Always have albuterol as the short-term med for any acute asthma attacks
Remember, the hallmark of asthma is inflammation. Therefore, the 1st drug to use for asthma treatment would be ICS. Inhaled because you don't want a systemic, but just targeting the lungs mostly.
Then, for moderate (step 3, 4, 5), you wanna add LABA to help open airways.
Not until the last step (step 6), for severe, do you wanna add oral corticosteroids to help with asthma control.
Cromolyn or Nedocromil (mast cell stabilizer) is only used in Step 2.
Zileuton is only used in step 3&4.
LTRA/Theophylline is used in step 2,3,4.
Omalizumab is MUST used in step 5&6 for pts with allergies component.



I'M MS (I'M Master of Science)
0 1  2 3


I - 0 long-term med (Intermittent- step 1)
M - 1 long-term med such as ICS (mild - step 2)
M - 2 long-term meds such as ICS + LABA (moderate - step 3, 4, 5)
S - 3 long-term meds such as ICS + LABA + Oral Cortisteroids (severe - step 6)


I - 0 long-term med (Intermittent- step 1)
M - 1 long-term med such as ICS (mild - step 2****)
M - 2 long-term meds such as ICS + LABA (moderate - step 3, 4, 5 - low, moderate, high)
          Step 3*: low dose ICS + LABA***
          Step 4: medium dose ICS + LABA***
          Step 5**: high dose ICS + LABA
S - 3 long-term meds such as ICS + LABA + Oral Corticosteroids (severe - step 6**)


* step 3 is special in that you may not want to jump to use LABA immediatley with low-dose ICS. Remember that asthma's hallmark is inflammation? You may want to jump straight to medium-dose ICS alone without LABA for step 3?

** Step 5&6: you want to use a special new agent: omalizumab on top of those meds for pts with allergies component

***Step 3&4: instead of LABA, you may use LTRA, Theophylline or Zileuton

****Step 2: LTRA, Theophylline as in step 3&4, except that you don't want to use Zileuton. You may use Cromolyn & Nedocromil. In a sense these mast cell stabilizers are only used in step 2.


~Wonder Me!