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Table 1 Treatment steps for the experimental intervention. More details in relation to the treatment steps are provided in Appendix 1 of the supplement; a detailed decision tree is given in Appendix 2 of the supplement

From: Reducing Asthma Attacks in Children using Exhaled Nitric Oxide as a biomarker to inform treatment strategy: a randomised trial (RAACENO)

Step

Algorithm 1 (FENO high)

Algorithm 2 (FENO not high)

1

Short-acting beta-agonist (SABA) as required only

SABA as required only

2

Budesonide (or beclomethasone) 200 μg daily plus SABA

Budesonide (or beclomethasone 200 μg twice daily plus SABA

3

Budesonide (or beclomethasone) 400 μg OR fluticasone 200 μg daily plus SABA

Budesonide (or beclomethasone) 400 μg OR fluticasone 200 μg daily plus SABA

4

Budesonide (or beclomethasone) 800 μg OR fluticasone 500 μg daily plus SABA

Add long-acting beta-agonist (LABA)

5

Only for ≥ 12-year-olds: Budesonide (or beclomethasone 1600 μg daily or fluticasone 1000 μg daily plus SABA. Go to step 6 for < 12-year-olds

Add leukotriene receptor antagonist

6

Add LABA in fixed dose combination

Budesonide 800 μg or fluticasone 500 μg daily in fixed dose combination

7

Add leukotriene receptor antagonist

Only for ≥ 12-year-olds. Budesonide (or beclomethasone 1600 μg daily or fluticasone 1000 μg daily plus SABA. Go to step 8 for < 12-year-olds

8

Refer for specialist assessment

Refer for specialist assessment