Medications for Long-Term Control of Asthma

 
Medications Dosage and Form Dose for Children Dose for Adults Comments
Inhaled Steroids
  • See list
Oral Steroids
Methylprednisolone 2,4,8,16,32, mg tablets 0.25-2 mg/kg daily in a single dose or qod as needed for control

Short course "burst": 1-2 mg/kg/day, maximum of 60 mg/day for 3-10 days.

 7.5-60 mg daily in a single dose or qod as needed for control

Short course "burst" 40-60 mg per day as single or 2 divided doses for 3-10 days.
  • For long-term treatment of severe persistent asthma, administer single dose in a.m. either daily or on alternate days (which may lessen adrenal suppresion).  One study suggests improved efficacy and no increase in adrenal suppression when administered at 3:00 pm.
  • Short courses or "bursts" are effective for establishing control when initiating therapy or during a period of gradual deterioration.
  • The burst should be continued until patient achieves 80% of peak flow personal best of symptoms resolve.  This usualy requires 3-10 days but may require longer.  There is no evidence that tapering the dose following improvement prevents relapse.
Prednisolone 5 mg tabs
5 mg/5mL
15 mg/5mL 
Prednisone 1, 2.5, 5, 10, 20, 25 mg tabs; 
5 mg/mL, 
5 mg/5 mL
Membrane Stabilizers
Cromolyn MDI:
1 mg/puff 
200 sprays/MDI
1-2 puffs tid-qid		 2-4 puffs tid-qid

1 ampule tid-qid
  • An initial trial in children with mild-to-moderate persistent asthma is often given due to strong safety profile.
  • Can usually see therapeutic effect of cromolyn within 2 weeks; takes 4 to 6 weeks to determine maximum effect.
  • Dose of cromolyn by MDI may be adequate, so nebulizer may be preferred.
Nedocromil MDI:
1.75 mg/puff
104 sprays/canister		 1-2 puffs bid-qid 2-4 puffs bid-qid
Long-acting bronchodilators
Salmeterol MDI: 21 mcg/puff, 60 or 120 puffs
120 sprays per canister

DPI:  50 mcg/blister

 1-2 puffs q 12 hours
1 blister q 12 hours		 2 puffs q 12 hours
1 blister q 12 hours
  • Should not be used in place of anti-flammatory therapy.
  • Use with inhaled steroids in Step 3.
  • May use one dose nightly for symptoms.
  • Duration of bronchodilators is 12 hours.
  • Should not be used for symptom relief or for exacerbations.
Sustained-release albuterol 4 mg tablet 0.3 to 0.6 mg/kg/day, not to exceed 8 mg/day 4 mg q 12 hours
Theophylline Liquids
Sustained-release tablets and capsules		 Starting dose 10 mg/kg/day; usual max:

1 yr of age or more: 16 mg/kg/day

Less than 1 year: 0.2*(age in weeks) + 5 = mg/kg/day
 

 Starting dose 10 mg/kg/day up to 300 mg max; usual max 800 mg/day
  • Adjuvant to inhaled steroids for nocturnal symptoms
  • Alternative, but not preferred, long-term therapy for step 2
  • Adjust dosage to achieve peak serum concentration of 5-15 mcg/mL at steady-state (at least 48 hours on same dosage).
  • Due to wide interpatient variability in theophylline metabolic clearance, routine serum theophylline level monitoring is important.
Leukotriene modifiers
Zafirlukast 20 mg tablet   40 mg daily 1 tablet bid
  • May be considered at step 2 for patients greater than 12 years of age, although their position in therapy is not fully established.
  • For zafirlukast, administration with meals decreases bioavailability; take at least 1 hour before or 2 hours after meals.
  • For patients taking zafirlukast and warfarin, closely monitor prothrombin and adjust warfarin dosage
  • For zileuton, monitor hepatic enzymes (ALT).
Zileuton 300 mg tablet
600 mg tablet		   2,400 mg daily, two 300 mg tabs or one 600 mg tablet, qid
Also see brand names index

This page is based on the Practical Guide for the Diagnosis and Management of Asthma, a publication of the National Heart, Lung and Blood Institute of the National Institutes of Health of the United States
NIH Publication No. 97-4053, October 1997

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