Asthma Clinical Pathway – Inpatient – Asthma Control Assessment

Asthma Clinical Pathway – Inpatient

Asthma Control Assessment

< 5 yrs
Is this the second asthma exacerbation requiring systemic steroids in 6 mos?
  • If yes, asthma is not well controlled, consider Step up
    (see Stepwise table below).
  • If no, assess asthma control based on symptoms/impairment prior to onset of this exacerbation. Assess control using Asthma Control Tool.
  • Recommend Step up at discharge if not well or poorly controlled.
≥ 5 yrs
Is this the second exacerbation requiring systemic steroids in 12 mos?

Stepwise Recommended Medication Escalation Treatment for Managing Asthma Long Term

Adapted from 2020 Focused Updates to the Asthma Management Guidelines: Clinician's Guide  

  Step 1 Step 2 Step 3 Step 4 Step 5 Step 6
Symptoms Intermittent Mild Persistent Moderate Persistent Severe Persistent
0–4 yrs* Preferred
  • Low-dose:
    ICS and PRN SABA
 Medium-dose:
ICS and PRN SABA		 Daily medium-dose:
ICS-LABA and PRN SABA		 Daily high-dose:
ICS-LABA and PRN SABA		 Daily high-dose:
ICS-LABA + OCS and PRN SABA
5–11 yrs Preferred SABA as needed for symptoms Daily low-dose:
ICS and PRN SABA		 Daily and PRN combination low-dose:
ICS-formoterol		 Daily and PRN medium-dose:
ICS-formoterol		 Daily high-dose:
ICS-LABA and PRN SABA		 Daily high-dose:
ICS-LABA + OCS and PRN SABA
≥ 12 yrs Preferred SABA as needed for symptoms Daily low-dose:
ICS and PRN SABA or PRN concomitant ICS and SABA		 Daily and PRN combination low-dose:
ICS-formoterol		 Daily and PRN combination medium-dose:
ICS-formoterol		 Daily medium- or high-dose:
ICS-LABA + LAMA and PRN SABA		 Daily high-dose:
ICS-LABA + OCS + PRNs SABA
Quick Relief
  • Use SABA as needed for symptoms. The intensity of treatment depends on the severity of symptoms: up to 3 treatments at 20-min intervals as needed.
  • Preferred
    In steps 3 and 4, the preferred option includes the use of ICS-formoterol 1 to 2 puffs as needed up to a maximum total daily maintenance and rescue dose of 8 puffs (< 12 yrs) and 12 puffs (> 12 yrs).
*Adapted from 2020 NHLBI Asthma Focused Updates Highlighted table cells are consistent with SMART

API, Preschool Age

Early frequent wheezer (≥ 3x) and 1 major or 2 minor.

Major Criteria
  • Parental MD asthma
  • MD diagnosed eczema + skin/blood test to one allergen
Minor Criteria
  • Wheezing apart from colds
  • Eosinophilia
  • Allergic sensitization to milk, egg or peanuts
  • Allergic rhinitis