High-dose inhaled corticosteroid with spacer/holding chamber and face mask

If needed, add systemic corticosteroids 2 mg/kg/day and reduce to lowest daily or alternate-day dose that stabilizes symptoms

Medium-dose inhaled corticosteroid with spacer/holding chamber and face mask

OR, once control is established:

Medium-dose inhaled corticosteroid and nedocromil

OR

Medium-dose inhaled corticosteroid and long-acting bronchodilator (theophylline)

Cromolyn (nebulizer is preferred; or MDI) or nedocromil (MDI only) tid-qid

Infants and young children usually begin with a trial of cromolyn or nedocromil OR

Low-dose inhaled corticosteroid with spacer/holding chamber and face mask

Oral beta₂-agonist for symptoms

Consider systemic corticosteroid if

Gain control as quickly as possible; then decrease treatment to the least medication necessary to maintain control. Gaining control may be accomplished by either starting treatment at the step most appropriate to the initial severity of their condition or by starting at a higher level of therapy (e.g., a course of systemic corticosteroids or higher dose of inhaled corticosteroids).

A rescue course of systemic corticosteroid (prednisolone) may be needed at any time and step.

In general, use of short-acting beta₂-agonist on a daily basis indicates the need for additional long-term-control therapy.

It is important to remember that there are very few studies on asthma therapy for infants.

Consultation with an asthma specialist is recommended for patients with moderate or severe persistent asthma in this age group. Consultation should be considered for all patients with mild persistent asthma.