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Stepwise Approach to Asthma Symptom Control

Stepwise Approach to Asthma Symptom Control - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Respiratory, Related


Stepwise Approach to Asthma Symptom Control

STEP 5
CO
NT
RO
L
LE
R
STEP 4
Age 0-5 yrs.
Preferred:
Refer to asthma
specialist STEP 3
Age 0-5 yrs.
Preferred:
Refer to asthma specialist
Alternatives:
Add LTRA or increase ICS
frequency or add
intermittent ICS STEP 2
Age 0-5 yrs.
Preferred:
Double low dose ICS
Alternative:
Add LTRA
Age 6-11 yrs.
Preferred:
Refer to asthma
specialist
Alternative:
Omalizumab
STEP 1
Age 0-5 yrs.
Preferred:
Low dose ICS
Alternatives:
LTRA or
intermittent ICS
Age 6-11 yrs.
Preferred:
Medium dose ICS or
Low dose ICS + LABA
Alternative:
Low dose ICS + LTRA
Age 6-11 yrs.
Preferred:
Refer to asthma specialist
Alternatives:
Medium dose ICS + LABA or
High dose ICS + LABA
All Ages
Alternative:
Low dose ICS
Age 6-11 yrs.
Preferred:
Low dose ICS
Alternatives:
LTRA
Age > 12 yrs.
Preferred:
Low dose ICS + LABA
Alternatives:
Medium dose ICS or
Low dose ICS + LTRA +
theophyline
Age > 12 yrs.
Preferred:
Medium dose ICS + LABA
Alternatives:
High dose ICS + LABA and/or
LTRA + theophylline or add
tiotropium*
Age > 12 yrs.
Preferred:
Refer to asthma
specialist
Alternatives:
Add
tiotropium*or
omalizumab or
bronchial
thermoplasty*
Age > 12 yrs.
Preferred:
Low dose ICS
Alternatives:
LTRA or
theophyline
*For adult patients only. Not indicated or recommended for patients younger than 18 years.
RE
SC
UE
All Ages
Preferred: PRN Short-acting Beta2-agonist (SABA)
Consider stepping down if symptoms controlled for 3 months and low risk for exacerbations.
Ceasing ICS is not advised.
Last reviewed/revised: 07/2015
Contact CCKM for revisions.
Asthma – Pediatric/Adult –
Inpatient/Ambulatory Guideline
ASSESS
•Diagnosis
•Symptom control + risk factors
•Inhaler technique + adherence
•Parent or patient preferences
ADJUST TREATMENT
•Asthma medications
•Non-pharmacological
interventions
•Treat modifiable risk factors
REVIEW RESPONSE
•Symptoms and side effects
•Exacerbations
•Parent or patient preferences
•Lung function
Consider stepping up if uncontrolled symptoms, exacerbations or risks. Always evaluate diagnosis, inhaler
technique, and adherence before making therapy changes.
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2015CCKM@uwhealth.org