Table 1

Summary of treatment recommendations for childhood asthma according to 2005 Global Initiative for Asthma (GINA) guidelines [9] and 2005 British Thoracic Society (BTS) guidelines [7]

2005 GINA Guidelines for adults & children > 5 years old*

2005 BTS Guidelines for children 5-12 years old*

GINA Step 1 Intermittent asthma

No controller medication necessary Short acting β2 agonist as needed

BTS Step 1 Mild intermittent asthma

Short acting β2 agonist as required

GINA Step 2 Mild persistent asthma

Low-dose ICS (or SR-theophylline; cromone; or leukotriene modifier)

BTS Step 2 Regular preventer therapy

ICS 200-400 μg/d†: 200 μg/d is a reasonable starting dose [for those < 5 y, use LTRA if cannot use ICS]

GINA Step 3 Moderate persistent asthma

Low- to medium-dose ICS plus inhaled LABA (or medium-dose ICS plus SR-theophylline, plus oral LABA, or plus leukotriene modifier; OR high-dose ICS) [for those ≤ 5 y, medium-dose ICS]

BTS Step 3 Add-on therapy

Add inhaled LABA; if poor response try ICS 400 μg/d; if poor response, add LTRA or SR-theophylline (ICS dose up to 400 μg/d) [for those 2-5 y, trial of LTRA]

GINA Step 4 Severe persistent asthma

High-dose ICS plus LABA plus 1 or more of the following if needed: SR-theophylline, leukotriene modifier, oral LABA, oral steroid, anti-IgE [for those ≤ 5 y, high-dose ICS plus add-on Rx if needed]

BTS Step 4 Persistent poor control

Increase ICS dose to 800 μg/d Consider adding the following if needed: LTRA, theophylline, SR-β2 agonist tablets [for those < 5 y, refer to respiratory paediatrician]



BTS Step 5 Continuous or frequent use of oral steroids

Use daily steroid tablet in lowest dose; maintain high-dose ICS; refer to respiratory paediatrician

ICS = inhaled corticosteroid; LABA = long-acting β2-agonist; LTRA = leukotriene receptor antagonist; SR = slow-release

*Guidelines are the same for children ≤ 5 years (GINA) or < 5 years old (SIGN/BTS) unless specified.

† ICS doses are the beclometasone dipropionate equivalent doses.

Thomas et al. BMC Pulmonary Medicine 2010 10:29   doi:10.1186/1471-2466-10-29

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