Table 4.
Summary of stepwise approaches for management of asthma in preschoolers suggested by current guidelines
| NAEPP (2020) | GINA (2020) | Korean guideline (2021) | |
|---|---|---|---|
| Step 1 | SABA as-needed & add short course ICS at the start of RTI | SABA as-needed | SABA as-needed |
| Step 2 | Pref: daily low-dose ICS | Pref: daily low-dose ICS | Pref: daily low-dose ICS |
| Alter: daily montelukasta) or cromoly | Alter: daily LTRA or intermittent short course ICS at the onset of respiratory illness | Alter: daily LTRA or intermittent ICS | |
| Step 3 | Daily medium-dose ICS | Pref: double low-dose ICS | Pref: double low-dose ICS |
| Alter: low-dose ICS + LTRA | Alter: low-dose ICS + LTRA | ||
| Consider specialist referral | Refer for specialist assessment | ||
| Step 4 | Pref: daily medium-dose ICS + LABA | Pref: continue controller & refer for specialist assessment | Pref: continue controller & refer for specialist assessment |
| Alter: daily medium-dose ICS + montelukasta) | Alter: add LTRA, increase ICS frequency, add intermittent ICS | Alter: double low-dose ICS + LTRA | |
| Step 5 | Pref: daily high-dose ICS + LABA | ||
| Alter: daily high-dose ICS + montelukasta) | |||
| Step 6 | Pref: daily high-dose ICS + LABA + OCS | ||
| Alter: daily high-dose ICS + montelukasta) + OCS | |||
| Symptom reliever | SABA as-needed |
NAEPP, National Asthma Education Prevention Program; GINA, Global Initiative for Asthma; SABA, inhaled short-acting beta-2 agonist; ICS, inhaled corticosteroid; RTI, respiratory tract infection; Pref, preferred; Alter, alternative; LTRA, leukotriene receptor antagonist;LABA, inhaled long-acting beta-2 agonist; OCS, oral corticosteroid.
a)
The United States Food and Drug Administration issued a boxed warning for montelukast in March 2020.