Superceded by SIGN/BTS 2019.

For suspected asthma, where child unable to do spirometry, then watchful waiting or trial of treatment for specified time period.  Choice of treatment depends on severity and frequency of symptoms – “typically 6 weeks inhaled steroid”, “very low dose”.

Start regular preventer treatment or escalate treatment if you are getting frequent symptoms, viz:

• three times a week or more, or
• using your blue inhaler three times a week or more, or
• if your asthma is waking you up once a week or more.

Start regular preventer if asthma attack in previous 2 years!

Same table for all ages now, and same steroid doses!

Step 1 – very low dose inhaled corticosteroid (ICS).  OR leukotriene receptor antagonist (LRTA) if under 5.

Step 2 – Add LRTA if under 5, else inhaled long acting Beta agonist (LABA) if 5+.

Step 3 – If no response to LABA, stop and increase ICS dose.  If some benefit from LABA continue and increase ICS dose, or consider trial of LTRA.

Step 4 – high dose therapies: increase ICS dose to medium, or add slow release theophylline.  Refer for specialist care.

ICS doses

Very low dose is 50mcg 2 puffs twice daily of beclometasone.  Low dose is double that, medium 200mcg 2 puffs twice daily.

QVAR and fluticasone are double the efficacy of beclometasone so doses are halved.  Ciclesonide is somewhere in between.