Asthma medications for adults, teens, and children older than age 5

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).

Mild 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.

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 more than 2 times a week (except for exercise) or more than 1 canister in 3 months may indicate the need to start (or increase) long-term control therapy.