Stepwise pharmacological treatment of chronic asthma in adults and children ≥ 12 years old (NAEPP)

See “Overview of asthma medications” for dosages. [3][11][12]

Daily therapy

Treatment steps Single inhalers are preferred for Rescue inhaler (as needed)

combination medications.

Step 1 (intermittent asthma) • None [16][17][18] • SABA

• Low-dose ICS • SABA

Preferred
Step 2 (mild persistent
• OR rescue ICS-SABA only
asthma)

Alternatives • LTRA • SABA

Preferred • Low-dose ICS-formoterol (daily and rescue therapy)

Step 3 (moderate persistent • Medium-dose ICS

asthma) • Low-dose ICS-LABA

Alternatives • SABA
• Low-dose ICS-LAMA

• Low-dose ICS, PLUS LTRA

Preferred • Medium-dose ICS-formoterol (daily and rescue therapy)

Step 4 (moderate to severe • Medium-dose ICS-LABA

persistent asthma) • Medium-dose ICS-LAMA

Alternatives • SABA
• Medium-dose ICS,

PLUS LTRA

• Medium- to high-dose ICS-

Preferred
LABA, PLUS LAMA
Step 5 (severe persistent
• SABA
asthma) • Medium- to high-dose ICS-
Alternatives LABA

• High-dose ICS, PLUS LTRA

 Stepwise pharmacological treatment of chronic asthma in adults and children ≥ 12 years old (NAEPP)

See “Overview of asthma medications” for dosages. [3][11][12]

Daily therapy

Treatment steps Single inhalers are preferred for Rescue inhaler (as needed)

combination medications.

• Consider adding

immunotherapy.

• High-dose ICS-LABA, PLUS

oral corticosteroids
Step 6 (severe persistent asthma) • SABA
• Consider adding biologics for

severe asthma.

• Assess response to therapy in 2–6 weeks

• Good response for ≥ 3 consecutive months: Consider a gradual decrease in pharmacotherapy (step down).
• Inadequate response
o Assess treatment adherence, inhaler technique.

o Manage comorbidities and environmental factors (see “Adjunctive therapy” below).

o Consider advancing treatment to the next step (step up).