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How to treat asthma (with specific details)?

Treating asthma is complicated and a meticulous process. How asthma is treated depends on age, where the treatment algorithm changes based on whether they are younger than 12 years old.

In children who are over the age of 12, and adults of the general population, there are 4 main steps involved in the treatment of asthma

  1. Like with COPD, we start with only providing the rescue medication, and then monitoring for how often they use it
    1. First choice is SABA prn such as ventolin or bricanyl
    2. Second choice is a SAMA prn such as atrovent
  2. If symptoms worsen (which may be evident based on over use of rescue medication and more exacerbations) then it may be time to add a controller medication which is used preventatively
    1. First choice is low-dose ICS such as pulmicort or flovent
    2. Second choice is leukotriene receptor antagonists (LTRA) such as singulair or accolate
  3. But if symptoms continue to worsen then it may be time to switch the controller medication to a combo medication such as
    1. First choice is LABA/ICS combo, examples include symbicort or advair
  4. Symptoms worsen again? We have 2 options
    1. Add LTRA with the LABA/ICS combo OR increase the dose of the ICS part of the LABA/ICS combo from step 3
    2. Second choice is to add spiriva respimat with the LABA/ICS combo
  5. If symptoms are still not well controlled by this point, then by this point you should have already referred to a respirologist!

If you are dealing with asthma in a child between the age of 6 and 11, the 4 steps are different (here they are again copy pasted, with some modifications)

  1. Like with COPD, we start with only providing the rescue medication, and then monitoring for how often they use it
    1. First choice is SABA prn such as ventolin or bricanyl
  2. If symptoms worsen (which may be evident based on over use of rescue medication and more exacerbations) then it may be time to add a controller medication which is used preventatively
    1. First choice is low-dose ICS such as pulmicort or flovent
    2. Second choice is leukotriene receptor antagonists (LTRA) such as singulair
  3. But if symptoms continue to worsen then it may be time to increase the low-dose ICS to medium-dose ICS
  4. Symptoms worsen again? We have only 1 choice
    1. Switch to LABA/ICS combo OR add LTRA to medium-dose ICS from step 3
  5. If symptoms are still not well controlled by this point, then by this point you should have already referred to a respirologist!