Mild-to-severe asthma treatment guidelines

Recommendations for adult therapy

The following are the therapy/treatment guidelines for managing asthma in adults from Trigon Blue Cross Blue Shield in Richmond, VA:

For patients with mild asthma

— Use beta agonist as needed, not to exceed two puffs four times a day.

— Consider using beta-agonist or cromolyn before exercise if exercise-induced asthma occurs.

For patients with moderate asthma

— Use short-acting inhaled beta-agonists prior to steroid inhaler (two to three puffs q6h).

— Use inhaled corticosteroid, two to four puffs q6h (preferred).

— Consider long-acting bronchodilator, especially for nocturnal symptoms.

— Consider oral beta-agonist, cromolyn, or theophylline.

— Consider oral corticosteroid (alternate day or daily dose).

— Consider oral antibiotics as indicated.

For patients with severe asthma

— Use short-acting inhaled beta-agonists prior to steroid inhaler (two to three puffs q6h).

— Use inhaled corticosteroid, two to four puffs (q6h preferred).

— Consider long-acting bronchodilator, especially for nocturnal symptoms.

— Consider oral beta-agonist, cromolyn, or theophylline.

— Consider oral corticosteroid (alternate day or daily dose).

— Consider oral antibiotics as indicated.

— Home nebulizer may be valuable.