Diagnosis and Management of Asthma – Ages 5 and Up INTEGRIS Health Partners Asthma Task Force 1

Patient presents with symptoms of asthma Previous diagnosis of asthma? Acute asthma exacerbation? Evaluation: Medical history Use of validated questionnaire Assess asthma triggers/allergies Physical Examination Measure lung function At a minimum, consider spirometry every 12 months Consider specialty consultation Determine level of asthma control Step care of pharmacologic treatment Asthma Education: Basic facts about asthma*Environmental control measures How medications work*Emphasize need for regular follow- Inhaler technique with spacer up visits Written action plan based on symptom diary Establish diagnosis of asthma and determine level of severity. Assess severity of asthma exacerbation Does ED patient need ED or inpatient management? See ED and Inpatient Management of Asthma algorithm Management of asthma exacerbation: Beta₂ - agonists Corticosteroids Assess response to treatment Does patient need ED or inpatient asthma management? Schedule regular follow-up visits 2 IHP - Asthma Outpatient Guidelines No Yes No Yes

Suggested Cost Effective Drugs in Treating Asthma 3 Low Dose Steroid InhalersDosageFrequencyCost Qvar40 micrograms2 puffs twice a day●● Asmanex110 micrograms1 puff daily●●● Flovent HFA44 micrograms2 puffs twice a day●●● Moderate Dose Steroid InhalersDosageFrequencyCost Qvar80 micrograms2 puffs twice/day●● Asmanex220 micrograms1 puff daily●●● Flovent HFA110 micrograms2 puffs twice/day●●● Pulmicort Flexhaler90 micrograms1 puff twice/day●●● High Dose Steroid InhalersDosageFrequencyCost Pulmicort Flexhaler180 micrograms1 puff twice/day●●● QVar80 micrograms4 puffs twice/day●●●●● Flovent HFA220 micrograms2 puffs twice/day●●●●● Asmanex220 micrograms2 puffs daily●●●●●● Pulmicort Flexhaler180 micrograms2 puffs twice/day●●●●●● Note: Each ● represents approximately $50 in cost. If a drug says “minimal”, it costs < $50. Cost is based on prescribed dose for 1 month.

4 Suggested Cost Effective Drugs in Treating Asthma Nebulizer MedicationsDosageFrequencyCost Albuterol.083%Minimal Accuneb● Budesonide0.25 mg/2ml1 ampule twice/day●●●●● Budesonide0.5 mg/2ml1 ampule twice/day●●●●●● Xopenex1.25 mg1 ampule every 6 hrs●●●●●● Rescue InhalerCost Proair HFAMinimal Proventil HFA● Ventolin HFA● Xopenex HFA● Note: Each ● represents approximately $50 in cost. If a drug says “minimal”, it costs < $50. Cost is based on prescribed dose for 1 month.

5 Low Dose SteroidDosageFrequencyCost Advair Diskus100/501 puff twice/day●●●● Advair HFA45/212 puffs twice/day●●●● Suggested Cost Effective Drugs in Treating Asthma Moderate Dose SteroidDosageFrequencyCost Symbicort80/4.52 puffs twice/day●●●● Dulera100/52 puffs twice/day●●●●● Advair Diskus250/501 puff twice/day●●●●● Advair HFA115/212 puffs twice/day●●●●● Combination Inhalers High Dose SteroidDosageFrequencyCost Symbicort160/4.52 puffs twice/day●●●●● Dulera200/52 puffs twice/day●●●●● Advair Diskus500/501 puffs twice/day●●●●●● Advair HFA230/212 puffs twice/day●●●●●● Note: Each ● represents approximately $50 in cost. If a drug says “minimal”, it costs < $50. Cost is based on prescribed dose for 1 month.