Asthma Management Handbook
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Figure. Stepped approach to adjusting asthma medication in children

Planning routine asthma review for children Table. Reviewing and adjusting preventer treatment for children aged 6 years and over Table. Reviewing and adjusting preventer treatment for children aged 0–5 years Table. Initial preventer treatment for children aged 6 years and over Table. Initial preventer treatment for children aged 0–5 years Table. Definitions of ICS dose levels in children Table. Definition of levels of recent asthma symptom control in children (regardless of current treatment regimen)

Before considering stepping up, check symptoms are due to asthma, inhaler technique is correct, and adherence is adequate.
Consider stepping up if good control is not achieved.
When asthma is stable and well controlled for more than 3 months, consider stepping down (e.g. reducing inhaled corticosteroid dose to low).

ICS: inhaled corticosteroid; SABA: short-acting beta2 agonist; LABA: long-acting beta2 agonist 

* Or low-dose budesonide/formoterol combination, only for children aged 12 years or over who are using this combination as both maintenance and reliever.

§ In addition, manage flare-ups with extra treatment when they occur, and manage exercise-related asthma symptoms as indicated.

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