Figure 4-3b

Figure 4-3b



[filled square] The stepwise approach is meant to assist, not replace, the clinical decisionmaking required to meet individual patient needs.

[filled square] 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.

[filled square] At present, there are inadequate data to correspond frequencies of exacerbations with different levels of asthma control. In general, more frequent and intense exacerbations (e.g., 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.

[filled square] Before step up in therapy:

— Review adherence to medications, inhaler technique, environmental control, and comorbid conditions.

— If alternative treatment option was used in a step, discontinue it and use preferred treatment for that step.

From: Section 4, Managing Asthma Long Term in Children 0–4 Years of Age and 5–11 Years of Age

Cover of Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma
Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.
National Asthma Education and Prevention Program, Third Expert Panel on the Diagnosis and Management of Asthma.

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