Guidelines for the Diagnosis and Management of Asthma

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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. Symptoms and Signs Initial PEF (or FEV1) Clinical Course Mild Dyspnea only with activity (assess tachypnea in young children) PEF ≥ 70 percent predicted or personal best ■ ■ ■ Usually cared for at home Prompt relief with inhaled SABA Possible short course of oral systemic corticosteroids Moderate Dyspnea interferes with or limits usual activity PEF 40–69 percent predictedor personal best ■ ■ ■ 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 Severe Dyspnea at rest; interferes with conversation PEF 3 days after treatment is begun Adjunctive therapies are helpful Subset: Life threatening Too dyspneic to speak; perspiring PEF
FIGURE 21. MANAGEMENT OF ASTHMA EXACERBATIONS: EMERGENCY DEPARTMENT AND HOSPITAL-BASED CARE Key: FEV 1 , forced expiratory volume in 1 second; ICS, inhaled corticosteroid; MDI, metered-dose inhaler; PCO2, partial pressure carbon dioxide; PEF, peak expiratory flow; SABA, short-acting beta 2 -agonist; SaO2, oxygen saturation Managing Exacerbations 55
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SUMMARY REPORT 2007 National Asthma
Page 3 and 4:
Contents Acknowledgments iii Prefac
Page 5 and 6:
Acknowledgements National Asthma Ed
Page 7 and 8:
Development of the guidelines was f
Page 9 and 10:
Robert Zeiger, M.D. Kaiser Permanen
Page 11 and 12:
Preface The Expert Panel Report 3 (
Page 13 and 14:
Introduction More than 22 million A
Page 15 and 16: New emphasis on multifaceted approa
Page 17 and 18: Figure 1. SUMMARY OF RECOMMENDED KE
Page 19 and 20: Figure 1. SUMMARY OF RECOMMENDED KE
Page 21 and 22: Asthma Definition and Implications
Page 23 and 24: Diagnosis of Asthma To establish a
Page 25 and 26: FIGURE 3. SUGGESTED ITEMS FOR MEDIC
Page 27 and 28: Managing Asthma Long Term GOAL OF T
Page 29 and 30: FIGURE 4. SAMPLE PATIENT SELF-ASSES
Page 31 and 32: Develop an active partnership with
Page 33 and 34: FIGURE 6. SAMPLE ASTHMA ACTION PLAN
Page 35 and 36: FIGURE 7. DELIVERY OF ASTHMA EDUCAT
Page 37 and 38: these particles do not remain airbo
Page 39 and 40: Animal Dander Some people are aller
Page 41 and 42: Quick-relief medications are used t
Page 43 and 44: FIGURE 10. AEROSOL DELIVERY DEVICES
Page 45 and 46: The stepwise approach and recommend
Page 47 and 48: individual drug efficacy studies in
Page 49 and 50: of particular relevance (impairment
Page 51 and 52: ■ Albuterol is the preferred SABA
Page 53 and 54: FIGURE 12. ASSESSING ASTHMA CONTROL
Page 55 and 56: FIGURE 14. CLASSIFYING ASTHMA SEVER
Page 57 and 58: FIGURE 16. STEPWISE APPROACH FOR MA
Page 59 and 60: FIGURE 17. USUAL DOSAGES FOR LONG-T
Page 61 and 62: FIGURE 18. ESTIMATED COMPARATIVE DA
Page 63 and 64: FIGURE 19. USUAL DOSAGES FOR QUICK-
Page 65: Managing Exacerbations Asthma exace
Page 69 and 70: FIGURE 22. DOSAGES OF DRUGS FOR AST
Page 71 and 72: FIGURE 23a. EMERGENCY DEPARTMENT—
Page 73: For More Information The National H
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Guidelines for the Diagnosis and Management of Asthma

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