Asthma medications for adults, teens, and children older than age 5
The U.S. National Asthma Education and Prevention Program (NAEPP) has recommended the following approach for treating asthma in adults, teens, and children older than 5 years of age.1
Asthma treatment recommendations Severity Daily medications required to maintain long-term control Severe persistent
Preferred:
- High-dose inhaled corticosteroids AND
- Long-acting inhaled beta2-agonists AND IF NEEDED
- Corticosteroid tablets or syrup long-term (2 mg/kg/day, generally do not exceed 60 mg/day). (Make repeated attempts to reduce tablets or syrup, and maintain control with high-dose inhaled corticosteroids.) Treatment by a specialist is recommended if you are using oral corticosteroids long-term.
Moderate persistent
Preferred:
- Low- to medium-dose inhaled corticosteroids and long-acting inhaled beta2-agonists
Alternative:
- Increase inhaled corticosteroids within medium-dose range OR
- Low- to medium-dose inhaled corticosteroids and either leukotriene modifier (also called leukotriene receptor antagonist) or theophylline (a methylxanthine)
If needed (particularly in people with recurring severe asthma attacks):
- Preferred:
- Increase inhaled corticosteroids within medium-dose range, and add long-acting inhaled beta2-agonists.
- Alternative:
- Increase inhaled corticosteroids within the medium-dose range, and add either leukotriene modifier or theophylline.
Mild persistent
Preferred:
- Low-dose inhaled corticosteroids
Alternative:
- Leukotriene modifier
- Less commonly, your doctor may recommend mast cell stabilizers (cromolyn sodium or nedocromil) or theophylline (such as Uniphyl).
Intermittent
- No daily medication needed.
- Severe attacks may occur, separated by long periods of normal lung function and no symptoms. A course of corticosteroid tablets, syrup, or injection is recommended.
Recommendations for quick relief Treatment recommendations All patients
- Short-acting bronchodilator: 2 to 4 puffs of short-acting inhaled beta2-agonists as needed for symptoms
- Intensity of treatment will depend on severity of episode; up to 3 treatments at 20-minute intervals or a single nebulizer treatment as needed. Course of corticosteroid tablets, syrup, or injection may be needed.
- Use of short-acting beta2-agonists on more than 2 days a week (except for exercise) may indicate the need to start or increase long-term control therapy.
Cromolyn and nedocromil (mast cell stabilizers) are alternatives in mild persistent asthma, but they do not control asthma as effectively as corticosteroids.2
In moderate persistent asthma, using long-acting inhaled beta2-agonists along with inhaled corticosteroids is the best combination of medications to improve lung function and symptoms and to reduce overuse of quick-relief medications.1
A leukotriene pathway modifier or theophylline also may be added to corticosteroids, but they do not improve asthma control as effectively as a long-acting inhaled beta2-agonist along with corticosteroids.1
Concerns for children
Leukotriene pathway modifiers are available in oral formulations (swallowed rather than inhaled) that may be more convenient for young children.
Young children should receive long-term treatment if they have had 4 or more wheezing episodes lasting more than 1 day in the past year and they have risk factors for asthma such as allergic rhinitis or a parent with asthma.3
If your child has severe asthma attacks, he or she may need to take corticosteroids by mouth. Corticosteroids by mouth also may be necessary at the beginning of a viral respiratory infection.
| Author: | Maria G. Essig, MS, ELS | Last Updated: May 15, 2007 |
| Medical Review: | Caroline S. Rhoads, MD - Internal Medicine Harold S. Nelson, MD - Allergy and Immunology | |
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