2537 2537 2538 2538 2539 2539

	Address exposures and comorbidities (see Tables 298-2 and 298-3)
	STEP 1	STEP 2	STEP 3	STEP 4	STEP 5
Preferred regular therapy	None	None^a or low-dose ICS^a	Low-dose ICS/formoterol	Medium-dose ICS/formoterol	High-dose ICS/LABA + add-on LAMA
Alternative regular therapy	None	LTRA	Medium-dose ICS	High-dose ICS	Anti-IgE or anti-IL-5 or anti-IL4-Ro or anti-TSLP
Adjunctive therapy					LTM, azithromycin, OCS^c
As-needed (PRN) reliever therapy	ICS/formoterol (low dose) or SABA^a^,^b or ICS/SABA^c	ICS/formoterol (low dose)^a or PRN concomitant ICS and SABA^a,b or SABA^a,b^,^c or ICS/SABA^c		ICS/formoterol (low or medium dose)^a or ICS/SABA^c

2540 2540 2541 2541 *"(If using as-needed ICS/formoterol or PRN concomitant ICS and SABA, this is an option in which no regular daily therapy is prescribed. "National Asthma Education and Prevention Program (NAEPP) recommendation. "To be avoided as much as possible. "PRN ICS/formoterol only suggested for steps 3 and 4 by NAEPP. "If using low-dose ICS as regular therapy. Alternative GINA recommendation.* 2542 2542 2543 2543 *Abbreviations: GINA, Global Initiative for Asthma; ICS, inhaled corticosteroid; ICS/LABA, combined ICS and LABA in one device; ICS/SABA, combined ICS and SABA in one device; IL, interleukin; LABA, long-acting β-agonist; LAMA, long-acting muscarinic antagonist; LTM, leukotriene modifier; LTRA, leukotriene receptor antagonist; OCS, oral corticosteroid; PRN, as needed; SABA, short-acting β-agonist.* 2544 2544 2545 2545 are well absorbed, they may also be used for managing hospitalized patients. 2546 2546 2547 2547 Intravenous Corticosteroids Intravenous preparations are frequently used in hospitalized patients. Patients are rapidly transitioned to OCS once their condition has stabilized. 2548 2548 2549 2549 Intramuscular Corticosteroids In high-risk, poorly adherent patients, intramuscular triamcinolone acetonide has been used to achieve asthma control and reduce exacerbations. 2550 2550 2551 2551 Safety Chronic administration of systemic corticosteroids is associated with a plethora of side effects including diabetes, osteoporosis, cataracts and glaucoma, bruising, weight gain, truncal obesity, hypertension, ulcers, depression, and accelerated cardiac risk, among others. Appropriate monitoring and infectious (pneumocystis pneumonia prophylaxis for those treated chronically with ≥20 mg prednisone/d) and bone health prophylaxis are necessary. Intermittent "bursts" of systemic corticosteroids to treat asthma exacerbations are associated with reduced side [... Output truncated due to length. 3223 tokens/13026 characters removed ...]