《2010MQIC哮喘的诊断和管理的一般原则》内容预览

 Detailed medical history and physical exam to determine that symptoms of recurrent episodes of airflow obstruction are present

 Use spirometry* in all patients > 5 years of age to determine that airway obstruction is at least partially reversible [C].

 Consider alternative causes of airway obstruction.Goals of therapy are to achieve control by [A]:

 Reducing impairment (prevent chronic symptoms, minimize need for rescue therapy with short-acting beta2-agonists (SABA), maintain near-normallung function and activity levels).

 Reducing risk (prevent exacerbations, minimize need for emergency care or hospitalization, prevent loss of lung function or prevent reduced lung

growth in children, have minimal or no adverse effects of therapy).

Assess asthma severity to initiate therapy. (Use severity classification chart, assessing both domains of impairment [B] and risk [C] to determine

initial treatment.)

 Assess asthma control to monitor and adjust therapy [B]. (Use asthma control chart, assessing both domains of impairment and risk to determine if

therapy should be maintained or adjusted. (Step up if necessary; step down if possible.)

 Obtain spirometry* to confirm control, and at least every 1-2 years [B], more frequently for not well-controlled asthma.

Schedule follow-up care: In general, consider sche**ng patients at 2- to 6-week intervals while gaining control [D]; at 1- to 6-month intervals, depending

on step of care required or duration of control, to monitor if sufficient control is maintained; at 3-month intervals if a step-down in therapy is anticipated [D].

Assess asthma control, medication technique, written asthma action plan, patient adherence and concerns at every visit.

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