Asthma Management Guidelines


 The goals for successful management of asthma  include the following :

  • Achieve and maintain control of asthma symptoms
  • Maintain normal activity levels, including exercise
  • Maintain pulmonary function as close to normal as possible
  • Prevent asthma exacerbations
  • Avoid adverse effects from asthma medications
  • Prevent asthma mortality

Asthma symptoms and severity:

The pharmacologic treatment of asthma is based on stepwise therapy. Asthma medications should be added or deleted as the frequency and severity of the patient's symptoms change.

The 2019 GINA guidelines include the stepwise recommendations below for medication and symptom control.


The preferred reliever medication is specified as low-dose ICS(inhaled corticosteroid)-formoterol, which is an off-label use. Other reliever options include as-needed SABA (short-acting beta-agonist). See the following stepwise approach:

  • Step 1: As-needed low-dose ICS-formoterol (off-label); other options are low dose ICS taken whenever SABA  is taken
  • Step 2: Daily low-dose ICS, or as-needed low-dose ICS-formoterol (off-label); other options are leukotriene receptor antagonist (LTRA) or low-dose ICS taken whenever SABA is taken
  • Step 3: Low-dose ICS/LABA (long-acting beta-agonist); other options include medium-dose ICS or low-dose ICS + LTRA
  • Step 4: Medium-dose ICS-LABA; other options are high-dose ICS, add-on tiotropium, or add-on LTRA
  • Step 5: High-dose ICS-LABA; refer for phenotypic assessment with or without add-on therapy (eg, tiotropium, anti-IgE, anti-IL5/5R, and IL4R; other options are to add low-dose OCS (oral corticosteroid), but consider adverse effects.


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