Table 4 Indications for initial controller therapy in children aged 6 years and above
From: The use of inhaled corticosteroids in pediatric asthma: update
Presenting symptoms | Preferred initial controller (Strength of evidence) |
|---|---|
Infrequent asthma symptoms, but has one or more risk factors for exacerbations (see below) | Low dose ICS (Evidence D) |
Asthma symptoms or need for SABA between twice a month and twice a week; or patient wakes due to asthma one or more times a month | Low dose ICS (Evidence B) |
Asthma symptoms or need for SABA more than twice a week | Low dose ICS (Evidence A) |
Troublesome asthma symptoms most days; or waking due to asthma once a week or more, especially if any risk factors exist (see below) | Moderate/high dose ICS (Evidence A), or Low dose ICS/LABA (Evidence A)# |
Initial asthma presentation is with severely uncontrolled asthma, or with an acute exacerbation | Short course of oral corticosteroids AND start regular controller treatment: - High dose ICS (Evidence A), or - Moderate dose ICS/LABA (Evidence D)# |
Risk Factors for Exacerbations:  Uncontrolled asthma symptoms  High SABA use (with increased mortality if > one 200-dose canister per month)  Inadequate ICS (not prescribed ICS; poor adherence; incorrect inhaler technique)  Low FEV1, especially if <60 % predicted  Major psychological or socioeconomic problems  Exposures: Smoking; allergen exposure if sensitized  Comorbidities: obesity; rhinosinusitis; confirmed food allergy  Sputum or blood eosinophilia  Pregnancy  Ever intubated on in intensive care for asthma  At least one severe exacerbation in the last 12 months | |
Risk factors for developing fixed airflow limitation:  Lack of ICS treatment  Exposures: tobacco smoke; noxious chemicals; occupational exposures  Low FEV1; chronic mucus hypersecretion; sputum or blood eosinophilia | |