Full Clinical Guidelines - Community First Health Plans.

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4.9 Estimated Comparative Daily Dosages for Inhaled Corticosteroids FIGURE 18. ESTIMATED COMPARATIVE DAILY DOSAGES FOR INHALED CORTICOSTEROIDS Drug Beclomethasone HFA 40 or 80 mcg/puff Budesonide DPI 90, 180, or 200 mcg/inhalation Budesonide Inhaled Inhalation suspension for nebulization Flunisolide 250 mcg/puff Flunisolide HFA 80 mcg/puff Fluticasone HFA/MDI: 44, 110, or 220 mcg/puff DPI: 50, 100, or 250 mcg/inhalation Mometasone DPI 200 mcg/inhalation Triamcinolone acetonide 75 mcg/puff NA NA 0.25–0.5 mg NA NA 176 mcg NA NA NA 80–160 mcg 180–400 mcg 0.5 mg 500–750 mcg 160 mcg 88–176 mcg 100–200 mcg NA 300–600 mcg 80–240 mcg 180–600 mcg NA 500–1,000 mcg 320 mcg 88–264 mcg 100–300 mcg 200 mcg 300–750 mcg NA NA >0.5–1.0 mg NA NA >176–352 mcg NA NA NA Key: DPI, dry power inhaler; HFA, hydrofluoroalkane; MDI, metered-dose inhaler; NA, not available (either not approved, no data available, or safety and efficacy not established for this age group) Therapeutic Issues: Child 0–4 Years of Age >160–320 mcg >400–800 mcg 1.0 mg 1,000– 1,250 mcg 320 mcg >176–352 mcg >200–400 mcg NA >600–900 mcg >240–480 mcg >600– 1,200 mcg NA >1,000– 2,000 mcg >320–640 mcg >264–440 mcg >300–500 mcg 400 mcg >750– 1,500 mcg NA NA >1.0 mg NA NA >352 mcg NA NA NA >320 mcg >800 mcg 2.0 mg >1,250 mcg ≥640 mcg >352 mcg >400 mcg NA >900 mcg >480 mcg >1,200 mcg NA >2,000 mcg >640 mcg >440 mcg >500 mcg >400 mcg >1,500 mcg ■ The most important determinant of appropriate dosing is the clinician’s judgment of the patient’s response to therapy. The clinician must monitor the patient’s response on several clinical parameters and adjust the dose accordingly. Once control of asthma is achieved, the dose should be carefully titrated to the minimum dose required to maintain control. ■ Preparations are not interchangeable on a mcg or per puff basis. This figure presents estimated comparable daily doses. See EPR—3 <strong>Full</strong> Report 2007 for full discussion. ■ Some doses may be outside package labeling, especially in the high-dose range. Budesonide nebulizer suspension is the only inhaled corticosteroid (ICS) with FDA-approved labeling for children
FIGURE 20. CLASSIFYING SEVERITY OF ASTHMA EXACERBATIONS IN THE URGENT OR EMERGENCY CARE SETTING Note: Patients are instructed to use quick-relief medications if symptoms occur or if PEF drops below 80 percent predicted or personal best. If PEF is 50–79 percent, the patient should monitor response to quick-relief medication carefully and consider contacting a clinician. If PEF is below 50 percent, immediate medical care is usually required. In the urgent or emergency care setting, the following parameters describe the severity and likely clinical course of an exacerbation. Mild Moderate Severe Subset: Life threatening Symptoms and Signs Dyspnea only with activity (assess tachypnea in young children) Dyspnea interferes with or limits usual activity Dyspnea at rest; interferes with conversation Too dyspneic to speak; perspiring Initial PEF (or FEV1) PEF ≥ 70 percent predicted or personal best <strong>Clinical</strong> Course ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Usually cared for at home Prompt relief with inhaled SABA Possible short course of oral systemic corticosteroids Usually requires office or ED visit Relief from frequent inhaled SABA Oral systemic corticosteroids; some symptoms last for 1–2 days after treatment is begun Usually requires ED visit and likely hospitalization Partial relief from frequent inhaled SABA Oral systemic corticosteroids; some symptoms last for >3 days after treatment is begun Adjunctive therapies are helpful Requires ED/hospitalization; possible ICU Minimal or no relief from frequent inhaled SABA Intravenous corticosteroids Adjunctive therapies are helpful Key: ED, emergency department; FEV 1 , forced expiratory volume in 1 second; ICU, intensive care unit; PEF, peak expiratory flow; SABA, short-acting beta 2 -agonist Management in the Urgent or Emergency Care and Hospital Settings Emergency medical services providers should have prehospital protovols that allow administration of SABA, supplemental oxygen, and (with appropriate medical oversight) anticholinergics and oral systemic corticosteriods to patients who have signs or symptoms of an asthma exacerbation. Treatment strategies for managing moderate or severe exacerbations in the urgent or emergency care setting are described below. Also see figure 21 for a detailed sequence of recommended actions for monitoring and treatment and figure 22 for dosages of drugs for asthma exacerbations. PEF 40–69 percent predictedor personal best PEF
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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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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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CHILDREN’S SERVICES HANDBOOK P R
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FIGURE 2: Recommended immunization
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Comprehensive antepartum care is vi
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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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. 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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