54 KFHC DRUG FORMULARY*See <strong>Health</strong>y Families Exception Warning on Page 41GENERIC TREATMENT BRAND FOR INFANTS AND FORMS YOUNG CHILDREN(5 years or younger)Preferred treatments are in bold print.*Patient education is essential at every stepLong-Term PreventiveQuick-ReliefSTEP 4SeverePersistentDaily medication:• Inhaled corticosteroid- MDI with spacer and face mask >1 mg dailyor- Nebulized budesonide >1 mg bid- If needed, add oral steroids-lowest possibledose on an alternate-day, early morningschedule.• Inhaled short-acting bronchodilator: inhaled Beta2-agonistor ipratropium bromide, or Beta2-agonist tablets or syrupas needed for symptoms, not to exceed 3-4 times in oneday.STEP 3ModeratePersistentSTEP 2Mild PersistentDaily medication:• Inhaled corticosteroid- MDI with spacer and face mask 400-800 mcgdaily or- Nebulized budesonide
KFHC DRUG FORMULARY*See <strong>Health</strong>y Families Exception Warning on Page 41GENERIC TREATMENT: BRAND ADULTS & CHILDREN FORMSOVER 5 YEARS OLDPreferred treatments are in bold print.* Patient education is essential at every stepLong-Term PreventiveQuick-Relief55STEP 4SeverePersistentSTEP 3ModeratePersistentDaily medications:• Inhaled corticosteroid, 800-2,000 mcg or more, and• Long-acting bronchodilator: either long-actinginhaled Beta 2 -agonist, and/or sustained-releasetheophylline, and/or long-acting Beta 2 -agonist tablets orsyrup, and• Corticosteroid tablets or syrup long term.Daily medications:• Inhaled corticosteroid, ≥500 mcg AND, if needed• Long-acting bronchodilator: either long-acting inhaledBeta 2 -agonist, sustained-release theophylline,or long-acting Beta 2 -agonist tablets or syrup. (Long-actingBeta 2 -agonist may provide more effective symptom controlwhen added to low-medium dose steroid compared toincreasing the steroid dose).• Consider adding anti-leukotriene, especially for aspirinsensitivepatients and for preventing exercise-inducedbronchospasm.• Short-acting bronchodilator: inhaled Beta 2 -agonist as needed for symptoms.• Short-acting bronchodilator: inhaled Beta 2 -agonist as needed for symptoms, not to exceed3-4 times in one day.STEP 2MildPersistentDaily medication:• Either Inhaled corticosteroid, 200-500 mcg,cromoglycate, nedocromil, or sustained-release theophylline.Antileukotrienes may be considered, but their position intherapy has not been fully established.• Short-acting bronchodilator: inhaled Beta 2 -agonist as needed for symptoms, not to exceed 3-4times in one day.STEP 1Intermittent• None needed. • Short-acting bronchodilator: inhaled Beta 2 -agonistas needed for symptoms, but less than once a week• Intensity of treatment will depend on severity of attack (seefigures on management of asthma attacks)• Inhaled Beta 2 -agonist or cromoglycate before exercise orexposure to allergen.StepdownReview treatment every 3 to 6 months. If control issustained for at least 3 months, a gradual stepwisereduction in treatment may be possible.StepupIf control is not achieved, consider stepup. Butfirst: review patient medication technique, compliance,and environmental control (avoidance ofallergens or other trigger factors).*Dosage note: Steroid doses are for Beclomethasone Dipropionate (on the WHO list of “Essential Drugs”). Other preparations have equal effect, but adjust the dose because inhaledsteroids are not equivalent on a microgram or per puff basis.
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