Step-down therapy is necessary to identify the minimum medication necessary to maintain control. At each step, patients should be advised to avoid or control allergens, irritants, or other factors that make the patient s asthma worse. Referral to an asthma specialist for consultation or comanagement is recommended if there are difficulties achieving or maintaining control of asthma or if the patient requires step 4 care. Referral may be considered for patients who require step 3 care. For patients younger than 3 years of age, referral is recommended if the patient requires step 3 or 4 care and should be considered if the patient requires step 2 care.
New medications are available.
Early intervention with inhaled corticosteroids can improve asthma control and normalize lung function and may prevent irreversible airway injury. Higher doses of inhaled corticosteroids may be associated with possible, but not predictable, growth retardation in children. The clinical significance of this potential systemic effect has yet to be determined. Issues regarding clinical comparability and bioavailability of different preparations and different delivery systems indicate the need to adjust doses accordingly. There is an increased understanding of inhaled corticosteroids and their significant role in asthma therapy.