PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.
PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.
PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.
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Appendix D<br />
Clinical Practice Guidelines<br />
Diagnosis and Management of Pediatric Asthma<br />
Severity<br />
Level<br />
Step 1: Mild<br />
intermittent<br />
Min follow-up<br />
6 mos<br />
Step 2: Mild<br />
Persistent<br />
Min follow-up<br />
3 mos<br />
Step 3:<br />
Moderate<br />
Persistent<br />
Symptoms Night sxs Lung Function<br />
* if able<br />
• sxs ≤ 2xs/wk<br />
• no sxs; normal PEF<br />
between exacerbations<br />
• brief exacerbations<br />
(few hours – few days)<br />
• Sxs > 2xs/wk; < 1<br />
x/day<br />
• Exacerbations may<br />
affect activity<br />
• Daily sxs<br />
• Daily use of shortacting<br />
ß2 agonist<br />
• Exacerbations affect<br />
activity<br />
• Exacerbations ≥ 2<br />
xs/wk; may last days<br />
≤2 xs/mo<br />
• FEV1 or PEF<br />
≥ 80%<br />
predicted<br />
• PEF<br />
variability <<br />
20%<br />
> 2 xs/mo • FEV1 or PEF<br />
≥ 80%<br />
predicted<br />
• PEF<br />
variability 20-<br />
30%<br />
> 1 x/wk • FEV1 or PEF<br />
> 60% < 80%<br />
predicted<br />
• PEF<br />
variability<br />
>30%<br />
Pediatric Patients<br />
Long Term Control (see attached formulary<br />
guidelines). Note: All patients on long-term control<br />
must have quick relief medication<br />
None needed<br />
Daily medications:<br />
• Anti-inflammatory Either: low dose inhaled<br />
corticosteroid or leukotriene modifier or cromolyn or<br />
nedocromil<br />
• MDI use spacer/face mask<br />
Daily medications:<br />
• Med dose inhaled corticosteroid with spacer and face<br />
mask or by nebulizer<br />
OR<br />
• Low-med dose inhaled corticosteroid with spacer and<br />
mask or by nebulizer PLUS a long acting<br />
brochodilator (salmeterol ≥ 4 yrs) and/or leukotriene<br />
modifier<br />
Quick Relief<br />
(see attached formulary<br />
guidelines)<br />
Short-acting<br />
bronchodilator:<br />
• Inhaled with spacer,<br />
nebulized, or oral ß2<br />
agonists pm sxs<br />
(e.g., albuterol)<br />
Short-acting<br />
bronchodilator:<br />
• Inhaled spacer,<br />
nebulized, or oral ß2<br />
agonists prn sxs<br />
(e.g. albuterol)<br />
Short-acting<br />
bronchodilator:<br />
• Inhaled spacer,<br />
nebulized, or oral ß2<br />
agonists prn sxs<br />
(e.g. albuterol)<br />
Education<br />
• Basic asthma facts<br />
• MDI/spacer/nebulizer<br />
technique<br />
• Roles of meds<br />
• Self-management plan<br />
• Action plan for acute<br />
exacerbations and<br />
prophylaxis during viral<br />
illnesses<br />
• Environmental control; avoid<br />
trigger exposure<br />
Step 1, Plus:<br />
• Teach patient monitoring<br />
• Refer to group education if<br />
available<br />
• Review and update patient<br />
management plan<br />
Same as Step 2, Plus:<br />
• Consider Case Mgmt if<br />
exacerbations persist<br />
Min follow-up<br />
2 mos<br />
Step 4: Severe<br />
Persistent<br />
• Continual sxs<br />
• Limited physical<br />
activity<br />
• Frequent exacerbations<br />
Frequent<br />
• FEV1 or PEF<br />
≤ 60%<br />
predicted<br />
• PEF<br />
variability<br />
• > 30%<br />
The brochodilator combination therapy is the preferred<br />
choice of nighttime sxs.<br />
Daily medications:<br />
• High dose inhaled corticosteroid with spacer and face<br />
mask or by nebulizer<br />
AND<br />
• Long-acting brochodilator (salmeterol ≥ 4 yrs)<br />
AND<br />
• Corticosteroid tabs or syrup long-term (2 mg/kg/day<br />
generally not to exceed 60 mg/day). Wean ASAP; if<br />
unable, specialist req’d.<br />
Short-acting<br />
bronchodilator:<br />
• Inhaled spacer,<br />
nebulized, or oral ß2<br />
agonists prn sxs<br />
(e.g. albuterol)<br />
Same as Step 3, Plus:<br />
• Refer to individual<br />
education/counseling and<br />
support services for<br />
additional interventions<br />
Note: Symptom severity assessed by clinical features before treatment.<br />
Review medication technique, adherence, and environmental control<br />
*adapted from MHLBI Guidelines for the Diagnosis and Management of Asthma<br />
All Asthmatics need annual flu shots<br />
Step down if well controlled<br />
Step up if not well controlled<br />
These practice guidelines are based on medical literature and opinions that are current as of the date stated above and are not intended to replace your clinical medical judgment. Each medical decision should be based on current<br />
medical knowledge and practice considered in the clinical circumstances of the individual patient.<br />
Copyright© 2002 PHHS<br />
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