Asthma in Children Aged 6–11 Years When Step 3 Did Not Achieve Control
This protocol applies to children aged 6 to 11 years with asthma who have not reached well-controlled status on a Step 3 regimen. When Step 3 treatment fails to meet the defined control goals, Step 4 management is the appropriate next step.
Previous Treatment — Step 3 Did Not Achieve Control
The child received a Step 3 regimen — which may have included low-dose ICS-LABA, medium-dose inhaled corticosteroid, or very-low-dose ICS-formoterol MART — but did not reach well-controlled asthma: symptoms persisted during the day or night, severe exacerbations continued, or lung function and activity remained substantially impaired.
Treatment Goals
Well-controlled asthma means no troublesome symptoms day or night, no severe exacerbations, normal or near-normal lung function, and the ability to lead an active life including exercise.
Step 4 Approach — Partial Overview
Step 4 escalates to a more intensive inhaled corticosteroid-based maintenance regimen, with options that include a long-acting bronchodilator component. Referral to a pediatric asthma expert is a core part of this step. The complete set of options, decision criteria, and clinical sequencing is available in the full protocol.
References
- Children aged 6–11 years with asthma should not be treated with SABA alone; they should all receive ICS-containing treatment.
- In Steps 3–4, the child takes ICS or ICS-LABA every day, plus reliever as needed.
- If a child needs Step 4 treatment to control asthma, refer them to a pediatric asthma expert.
- 'Well-controlled asthma' means that the person does not have severe asthma exacerbations, they do not have troublesome asthma symptoms during the day or night, they have normal lung function or almost normal lung function, and they are able to lead active lives, including exercise.