Mount Carmel Health Partners Clinical Guidelines Asthma | Page 3

Management Patient Education
The goal of asthma management is to reduce functional
impairment and risk.
“Impairment” refers to the intensity and frequency of asthma
symptoms and the degree to which the patient is limited by these
symptoms. The goal is to:
• Prevent frequent or troublesome symptoms
• Maintain activities indicative of normal daily living
• Minimize the need (less than or equal to 2 times per weeks) of
inhaled short-acting beta agonists (SABAs) to relieve symptoms
• Lessen nighttime awakenings (less than 2 nights per month)
• Optimize lung function
• Reduce risk
• Prevent recurrent exacerbations and the need for emergency
department or hospital care
• Prevent reduced lung maturation in children
• Prevent the loss of lung function in adults
• Optimize pharmacology with minimal or no adverse side effects • Teach patient how to manage and control asthma
signs/symptoms.
• Provide medication instructions.
• Reinforce the importance of compliance.
• Demonstrate proper inhaler usage.
• Instruct patient on spacer/holding chamber usage.
• Discuss self-monitoring skills and the avoidance of triggers.
Vaccinations
• Influenza vaccination: the live attenuated vaccine (nasal spray)
is not recommended for people with asthma; the inactivated
vaccine (flu shot) should be given.
• Pneumococcal vaccination: recommended for all adults with
asthma. For persons ages 65 and older, a one-time
revaccination is recommended if previously vaccinated five or
more years earlier and less than age 65 at the time of primary
vaccination.
Indicators for Referral
• The patient has required hospitalization or more than 2 bouts
of oral corticosteroids in a year
• A diagnosis of asthma is uncertain
• The patient has asthma that is difficult to control
• Patient suffers frequent or continuous exacerbations
• The adult or pediatric patient older than age 5 requires Step 4
care or higher or a child under age 5 requires Step 3 care or
higher
Ongoing Monitoring
Routine follow-up after establishing the diagnosis of asthma
should be scheduled within one month of the initial evaluation.
Subsequent visits should be scheduled every one to six months
depending upon the severity of the asthma. Follow-up visits are
recommended within two weeks of an emergency room visit or
inpatient admission.
Consult a pulmonologist, asthma specialist, or allergist
depending upon the patient’s condition.
Inhaled Steroids
Generic Name
(Brand Name)
albuterol (ProAir®,
Proventil®, Ventolin®) Concentration
(mcg/puff)
levalbuterol (Xopenex®) 45
Short-Acting Anticholinergic ipratropium (Atrovent®) 17
Combined Short-Acting Beta
Agonist and Short-Acting
Anticholinergic ipratropium/Albuterol
(Combivent®) 20/100
beclomethasone (Qvar®) 40, 80
budesonide (Pulmicort®) 90, 180
Category
Category
90
Short-Acting Beta Agonists
Inhaled Corticosteroids
fluticasone propionate
(Flovent®)
fluticasone furoate
(Arnuity Ellipta®)
mometasone
(Asmanex®)
Combination
Long-Acting
Beta Agonist
and Inhaled
Corticosteroid
44, 110, 220
Long-Acting
Anticholinergic
Generic Name
(Brand Name)
budesonide/formoterol
(Symbicort®)
fluticasone/vilanterol
(Breo Ellipta®) Concentration (mcg/
puff)
80/4.5
160/4.5
Advair HFA
45/21
115/21
230/21
Advair Diskus
100/50
250/50
500/50
100/25
200/25
mometasone/formoterol
(Dulera®) 100/5
200/5
tiotropium (Spiriva
Respimat® ONLY) 1.25, 2.5
fluticasone/salmeterol
(Advair®)
100, 200
100, 200
Black Box Warning--Asthma-Related Death: fluticasone/sameterol (Advair®), fluticasone/vilanterol (Breo Elipta®), budesonide/formoterol
(Symbicort®), mometasone/formoterol (Dulera®)
Long-acting beta-2 adrenergic agonists (LABA) increase the risk of asthma-related death. Data from a large placebo-controlled U.S. study showed an increase in
asthma-related deaths in patients receiving salmeterol plus a usual asthma treatment, with results considered to be a LABA class effect. There is inadequate data
to determine if concurrent inhaled corticosteroids or other long-term asthma control treatments mitigate an increased risk of asthma-related death from LABA.
LABA use may increase the risk of asthma-related hospitalization in pediatric and adolescent patients. Use only for asth ma patients not controlled on long-term
asthma control treatment such as an inhaled corticosteroid or whose disease severity requires treatment with both corticosteroid and LABA. Once asthma control
is achieved and maintained, assess the patient at regular intervals and initiate a step down treatment (such as discontinue corticosteroid/LABA combination) if
possible without loss of asthma control. Maintain the patient on a long-term asthma control treatment such as inhaled corticosteroid; do not use corticosteroid/
LABA combination if asthma is adequately controlled on low-or medium-dose inhaled corticosteroids.
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