12 يي
Mild Moderate Severe
+ asthma
Symptoms Less than 4-5 4-5 days a Daily
times a week week
Sym.
Most days
Waking up with Once a week or Once or more with
- Step 5
asthma more low lung function <
60 -Add on tiotropium (≥ 6 ys) or
LAMA (+18)
Step 3 Step 4 -Refer to phenotypic assesment
Track 1 use of + biological therapy
Low dose of Medium dose
MART Step 1-2 mart mart -consider high dose
Formeterol+ICS as needed low maintenance maintenance mart
dose MART 1 inhalation short course ocs
bid 2 inhalation
1 inhalation bid dose :more than 2 inhalation twice
daily
Reliever as needed , low dose MART ICS+ Formeterol dose 160/45
Step up if needed (first, check adherence, environment al control, and comorbid conditions assess control Step down
if possible (and asthma is well controlled for at least 3 months) same in all algorithms
Mild asthma Moderate Severe
less than twice twice a month or 4-5 days a week Daily
Symptom more, but less than
a month Most days Sym.
s 4-5 days a week
Waking up Once or more with Step 5
- Once a week
with asthma - low lung function <
or more -Add on tiotropium (≥ 6
60 ys) or LAMA (+18)
Step 4
-Refer to phenotypic
Step 3
Track 2 use of step 2 assesment+ biological
Step 1 -Daily low Medium/high therapy
SABA+ICS Daily low dose ICS-LABA
- low dose ICS dose ICS-
LABA IF dose ICS + as- + as needed consider high dose ics+
whenever SABA LABA + as
NEEDED needed SABA SABA
is taken needed SABA LABA
dose 100/50 dose 250/50
Before using dose 100/50 dose 100/50 -short course ocs
1 Inhalation 1 Inhalation
track 2 we 1Inhalation bid 1 Inhalation dose 500/50
bid bid
should assesss bid
1 Inhalation bid
compliance
Reliever as needed , low dose SABA or SABA AND ICS
Add on tiotropium (≥ 6
ys) or LAMA (+18) •
Medium dose ICS ADD LAMA
Low dose ICS taken Add-on azithromycin (3
OTHER or add Daily LTRA and/or LTRA or
whenever SABA is days/week) (≥ 18
CONTROLLERS - or add SLIT HDM HDM SLIT
taken • Daily LTRA years) or LM/LTRA or
Low dose ICS +LABA Switch to high theophylline (+12).
Consider adding SLIT and/or LTRA or dose ICS • Add-on low dose OCS
HDM theophylline
Refer for phenotypic assessment:
Allergic asthma: Add on SC anti-IgE omalizumab (≥ 6 years).
Eosinophilic asthma: Add on SC anti-IL5 mepolizumab (≥ 6 years), benralizumab (≥ 12 years) & IV reslizumab (≥ 18 years).
Eosinophilic/Type 2 asthma: SC anti-IL4 dupilumab (≥ 6 years).
Severe asthma: SC anti-TSLP Tezepelumab ≥ 12 years
NOTE
Azithromycin is used in persistent asthma in sever cases
6-11 Mild asthma Moderate Severe
less than twice twice a month or 4-5 days a week Daily
Symptom more, but less than
a month Most days Sym.
s daily
Waking up Once or more with
- - Once a week
with asthma low lung function <
or more Step 5
60
-Refer to phenotypic
Step 4
Step 3 assesment
Step 1 medium dose ICS-
step 2 -Medium dose ICS LABA higher dose ics+
- low dose
• Very low dose ICS- LABA or add onanti-
Preferred ICS Daily low Low dose ICS-
formoterol MART formoterol IL5 or anti-IL4R or
controller whenever dose ICS dose 80/4.5 “MART” Anti Ige All: SC
SABA is mcg/inhalation (1
1 inhalation80/4.5 omalizum. Eos/Type
taken inhalation QD)
mcg (1 inhalation 2: SC dupil. Eosin:
Low dose ICS +LABA BID) SC mepolizu.
Low dose ICS taken
Daily low whenever SABA is Low dose ICS ADD LTRA
OTHER • Add-on low dose
dose ICS taken or +LTRA
CONTROLL Ortiotropium OCS
Daily LTRA
ERS
Consider side effects
Reliever as needed , low dose SABA or Low dose Mart as in stage 3 and 4
0-5
Step 1
step 2 Step 3 Step 4
- (Insufficient Continue
Preferred Daily low dose ICS - double low dose ICS
controller evidence for controller & refer for
daily controller) (Medium dose) specialist assessment
Daily leukotriene
Consider receptor antagonist Low dose ICS +
Add LTRA, or
intermittent (LTRA), or LTRA
Other increase
controlle short course ICS intermittent short Consider specialist
ICS frequency, or
rs at onset of viral course of ICS at referral
add intermittent
illness if Saba onset of respiratory
ICS high dose
not illness
sufficient Reliever as needed , low dose SABA
Symptom pattern not consistent with Asthma
Infrequent viral asthma but wheezing episodes requiring diagnosis, and Asthma not
Consider
Wheezing and no sABA occur frequently, e.g. a3 per well-controlled
this step Give diagnostic trial for 3 months. .year Asthma not well-
or few interval controlled on
For Symptom .Consider specialist referral controlled
symptoms double dose ICS
patter consistent with asthma, and controlled on low
asthma symptoms not well-controlled or dose ICS
.23 exacerbations per year
frequent viral-induced wheezing and Before stepping up, check for
interval asthma symptoms altemative diagnosis, check inhaler
Imp doses
Combined ICS-LABA
Fluticasone/Salmeterol DPI Diskus and Inhub 100/50 mcg, 250/50 mcg,
500/50 mcg
12 year and older Low dose medium high
Fluticasone/Salmeterol DPI 100/50 mcg 1 Inhalation 250/50 mcg 1 Inhalation 500/50 mcg
Diskus and Inhub twice daily twice daily 1 inhalation twice daily
Budesonide/Formoterol FFA 160 4.5 mcg 1 inhalation 160 4.5 mcg 2 inhalations 160/4.5 mcg > 2 inhalations
MDI twice daily twice daily twice dailv
80/4.5 mcg, 160/4.5 mcg
6-11 LOW DOSE
Budesonide/Formoterol hFA MDI 80/4.5 mcg 1 inhalation twice dailv
OUTCOME
Assess patient after 3 month
Adults, Adolescents, and Children 6-11 Years
The patient is controlled
Daytime asthma symptoms not more than twice per week
• NO Nighttime awakening due to asthma
• Reliever not needed for symptoms more than twice per week
• no Activity limitation due to asthma
• The patient is partially uncontrolled if 2 of the above aren't met and uncontrolled if 3 to 4
are not met
Children < 5 Years
The patient is controlled if
Daytime asthma symptoms are for few minutes once a week
• NO Nighttime awakening or nighttime coughing due to asthma
• Reliever medication used once per week
• NO Activity limitation due to asthma
Step up if needed (first, check adherence, environment al control, and comorbid conditions assess control Step down
if possible (and asthma is well controlled for at least 3 months) same in all algorithms and age groups
