Diagnostic Considerations

Problems to be considered include the following:

Tracheobronchomalacia
Hyperventilation syndrome
Vocal cord dysfunction
Pulmonary edema
Collagen vascular disease
Reactive airway disease

Differential Diagnoses

Workup

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Table 1. Stepwise Approach to Asthma Medications

Table 1. Stepwise Approach to Asthma Medications

Intermittent Asthma		Persistent Asthma: Daily Medication
Age	Step 1	Step 2	Step 3	Step 4	Step 5	Step 6
< 5 y	Rapid-acting beta2-agonist prn	Low-dose inhaled corticosteroid (ICS)	Medium-dose ICS	Medium-dose ICS plus either long-acting beta2-agonist (LABA) or montelukast	High-dose ICS plus either LABA or montelukast	High-dose ICS plus either LABA or montelukast; Oral systemic corticosteroid
		Alternate regimen: cromolyn or montelukast
5-11 y	Rapid-acting beta2-agonist prn	Low-dose ICS	Either low-dose ICS plus either LABA, LTRA, or theophylline OR Medium-dose	Medium-dose ICS plus LABA	High-dose ICS plus LABA	High-dose ICS plus LABA plus oral systemic corticosteroid
		Alternate regimen: cromolyn, leukotriene receptor antagonist (LTRA), or theophylline		Alternate regimen: medium-dose ICS plus either LTRA or theophylline	Alternate regimen: high-dose ICS plus either LABA or theophylline	Alternate regimen: high-dose ICS plus LRTA or theophylline plus systemic corticosteroid
12 y or older	Rapid-acting beta2-agonist as needed	Low-dose ICS	Low-dose ICS plus LABA OR Medium-dose ICS	Medium-dose ICS plus LABA	High-dose ICS plus LABA (and consider omalizumab for patients with allergies)	High-dose ICS plus either LABA plus oral corticosteroid (and consider omalizumab for patients with allergies)
		Alternate regimen: cromolyn, LTRA, or theophylline	Alternate regimen: low-dose ICS plus either LTRA, theophylline, or zileuton	Alternate regimen: medium-dose ICS plus either LTRA, theophylline, or zileuton

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Author

Girish D Sharma, MD, FCCP, FAAP Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush Children's Hospital, Rush University Medical Center

Girish D Sharma, MD, FCCP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

Coauthor(s)

Payel Gupta, MD Department of Allergy and Immunology, ENT Faculty Practice

Payel Gupta, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Charles Callahan, DO Professor, Chief, Department of Pediatrics and Pediatric Pulmonology, Tripler Army Medical Center

Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, The Society of Federal Health Professionals (AMSUS), Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Chief Editor

Kenan Haver, MD Associate Professor of Pediatrics, Harvard Medical School; Director of Asthma Program, Director of Flexible Bronchoscopy Program, Director of Pulmonary Division Asthma Program, Co-Director of Primary Ciliary Dyskinesia, Co-Leader of Empyema Standardized Clinical Assessment and Management Plans (SCAMP), Boston Children’s Hospital

Kenan Haver, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society

Disclosure: Author for: UptoDate.

Additional Contributors

Thomas Scanlin, MD Chief, Division of Pulmonary Medicine and Cystic Fibrosis Center, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School

Thomas Scanlin, MD is a member of the following medical societies: American Association for the Advancement of Science, Society for Pediatric Research, American Society for Biochemistry and Molecular Biology, American Thoracic Society, Society for Pediatric Research

Disclosure: Nothing to disclose.