Caphiasthmamgmttool_feb2009.indd

Summary of the NAEPP’s EPR-3: Guidelines for the
Diagnosis and Management of Asthma
Consider the Diagnosis of ASTHMA if:
Patient has RECURRENT episodes of cough, wheeze, shortness of breath, or chest tightness.
Symptoms occur or worsen at night, awakening the patient.
Symptoms occur or worsen in the presence of factors known to precipitate asthma.
Alternative diagnoses have been considered such as GERD (a common co-morbidity), airway anomaly, foreign body, cystic fi brosis, vocal cord dysfunction, TB, or COPD. If diagnosis is in doubt, consider consulting an asthma specialist.
Confi rm the Diagnosis of ASTHMA if:
Spirometry demonstrates obstruction and reversibility by an increase in FEV1 of >12% after bronchodilator (in all adults
and children 5 years of age or older).
Assess Asthma Severity: Any of the following indicate PERSISTENT ASTHMA
Daytime symptoms >2 days per week OR
Awakens at night from asthma >2X per month (age 0-4 years: >1X per month) OR
Limitation of activities, despite pretreatment for EIB OR
Short-acting beta -agonist (SABA) use for symptom control >2 days per week (not prevention of EIB) OR
Two or more bursts oral corticosteroids in 1 year (age 0-4 years: >2 bursts oral corticosteroids in 6 months*) OR
Age >5 years: FEV1 <80% predicted OR FEV1/FVC ratio < predicted normal range for age (see below)
*NOTE: For children age 0-4 years who had 4 or more episodes of wheezing during the previous year lasting >1 day, check risk
factors for persistent asthma. Risk factors include either (1) one of the following: parental history of asthma, a physician diagno-
sis of atopic dermatitis, or evidence of sensitization to aeroallergens, or (2) two of the following: evidence of sensitization to foods,
>4% peripheral blood eosinophilia, or wheezing apart from colds.
Treatment for Persistent Asthma:
Quick Tips for All Patients with Asthma
Daily Inhaled Corticosteroids (Step 2 or higher)
‰ Planned Asthma Visits: Every 1-6 months
Follow the Stepwise Approach
‰ Environmental Control: Identify and avoid exposures such as
tobacco smoke, pollens, molds, animal dander, cockroaches, and dust mites (Allergy testing recommended for anyone with persistent Assess response within 2-6 weeks
asthma who is exposed to perennial indoor allergens) ‰ Flu Vaccine: Recommend annually
‰ Spirometry (Not During Exacerbation): At diagnosis and at least
Is Asthma Well Controlled?
‰ Asthma Control: Use tools such as ACQ®, ACT™ or ATAQ to
1. Daytime symptoms <2 days per week AND
2. Awakens at night from asthma <1X per month ‰ Asthma Education: Review correct inhaled medication device
(age >12 years: <2X per month) AND
3. No limitation of activities AND
‰ Asthma Action Plan: At diagnosis; review and update at each visit
‰ SABA (e.g., inhaled albuterol): 1) for quick relief every 4-6 hours as
FEV1/FVC:
prevention of EIB) <2 days per week AND
needed (see step 1), 2) pretreat with 2 puffs for exercise-induced 5. <1 burst oral corticosteroids per year bronchospasm (EIB) 5 minutes before exercise ‰ Inhaled Corticosteroids (ICS): Preferred therapy for all patients
‰ Oral Corticosteroids: Consider burst for acute exacerbation
‰ Valved Holding Chamber (VHC) or Spacer: Recommend for use
‰ Mask: Recommend for use with VHCs or spacers and/or nebulizer
for age <5 years and anyone unable to use correct mouthpiece technique Consider step down if
Step up therapy.
well controlled for 3
Reassess in 2-6 weeks.
Indications for asthma specialist consultation include: Asthma is unrespon-
Continue to step up until
sive to therapy; asthma is not well controlled within 3-6 months of treatment; Reassess every 3 to 6
life-threatening asthma exacerbation; hospitalization for asthma; required well controlled.
>2 bursts oral corticosteroids in 1 year; requires higher level step care (see Stepwise Approach, next page); immunotherapy is being considered.
Produced by the California Asthma Public Health Initiative (CAPHI) in association with CAPHI’s Improving Asthma Control collaborative. Summarized from the NAEPP EPR-3: www.nhlbi.nih.gov/guidelines/asthma. Adapted from Colorado Clinical Guidelines Collaborative (www.coloradoguidelines.org/guidelines/asthma.asp). This summary of NAEPP’s guidelines is designed to assist the clinician in the diagnosis and management of asthma and is not intended to replace the clinician’s judgment or establish a protocol for all patients with a particular condition. Additional copies of the summary and other asthma resources available at www.
betterasthmacare.org. Permission to reprint granted if unaltered. Revised: February 2009
Summary of the NAEPP’s EPR-3: Stepwise Approach
for Managing Asthma in Children and Adults
Intermittent
Persistent Asthma: Daily Medication
Classifying asthma severity in patients not currently taking long-term control medication is a guide for selection of initial step therapy. Regularly monitoring the level of asthma control is a guide for adjust-ing therapy.
Assess Control
Step up as indicated and/or address possible poor adherence to
medication. Reassess in 2 to 6 weeks.
Step down if well controlled for 3 months and reassess in 3-6 months.
All long-acting beta-agonists (LABAs) and combination agents containing LABAs
have a black box warning.
Age 0-4 yrs
Preferred:
Age 0-4 yrs
Preferred:
Oral systemic
Age 0-4 yrs
corticosteroid
Preferred:
ICS + either
Age 0-4 yrs
Preferred:
Age 5-11 yrs
Age 5-11 yrs
Preferred:
Preferred:
Age 0-4 yrs
Preferred:
Age 5-11 yrs
Low dose ICS
Alternative:
Preferred:
(All ages)
Alternative:
Age 5-11 yrs
Oral systemic
Preferred - EITHER:
corticosteroid
Preferred:
Alternative:
Alternative:
Age 5-11 yrs
Oral systemic
Age >12yrs
Preferred:
corticosteroid
Preferred:
Alternative:
Age >12yrs
step up treatment
Preferred:
Age >12yrs
Age >12yrs
Preferred:
Preferred:
Oral systemic
corticosteroid
Age >12yrs
Alternative:
Preferred:
Alternative:
Alternative:
Produced by the California Asthma Public Health Initiative (CAPHI) in association with CAPHI’s Improving Asthma Control collaborative. Summarized from the NAEPP EPR-3: www.nhlbi.nih.gov/
guidelines/asthma. Adapted from Colorado Clinical Guidelines Collaborative (www.coloradoguidelines.org/guidelines/asthma.asp). This summary of NAEPP’s guidelines is designed to assist the clinician
in the diagnosis and management of asthma and is not intended to replace the clinician’s judgment or establish a protocol for all patients with a particular condition. Additional copies of the summary and
other asthma resources available at www.betterasthmacare.org. Permission to reprint granted if unaltered. Revised: February 2009

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