When a doctor prescribes medication to treat a health problem, the doctor doesn’t usually start at the most powerful medication available. Doctors will often prescribe a low dosage of a mild medication and increase medication treatments as necessary to control the condition.

The management of asthma in children is no exception to this approach of starting with less medication and increasing medication as needed. This process in asthma management for children is called stepwise management of asthma in children. The treatment plan for treating asthma begins with the occasional use of an asthma inhaler. This is step one, which consists of the use of an asthma inhaler as needed.

For children who are needing to use the inhaler more often than the doctor would like, the doctor may move the child to step two of the stepwise management of asthma in children. Step two retains the use of the inhaler for flare-ups of asthma symptoms, but also includes a daily dose of an anti-inflammatory medication or inhaled steroid.

If the child is continuing to struggle with asthma symptoms, the doctor may move the child’s treatment plan to step three. Step three of the stepwise management of asthma in children includes the asthma inhaler for flare-ups, a low dose inhaled steroid, and a long-acting inhaled bronchodilator. The doctor may increase the dosage of the inhaled steroid if necessary. Other medications may also be added to the child’s treatment plan.

The doctor may move treatment into step four if the child continues to have asthma attacks on step three. In step four, the doctor may replace the bronchodilator asthma inhaler with high-dose inhaled corticosteroid. Step four also includes a long-acting , inhaled beta2 agonist and other daily medication to reduce inflammation of the airways and decrease the likelihood of asthma attacks.

Less than five percent of children with asthma will need the level of medical management of asthma in step five. Step five of the stepwise management of asthma in children includes an inhaled short- acting beta2 agonist as needed with a regular high- dose inhaled corticosteroid. Step five also includes at least one long-acting bronchodilator and prednisone.

Whatever level of treatment the child needs to control the asthma above a step one, the doctor may occasionally attempt to gradually lower the child’s medication if the child has done very well on their current step. Therefore, a child who had to be on step four to get control of the asthma may gradually be lowered to previous step. The general guideline is that if a child has had no asthma symptoms with the use of the medication for six months, the doctor may reduce the medication to see if lesser amounts of medication would effectively control the asthma.