Michael E. Wechsler, MD Mayo Clinic Proceedings

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Presentation transcript:

Managing Asthma in Primary Care: Putting New Guideline Recommendations Into Context Michael E. Wechsler, MD Mayo Clinic Proceedings Volume 84, Issue 8, Pages 707-717 (August 2009) DOI: 10.4065/84.8.707 Copyright © 2009 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 1 Assessing asthma severity. EIB = exercise-induced bronchospasm; FEV1 = forced expiratory volume in 1 second; FVC = forced vital capacity; ICU = intensive care unit. From Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.9 Mayo Clinic Proceedings 2009 84, 707-717DOI: (10.4065/84.8.707) Copyright © 2009 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 2 Assessing asthma control. Criteria for well-controlled, not well-controlled, or very poorly controlled asthma in children aged 0 to 4 years. Level of control is based on the most severe impairment or risk category. Assessment of the impairment domain is based on the patient's (or caregiver's) recall of incidents during the previous 2 to 4 weeks. Symptom assessment over longer periods should reflect a global assessment, such as determining whether the patient's asthma is better or worse since the last visit. EIB = exercise-induced bronchospasm. From Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.9 Mayo Clinic Proceedings 2009 84, 707-717DOI: (10.4065/84.8.707) Copyright © 2009 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 3 Assessing asthma control. Criteria for well-controlled, not well-controlled, or very poorly controlled asthma in children aged 5 to 11 years. Level of control is based on the most severe impairment or risk category. Assessment of the impairment domain is based on the patient's (or caregiver's) recall of incidents during the previous 2 to 4 weeks and by spirometry or peak flow measures for patients aged 5 years or older. Symptom assessment over longer periods should reflect a global assessment, such as determining whether the patient's asthma is better or worse since the last visit. EIB = exercise-induced bronchospasm; FEV1 = forced expiratory volume in 1 second; FVC = forced vital capacity. From Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.9 Mayo Clinic Proceedings 2009 84, 707-717DOI: (10.4065/84.8.707) Copyright © 2009 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 4 Assessing asthma control. Criteria for well-controlled, not well-controlled, or very poorly controlled asthma in children aged 12 years or older. Level of control is based on the most severe impairment or risk category. Assessment of the impairment domain is based on the patient's (or caregiver's) recall of incidents during the previous 2 to 4 weeks and by spirometry or peak flow measures for patients aged 5 years or older. Symptom assessment over longer periods should reflect a global assessment, such as determining whether the patient's asthma is better or worse since the last visit. ACQ = Asthma Control Questionnaire; ACT = Asthma Control Test; ATAQ = Asthma Therapy Assessment Questionnaire; EIB = exercise-induced bronchospasm; FEV1 = forced expiratory volume in 1 second. a ACQ values of 0.76-1.4 are inconclusive regarding well-controlled asthma. From Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.9 Mayo Clinic Proceedings 2009 84, 707-717DOI: (10.4065/84.8.707) Copyright © 2009 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 5 Stepwise approach for managing asthma in patients aged 12 years or older. EIB = exercise-induced bronchospasm; ICS = inhaled corticosteroid; LABA = long-acting β-agonist; LTRA = leukotriene receptor antagonist; SABA = short-acting β-agonist. From Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.9 Mayo Clinic Proceedings 2009 84, 707-717DOI: (10.4065/84.8.707) Copyright © 2009 Mayo Foundation for Medical Education and Research Terms and Conditions