From the Guidelines
The most recent asthma treatment guidelines (as of 2025) follow a stepwise approach based on symptom severity and control, with the goal of achieving asthma control with the lowest effective medication dose, as recommended by the 2020 focused updates to the asthma management guidelines 1. For mild intermittent asthma (Step 1), as-needed short-acting beta-agonists (SABA) like albuterol (90-180 mcg per puff, 1-2 puffs every 4-6 hours as needed) are recommended. Some key points to consider in the stepwise approach include:
- For mild persistent asthma (Step 2), low-dose inhaled corticosteroids (ICS) such as fluticasone (88-220 mcg daily) or budesonide (180-360 mcg daily) are the preferred controller medication.
- Step 3 for moderate persistent asthma involves either medium-dose ICS or low-dose ICS combined with a long-acting beta-agonist (LABA) like fluticasone/salmeterol (100/50 mcg, 1 puff twice daily), as suggested by the expert panel report 3 (EPR-3) guidelines 1.
- Step 4 for moderate-to-severe persistent asthma recommends medium-to-high dose ICS/LABA combinations.
- Step 5 for severe asthma adds biologics like omalizumab, mepolizumab, or dupilumab based on specific inflammatory phenotypes.
- Step 6 for very severe asthma may include oral corticosteroids like prednisone (5-60 mg daily) as maintenance therapy. Throughout all steps, patients should have rescue medication available and receive education on proper inhaler technique, trigger avoidance, and a written asthma action plan, as emphasized in the EPR-3 guidelines 1 and the 2020 focused updates 1. Regular reassessment every 1-6 months is essential to step up or step down therapy as needed, taking into account the individual patient's response to treatment and the potential risks and benefits of different medication regimens, as discussed in the Mayo Clinic Proceedings article 1. This stepwise approach targets underlying airway inflammation while providing symptom relief, with the goal of achieving asthma control with the lowest effective medication dose, as recommended by the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Stepwise Treatment of Asthma
The most recent guidelines for the stepwise treatment of asthma, as of 2025, are based on the following principles:
- Introduction of inhaled corticosteroids (ICS) as the cornerstone of long-term management of asthma 2
- Use of ICS-based controllers and initiation of ICS as soon as possible 2
- Definition of two different treatment tracks in stepwise approaches: maintenance and reliever therapy or fixed-dose therapy, with equal recommendation for each track depending on the patient's risks and physician's decision in a personalized manner 2
- Strong recommendation for using add-on treatments before initiating phenotype-specific treatment in step 5 2
- Strong recommendation for using biologic agents and/or aspirin treatment after desensitization in severe asthma when indicated 2
Treatment Options
Some treatment options for asthma include:
- Fluticasone propionate and salmeterol administered via Diskus, which has been shown to be effective in improving asthma control compared to salmeterol or fluticasone propionate alone 3
- Fluticasone propionate/salmeterol combination, which has been compared to montelukast for the treatment of persistent asthma and shown to provide greater improvement in asthma control and patient satisfaction 4
- Fixed combination of fluticasone propionate and salmeterol, which has been shown to be effective in patients with moderate persistent asthma within a "real-life" setting 5
Key Considerations
Key considerations in the stepwise treatment of asthma include: