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Assess Asthma Control & Adjust Therapy

Managing asthma long term

Jennifer Glen, Tim Michalski

Provided by EVAL Foundation
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Usage

The Assess Asthma Control & Adjust Therapy tool can be used for patients currently taking asthma medication.

 

Use the Classify Asthma Severity tool if:

  • the patient's treatment plan is unknown or 
  • the patient is not taking asthma controller medications as prescribed for at least three months. 
.

Summary

The Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma details how to assess asthma control and adjust asthma therapy in a patient taking asthma medication. 

 

The Assess Asthma Control & Adjust Therapy tool can be used for patients currently taking asthma medication.

Use the Classify Asthma Severity tool if:

  • the patient's treatment plan is unknown or 
  • the patient is not taking asthma controller medications as prescribed for at least three months. 

 

Assessing asthma level of control is based on the most severe impairment or risk category. 

  • Classification of Asthma Control (≥12 years of age and older)
  • Classification of Asthma Control (5-11 years of age)
  • Classification of Asthma Control (0-4 years of age)

 

 

.

All questions & possible results

AgeTitle not visible
Choose age group

Select one option:

  • 0-3
  • 4
  • 5-11
  • 12+
Assess Control by Impairment Domain (Ages 12+)

Assess impairment domain by patient'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.

Daytime symptoms

Select one option:

  • throughout the day
  • > 2 days/week
  • ≤ 2 days/week
Nighttime symptoms

Select one option:

  • ≥ 4x/week
  • 1-3x/week
  • ≤ 2x/month
Interference with normal activity

Select one option:

  • Extremely limited
  • Some limitation
  • None
Short-acting beta agonist (SABA) for symptom control (not exercise induced)

Select one option:

  • Several times per day
  • > 2 days/week
  • ≤ 2 days/week
FEV₁ or peak flow

Select one option:

  • < 60% predicted/personal best
  • 60-80% predicted/personal best
  • > 80% predicted/personal best
  • Unknown
Validated questionnaires (ATAQ, ACQ, ACT)

Select one option:

  • ATAQ 3-4; ACQ N/A; ACT ≤ 15
  • ATAQ 1-2; ACQ ≥ 1.5; ACT ≤ 16-19
  • ATAQ 0; ACQ ≤ 0.75*; ACT ≥ 20 (*ACQ values of 0.76-1.4 are indeterminate regarding well-controlled asthma)
  • Unknown
Exacerbations requiring oral systemic corticosteroids

Consider severity and interval since last exacerbation

Select one option:

  • ≥ 2/year
  • 0-1/year
Assess Control by Impairment Domain (Ages 5-11)

Assess impairment domain by patient'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.

Daytime symptoms

Select one option:

  • throughout the day
  • > 2 days/week or multiple times on ≤ 2 days/week
  • ≤ 2 days/week but not more than once on each day
Nighttime symptoms

Select one option:

  • ≥ 2x/week
  • ≥ 2x/month
  • ≤ 1x/month
Interference with normal activity

Select one option:

  • extremely limited
  • some limitation
  • None
Short-acting beta agonist (SABA) for symptom control (not exercise induced)

Select one option:

  • several times per day
  • > 2 days/week
  • ≤ 2 days/week
FEV₁ peak flow & FEV₂/FVC

Select one option:

  • FEV₁ <60% predicted/personal best; FEV₂/FVC <75%
  • FEV₁ 60-80% predicted/personal best; FEV₂/FVC 75-80%
  • FEV₁ >80% predicted/personal best; FEV₂/FVC >80%
Exacerbations requiring oral systemic corticosteroids

Consider severity and interval since last exacerbation

Select one option:

  • ≥ 2/year
  • 0-1/year
Assess Control by Impairment Domain (Ages 0-4)

Assess impairment domain by patient'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.

Daytime symptoms

Select one option:

  • throughout the day
  • > 2 days/week
  • ≤ 2 days/week
Nighttime symptoms

Select one option:

  • > 1x/week
  • > 1x/month
  • ≤ 1x/month
Interference with normal activity

Select one option:

  • extremely limited
  • some limitation
  • none
Short-acting beta agonist (SABA) for symptom control (not exercise induced)

Select one option:

  • several times per day
  • > 2 days/week
  • ≤ 2 days/week
Exacerbations requiring oral systemic corticosteroids

Consider severity and interval since last exacerbation

Select one option:

  • > 3/year
  • 2-3/year
  • 0-1/year
Possible results
Not Well Controlled (Ages 0-4): Step up 1 step. If an alternative treatment option was used in a step, discontinue it and use preferred treatment in that step (or) step up one to a preferred plan. Re-evaluate in 2-6 weeks.

For side effects, consider alternative treatment options.

  • The stepwise approach is meant to assist, not replace, the clinical decision-making required to meet individual patient needs.
Due to severity, consider short course of oral corticosteroids: 30-60 mg/day, as a single or 2 divided doses max 60 mg/day. Treat for 3-10 days. Reevaluate in 2 weeks. (Very Poorly Controlled: Ages 12+)
Before step up in therapy: Review adherence to medication, inhaler technique, environmental control, and comorbid conditions. Consider remaining on current treatment step while addressing these factors. (Not Well Controlled: Ages 0-4)
If no clear benefit in 4-6 weeks, consider alternative diagnosis or adjusting therapy. (Not Well Controlled: Ages 0-4)
Before step up in therapy: Review adherence to medication, inhaler technique, environmental control, and comorbid conditions. Consider remaining on current treatment step while addressing these factors. (Not Well Controlled: Ages 12+)
Well Controlled (Ages 5-11): Maintain current step. Regular follow-ups every 1-6 months. Consider step down if well controlled for at least 3 months.

The stepwise approach is meant to assist, not replace, the clinical decision-making required to meet individual patient needs.

Due to severity, consider short course of oral corticosteroids: 30-60 mg/day, as a single or 2 divided doses max 60 mg/day. Treat for 3-10 days. Reevaluate in 2 weeks. (Very Poorly Controlled: Ages 0-4)
Risk: Progressive loss of lung function (Ages 12+). Evaluation requires long-term follow-up
Before step up in therapy: Review adherence to medication, inhaler technique, environmental control, and comorbid conditions. Consider remaining on current treatment step while addressing these factors. (Very Poorly Controlled: Ages 0-4)
Before step up in therapy: Review adherence to medication, inhaler technique, environmental control, and comorbid conditions. Consider remaining on current treatment step while addressing these factors. (Very Poorly Controlled: Ages 5-11)
Well Controlled (Ages 12+): Maintain current step. Regular follow-ups every 1-6 months. Consider step down if well controlled for at least 3 months.

The stepwise approach is meant to assist, not replace, the clinical decision-making required to meet individual patient needs.

Very Poorly Controlled (Ages 12+): Step up 1-2 steps. If an alternative treatment option was used in a step, discontinue it and use preferred treatment in that step (or) step up one to a preferred plan (or) step up two to an alternative plan.

For side effects, consider alternative treatment options.

  • The stepwise approach is meant to assist, not replace, the clinical decision-making required to meet individual patient needs.
Not Well Controlled (Ages 5-11): Step up 1 step. If an alternative treatment option was used in a step, discontinue it and use preferred treatment in that step (or) step up one to a preferred plan. Re-evaluate in 2-6 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.
Risk: Reduction in lung growth (Ages 5-11). Evaluation requires long-term follow-up.
Before step up in therapy: Review adherence to medication, inhaler technique, environmental control, and comorbid conditions. Consider remaining on current treatment step while addressing these factors. (Not Well Controlled: Ages 5-11)
If no clear benefit in 4-6 weeks, consider alternative diagnosis or adjusting therapy. (Very Poorly Controlled: Ages 0-4)
Very Poorly Controlled (Ages 5-11): Step up 1-2 steps. If an alternative treatment option was used in a step, discontinue it and use preferred treatment in that step (or) step up one to a preferred plan (or) step up two to an alternative plan.

For side effects, consider alternative treatment options.

  • The stepwise approach is meant to assist, not replace, the clinical decision-making required to meet individual patient needs.
Before step up in therapy: Review adherence to medication, inhaler technique, environmental control, and comorbid conditions. Consider remaining on current treatment step while addressing these factors. (Very Poorly Controlled: Ages 12+)
Well Controlled (Ages 0-4): Maintain current step. Regular follow-ups every 1-6 months. Consider step down if well controlled for at least 3 months.

The stepwise approach is meant to assist, not replace, the clinical decision-making required to meet individual patient needs.

Treatment-related adverse effects: Medication side effects vary in intensity from none to very troublesome. The level of intensity does not correlate to specific levels of control but should be considered in the overall risk assessment.
Very Poorly Controlled (Ages 0-4): Step up 1-2 steps. If an alternative treatment option was used in a step, discontinue it and use preferred treatment in that step (or) step up one to a preferred plan (or) step up two to an alternative plan.

The stepwise approach is meant to assist, not replace, the clinical decision-making required to meet individual patient needs.

Due to severity, consider short course of oral corticosteroids: 30-60 mg/day, as a single or 2 divided doses max 60 mg/day. Treat for 3-10 days. Reevaluate in 2 weeks. (Very Poorly Controlled: Ages 5-11)
Not Well Controlled (Ages 12+): Step up 1 step. If an alternative treatment option was used in a step, discontinue it and use preferred treatment in that step (or) step up one to a preferred plan. Re-evaluate in 2-6 weeks.

For side effects, consider alternative treatment options.

  • The stepwise approach is meant to assist, not replace, the clinical decision-making required to meet individual patient needs.

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