Browse the corpus

Consider severity and interval since last exacerbation Reduction in lung growth Evaluation requires long-term followup Treatment-related adverse effects Medication side effects can vary in intensity from none to very troublesome and worrisome. The level of intensity does not correlate to specific levels of control but should be considered in the overall assessment of risk. Recommended action for treatment • Maintain current step. • Regular followup every 1-6 months. • Consider step down if well controlled for at least 3 months. • Step up at least 1 step and • Reevaluate in 2-6 weeks. • For side effects, consider alternative treatment options. • Consider short course of oral systemic corticosteroids, • Step up 1-2 steps, and • Reevaluate in 2 weeks. • For side effects, consider alternative treatment options. The stepwise approach is meant to assist, not replace, the clinical decisionmaking required to meet individual patient needs. The level of control is based on the most severe impairment or risk category. Assess impairment domain by patient's/caregiver's recall of previous 2-4 weeks and by spirometry/or peak flow measures. Symptom assessment for longer periods should reflect a global assessment such as inquiring whether the patient's asthma is better or worse since the last visit. At present, there are inadequate data to correspond frequencies of exacerbations with different levels of asthma control. In general, more frequent and intense exacerbations (eg, requiring urgent, unscheduled care, hospitalization, or ICU admission) indicate poorer disease control. For treatment purposes, patients who had ≥2 exacerbations requiring oral systemic corticosteroids in the past year may be considered the same as patients who have persistent asthma, even in the absence of impairment levels consistent with persistent asthma.

Before step up in therapy: - Review adherence to medication, inhaler technique, environmental control, and comorbid conditions. - If an alternative treatment option was used in a step, discontinue and use the preferred treatment for that step. EIB: exercise-induced bronchospasm; FEV 1 : forced expiratory volume in 1 second; FVC: forced vital capacity; ICU: intensive care unit. Reproduced from: National Heart, Blood, and Lung Institute Expert Panel Report 3 (EPR 3): Guidelines for the Diagnosis and Management of Asthma. NIH Publication no. 08-4051, 2007.