. Global Initiative for Asthma-based steps for treatment of asthma at all stages of severity.
The Global Initiative for Asthma (GINA) recommends that asthma is classified and treated according to 5 steps that reflect symptom severity and patient characteristics. The relative widths of each step reflect the number of patients who receive each treatment. In particular, dose–response studies demonstrate that the majority of patients with asthma should be able to be treated with low-dose inhaled corticosteroids (ICSs; step 2). The relative heights of each step reflect disease severity, with treatment in step 5 reserved for those with the most severe disease. *For children 6–11 years of age, theophylline is not recommended and the preferred step 3 treatment with is medium-dose ICSs. ‡Tiotropium by soft-mist inhaler is indicated as add-on treatment for patients with a history of exacerbations; it is not indicated in patients <18 years of age. §For patients prescribed inhaled beclomethasone dipropionate/formoterol or budesonid/formoterol maintenance and reliever therapy. LABA, long-acting β2-adrenergic receptor agonist; LTRA, leukotriene receptor antagonist; OCS, oral corticosteroid; SABA, short-acting β2-receptor agonist. Adapted from the Global Strategy for Asthma Management and Prevention 2015, © Global Initiative for Asthma (GINA) all rights reserved. Available from http://www.ginasthma.org.