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The literature searches and results for all four components of asthma management (See section 3.) provided the foundation for the update of this section: "Managing Asthma Long Term." The Expert Panel's recommendations for managing asthma long term integrate the four components of therapy into a stepwise therapeutic approach for managing asthma long term, in which medications are increased as necessary and decreased if possible to achieve and maintain control of asthma. The general stepwise approach is applicable to all patients who have asthma. Adaptations are required, however, to tailor the approach to the needs of different patient groups. For example, it is important to consider the age of the patient, because the course of the disease may change over time, and the relevance of different assessment measures and potential short- and long-term impact of medications may be age related. Thus, the Expert Panel's recommendations are presented for three different age groups: children 0–4 years of age, children 5–11 years of age, and youths ≥12 years of age and adults, based on the following considerations:

▪ Evidence available demonstrating safety and efficacy for many medications is age dependent (e.g., many clinical trials have enrolled patients ≥12 years of age only, and it is unknown if these results are applicable to children 5–11 years of age; furthermore, few trial data are available for children <5 years of age). ▪ Issues related to drug delivery are often age dependent (e.g., the ability of a child and/or their caregivers to use nebulizers versus metered dose inhalers (MDIs) versus dry powder inhaler (DPI) devices). ▪ Approval of medications by the U.S. Food and Drug Administration (FDA) is based on age. ▪ Lung function measurements, used to classify asthma severity (impairment domain) and control (risk domain), are usually not possible in children <5 years of age, and interpretations of these tests may require special considerations for children 5–11 years of age. ▪ The characterization of various wheezing phenotypes is frequently age dependent, with different patterns among children 0–4 years of age compared to children 5–11 years of age or children 12 years of age or older and adults (e.g., severe episodes of virus-induced wheezing (risk domain) with periods of no symptoms in between episodes (impairment domain) are most frequently seen in preschool children).

Furthermore, situations arise which require special consideration of therapeutic options within the stepwise care: EIB, surgery, pregnancy, and racial and ethnic disparity. This section, "Managing Asthma Long Term," will present recommendations for each group separately: managing asthma long term in children (ages 0–4 years and 5–11 years), managing asthma long term in youths ≥12 years of age and adults, and managing special situations in asthma.