Management of Asthma: Treatment Follow-Up (C2)

VETERANS HEALTH ADMINISTRATION CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF COPD OR ASTHMA

Management of Asthma: Treatment Follow-Up (C2)

A. Assess Severity - The presence of one of the features of severity is sufficient to place a patient in that category. An individual should be assigned to the most severe grade in which any feature occurs. The characteristics noted in the algorithm are general and may overlap because asthma is highly variable. Furthermore, an individual's classification may change over time.

Patients at any level of severity can have mild, moderate, or severe exacerbations. Some patients with intermittent asthma may experience severe and life-threatening exacerbations separated by long periods of normal lung function and no symptoms.

B. Are Symptoms Controlled and Pulmonary Function Normal or Optimal for Patient? - Additional criteria for good asthma control.

2. Moderate: normal activity level; reduced PEF variability; infrequent nocturnal symptoms; infrequent exacerbations; and reduced frequency of prn-inhaled beta2-agonist.

3. Severe: near normal activity level; reduced PEF variability; improved pulmonary function; infrequent awakening at night; reduced frequency of prn-inhaled beta2-agonist; reduced need for corticosteroid burst; and reduced need for emergency department treatment.

C. Consider Medication Step-Up - If the patient does not have control of symptoms, or if asthma is not stable on current medication, many things should be considered. Return to box 2 to reclassify patient and reconsider the differential diagnosis or consider a comorbid process. This might be an appropriate time for referral of the patient to the next higher level of care, such as an asthma specialist. For guidelines on pharmacologic management of Asthma using the step classification system, see initial therapy module C-1, box 22.

Module C1 | Table of Contents | Module C3