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Asthma Management
Key Management Parameters
Patient’s Name ______________________ MRN # _____________ Asthma Diagnosis Confirmed? Yes o No o CLASSIFY SEVERITY:
DAILY MEDICATIONS REQUIRED TO
CLINICAL FEATURES BEFORE
MAINTAIN LONG-TERM CONTROL
TREATMENT OR ADEQUATE CONTROL
*Preferred Treatment in Bold Print
Preferred Treatment
SEVERE PERSISTENT
PEF or FEV
PEF Variability > 30%
• Corticosteroid tablets or syrup long term (2mg/kg/ day, generally do not exceed 60 mg per day). Make repeat attempts to reduce systemic corticosteroids and maintain control with high-dose inhaled corticosteroids Preferred Treatment
• Low-to-medium dose inhaled corticosteroids MODERATE PERSISTENT
PEF or FEV
PEF Variability > 30%
Alternative Treatment
• Increase inhaled corticosteroids within medium-dose range OR Low-to-medium dose inhaled corticosteroids and either leukotriene modifier or theophylline.
Consider Xolair if perennial allergies exist for those with moderate or severe persistent disease.
**Xolair needs prior auth for all insurers and dosing should be based upon FDA approved IgE levels and body weight Preferred Treatment
MILD PERSISTENT
PEF or FEV ≥ 80%
Alternative Treatment
PEF Variability 20-30%
• cromolyn, leukotriene modifier, nedocromil, OR sustained release theophylline to serum concentration MILD INTERMITTENT
No daily medication needed
PEF or FEV > 80%
• Severe exacerbations may occur, separated by long PEF Variability < 20%
periods of normal lung function and no symptoms. tA course of systemic corticosteroids is recommended.
Risk Assessment: Perform for all levels
Has the patient required urgent/emergent care and/or oral steroids two or more times in the past year? If so, increase the level of maintenance treatment by at least one severity.
STEP DOWN (decrease medications, when possible) • Short-acting bronchodilator: 2 puffs short-acting inhaled beta2-agonists as Review treatment every 1 to 6 months; a gradual needed for symptoms. (These agents should not be used more than 6 times a stepwise reduction in treatment may be possible.
day as increased use is associated with decreased responsiveness.) STEP UP (increase medications, when needed) If control is not maintained, consider step up. First, • Use of short-acting beta2-agonists > 2 times a week in intermittent asthma review patient medication technique, adherence, and (daily, or increasing use in persistent asthma) may indicate the need to initiate (increase) long-term control therapy.
• Intensity of treatment will depend on severity of exacerbation; may repeat doses of quick relief medications every 20 minutes in an emergency situation, but should seek immediate medical evaluation for possible steroid burst.
mercy.net
Asthma Management
Key Management Parameters
ASSESS LEVEL OF CARE
Daytime symptoms/day/week/mo
Severity ClassificationAsthma Control Test Score more information
ASSESS RISK LEVEL
Spirometry (annually)
Number of ER/UC recent and/or
MEDICATIONS: C = CONTRAINDICATED, R = REFUSED, A = ALLERGIC
PATIENT EDUCATION
Asthma Management
Action Plan
Patient’s Name _______________________ MRN # _____________ Primary Care Physician: _____________________ “CAUTION ALERT”
ALLERGIES TO
“MEDICAL ALERT”
MEDICATIONS
“ALL CLEAR”
contacting your health care provider every time you drop Best Peak Flow: ________ Greater than _____ (80%) or CONTROLLER
MEDICATIONS
(Usually only one of these
agents will be used at a
Remember: You should not
long acting bronchodilator to stay in the Red Zone for more scribed, for one or two weeks instructions from your physi- LEUKOTRIENE MODI-
(Do not use more than one
MEDICATIONS
of these agents)
(Do not use more than one
Inhale 2 puffs every 4 hours, of these agents)
(or nebulize rescue solution, (or nebulize rescue solution, if nebulizer medication is be- if nebulizer medication is be- Recheck peak flow before
MISCELANEOUS
(Do not use more than one
(Do not use more than one
next dose
agent from each category)
agents from each category)
Inhale as directed daily (if di- Inhale as directed, especially rected to do so) or as needed if cough is productive Nebulize 1 vial 3 times a day Nebulize 1 vial 3 times a day to Step 1) and continue this ORAL STEROIDS
*** Initiate rescue dose of
(These medications may be prescribed regularly for moder- steroid if prescribed ***
ate or severe persistent disease)
Take _____ tablets _____ times a day for ___________ Take _____ tablets _____ times a day for ___________ Asthma Management
Medications
RESCUE INHALERS OR NEBULIZER SOLUTIONS
Albuterol (proair, **proventil, ventolin) PREVENTIVE MEDICATIONS
Corticosteroid inhalers or nebulizer solution Budesonide (pulmicort flexhaler, pulmicort respules) Fluticasone (flovent diskus, flovent hfa) Long acting bronchodilator inhalers or nebulizer solution (Caution: must use with a corticosteroid agent) Formoterol (foradil aerolizer, perforomist) Combination corticosteroid and long acting bronchodilators Salmeterol-fluticasone (advair diskus, advair hfa) MISCELLANEOUS AGENTS
Albuterol-ipatroprium (combivent, duoneb) ORAL STEROIDS

Source: http://mercycaremanagement.org/resources/MRC_24608_AsthmaMgmt_FLR.pdf