• NOTE: Values are for persistent asthma
  • Intermittent asthma should have normal values in between exacerbations
  • Reference - 2
AGES 5 - 11 YEARS
Mild Moderate Severe
FEV₁ ≥ 80% of predicted 61 - 79% of predicted ≤ 60% of predicted
FEV₁ / FVC > 80% 75 - 80% < 75%

  • NOTE: Values are for persistent asthma
  • Intermittent asthma should have normal values in between exacerbations
  • Reference - 2
AGES ≥ 12 YEARS
Mild Moderate Severe
FEV₁ ≥ 80% of predicted 61 - 79% of predicted ≤ 60% of predicted
FEV₁ / FVC normal reduced ≤ 5% reduced > 5%





  • See ICS dosing for low, medium, high dosing
  • Reference [7]
PERSISTENT ASTHMA (0 - 4 YEARS OF AGE)
Treatment steps
(Proceed to next step if no clear benefit after 4 - 6 weeks)
All patients SABA as needed for immediate relief. Corticosteroids with severe exacerbations
Step 1 Low-dose ICS (Cromolyn or montelukast may be used as alternative treatments)
Step 2 Medium-dose ICS
Step 3 Medium-dose ICS + either LABA or montelukast
Step 4 High-dose ICS + either LABA or montelukast
Step 5 High-dose ICS + either LABA or montelukast + oral corticosteroids

  • See ICS dosing for low, medium, high dosing
  • For patients with persistent asthma that appears to be allergen related, consider allergy testing and immunotherapy
  • Reference [7]
PERSISTENT ASTHMA (5 - 11 YEARS OF AGE)
(Proceed to next step if no clear benefit after 2 - 6 weeks)
Preferred treatment Alternative treatment
All patients SABA as needed for immediate relief.
Corticosteroids with severe exacerbations.
Step 1 Low-dose ICS Cromolyn, LTRA, or theophylline
Step 2 Low-dose ICS + either LABA, LTRA, or theophylline OR medium-dose ICS
Step 3 Medium-dose ICS + LABA Medium-dose ICS + either LTRA or theophylline
Step 4 High-dose ICS + LABA High-dose ICS + either LTRA or theophylline
Step 5 High-dose ICS + LABA + oral corticosteroids High-dose ICS + either LTRA or theophylline + oral corticosteroids

  • See ICS dosing for low, medium, high dosing
  • For patients with persistent asthma that appears to be allergen related, consider allergy testing and immunotherapy
  • Reference [7]
PERSISTENT ASTHMA (≥ 12 YEARS OF AGE)
(Proceed to next step if no clear benefit after 2 - 6 weeks)
Preferred treatment Alternative treatment
All patients SABA as needed for immediate relief.
Corticosteroids with severe exacerbations.
Step 1 Low-dose ICS Cromolyn, LTRA, or theophylline
Step 2 Low-dose ICS + LABA OR medium-dose ICS Low-dose ICS + either LTRA, theophylline, or zileuton
Step 3 Medium-dose ICS + LABA Medium-dose ICS + either LTRA, theophylline, or zileuton
Step 4 High-dose ICS + LABA AND consider omalizumab for patients who have allergies
Step 5 High-dose ICS + LABA + oral corticosteroids AND consider omalizumab for patients who have allergies