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<strong>Guidelines</strong> for the Diagnosis and Management of Asthma FIGURE 15. ASSESSING ASTHMA CONTROL AND ADJUSTING THERAPY IN YOUTHS ≥12 YEARS OF AGE AND ADULTS *ACQ values of 0.76–1.4 are indeterminate regarding well-controlled asthma. Key: EIB, exercise-induced bronchospasm; ICU, intensive care unit Notes: • The stepwise approach is meant to assist, not replace, the clinical decisionmaking required to meet individual patient needs. • The level of control is based on the most severe impairment or risk category. Assess impairment domain by patient’s recall of previous 2–4 weeks and by spirometry/or peak flow measures. Symptom assessment for longer periods should reflect a global assessment, such as inquiring whether the patient’s asthma is better or worse since the last visit. • At present, there are inadequate data to correspond frequencies of exacerbations with different levels of asthma control. In general, more frequent and intense exacerbations (e.g., requiring urgent, unscheduled care, hospitalization, or ICU admission) indicate poorer disease control. For treatment purposes, patients who had ≥2 exacerbations requiring oral systemic corticosteroids in the past year may be considered the same as patients who have not-well-controlled asthma, even in the absence of impairment levels consistent with not-well-controlled asthma. ATAQ = Asthma Therapy Assessment Questionnaire © ACQ = Asthma Control Questionnaire © ACT = Asthma Control Test Minimal Important Difference: 1.0 for the ATAQ; 0.5 for the ACQ; not determined for the ACT. Before step up in therapy: — Review adherence to medication, inhaler technique, environmental control, and comorbid conditions. — If an alternative treatment option was used in a step, discontinue and use the preferred treatment for that step. 4.7 Assessing Asthma Control and Adjusting Therapy in Youths and Adults 24 H EALTH PLANS www.cfhp.com
FIGURE 16. STEPWISE APPROACH FOR MANAGING ASTHMA IN YOUTHS ≥12 YEARS OF AGE AND ADULTS Key: Alphabetical order is used when more than one treatment option is listed within either preferred or alternative therapy. ICS, inhaled corticosteroid; LABA, longacting inhaled beta 2 -agonist; LTRA, leukotriene receptor antagonist; SABA, inhaled short-acting beta 2 -agonist Notes: • The stepwise approach is meant to assist, not replace, the clinical decisionmaking required to meet individual patient needs. • If alternative treatment is used and response is inadequate, discontinue it and use the preferred treatment before stepping up. • Zileuton is a less desirable alternative due to limited studies as adjunctive therapy and the need to monitor liver function. Theophylline requires monitoring of serum concentration levels. • In step 6, before oral corticosteroids are introduced, a trial of high-dose ICS + LABA + either LTRA, theophylline, or zileuton may be considered, although this approach has not been studied in clinical trials. • Step 1, 2, and 3 preferred therapies are based on Evidence A; step 3 alternative therapy is based on Evidence A for LTRA, Evidence B for theophylline, and Evidence D for zileuton. Step 4 preferred therapy is based on Evidence B, and alternative therapy is based on Evidence B for LTRA and theophylline and Evidence D zileuton. Step 5 preferred therapy is based on Evidence B. Step 6 preferred therapy is based on (EPR—2 1997) and Evidence B for omalizumab. • Immunotherapy for steps 2–4 is based on Evidence B for house-dust mites, animal danders, and pollens; evidence is weak or lacking for molds and cockroaches. Evidence is strongest for immunotherapy with single allergens. The role of allergy in asthma is greater in children than in adults. • Clinicians who administer immunotherapy or omalizumab should be prepared and equipped to identify and treat anaphylaxis that may occur. Managing Asthma Long Term 45 4.8 Stepwise Approach for Managing Asthma in Youth and Adults H EALTH PLANS www.cfhp.com 25
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Revised 10-25-07 Publication #: 45-
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Revised 2-21-08 Publication #: E45-
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Abbreviations AGI Alpha-Glucosidase
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Orders for Adults with DKA and Hype
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D i a b e t e s t r e a t m e n t a
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CFHP has adopted the National Insti
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No CHD; 0 to 1, or 2+ Risk Factors
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NATIONAL CHOLESTEROL EDUCATION PROG
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NATIONAL CHOLESTEROL EDUCATION PROG
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Identification, Evaluation, and Tre
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11.3 Treatment of Hypertension H EA
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ALGORITHM FOR TREATMENT OF MAJOR DE
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CFHP has established guidelines for
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A. Documentation ______ B. Continui
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CFHP PCP MEDICAL RECORD REVIEW TOOL
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13.3 Specialist Medical Record Docu
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13.4 Specialist Medical Record Revi
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Risk Factors for Osteoporosis Fract
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It is well documented that obesity
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CLASSIFICATION OF OVERWEIGHT AND OB
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16.1.1 Preventive Pediatric Health
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TEXAS MEDICAID PROVIDER PROCEDURES
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CHILDREN’S SERVICES HANDBOOK P h
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FIGURE 2: Recommended immunization
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Comprehensive antepartum care is vi
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The following variables should be e
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CRITERIA 19. Unresolved Problems Fr
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CFHP OB/GYN SPECIALTY MEDICAL RECOR
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CFHP OB/GYN SPECIALTY MEDICAL RECOR
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According to the National Institute
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. aminotransferase (AST) and alanin
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PREVENTION RECOMMENDATIONS 1. The E
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2 to 20 years: Boys Body mass index
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AsthmaMatters is an initiative deve
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According to the Centers for Diseas
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