PARTNERSHIP HEALTHPLAN OF CALIFORNIA
GUIDELINE/ PROCEDURE
Guideline/Procedure Number: MPXG5001 (previously XG100501)
Guideline/Procedure Title: Clinical Practice Guidelines for the
Diagnosis & Management of Asthma
Original Date: 04/19/2000- Medi-Cal
06/20/2007 – Healthy Kids
Lead Department: Health Services
☒External Policy
☐ Internal Policy
Next Review Date: 02/19/2015
Last Review Date: 02/19/2014
Applies to:
☒ Medi-Cal
☒ Healthy Kids
☐ Employees
Reviewing
Entities:
☒ IQI
☐P&T
☒ QUAC
☐ OPERATIONS
☐ EXECUTIVE
☐ COMPLIANCE
☐ DEPARTMENT
☐ BOARD
☐ COMPLIANCE
☐ FINANCE
☒ PAC
☐ CREDENTIALING
☐ DEPT. DIRECTOR/OFFICER
Approving
Entities:
☐ CEO
☐ COO
Approval Signature: Robert Moore, MD, MPH
Approval Date: 02/19/2014
I.
RELATED POLICIES:
A. N/A
II.
IMPACTED DEPTS:
A. ---
III.
DEFINITIONS:
A. N/A
IV.
ATTACHMENTS:
A. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma published in
2007 (as updated through 2008) by the National Institute of Health, National Heart, Blood and Lung
Institute
V.
PURPOSE:
Asthma is a chronic condition of airway inflammation which manifests in wheezing, coughing, and dyspnea.
The prevalence of asthma has been increasing in the U.S. for many years, and it currently affects 8.2% of the
population (MMWR 2011; 60(17):547).
VI.
GUIDELINE / PROCEDURE:
A. Key Points in Diagnosis and Management
1. Diagnosis. The symptoms of asthma can be caused by other conditions, including, chronic
obstructive pulmonary disease (COPD), congestive heart failure (CHF), gastroesophageal reflux
disease (GERD), bronchiectasis, sarcoidosis, pulmonary embolism, panic disorder, and vocal cord
dysfunction, among others. An accurate diagnosis rests on an accurate history, physical findings,
pulmonary function tests (PFTs), and chest x-ray (CXR).
2. Treatment. The main principles of treatment consist of encouraging home monitoring of lung
function (peak flow), reducing environmental triggers where possible, and pharmacotherapy.
Pharmacotherapy should be individualized to the particular patient. This guideline cannot cover
every situation, but therapy for asthma generally includes anti-inflammatory inhalers (controller
therapy) used regularly, and bronchodilator inhalers (rescue therapy) used as needed.
B. PHC Formulary and other Medications ( Listing not inclusive)
1. Controller therapy (inhaled corticosteroids): QVAR (Inhaled beclomethasone), Pulmicort DPI
(inhaled budesonide), Flovent (inhaled fluticasone), Asmanex (inhaled mometasone).
2. Rescue therapy (short-acting beta agonist inhalers): Ventolin (inhaled albuterol).
I
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Guideline/Procedure Number: MPXG5001 (previously
Lead Department: Health Services
XG100501)
Guideline/Procedure Title: Clinical Practice Guidelines for the ☒ External Policy
Diagnosis & Management of Asthma
☐ Internal Policy
Original Date: 04/19/2000- Medi-Cal
Next Review Date: 02/19/2015
06/20/2007 – Healthy Kids
Last Review Date: 02/19/2014
Applies to: ☒ Medi-Cal
☒ Healthy Kids
☐ Employees
3. Other agents:
a. Long-acting beta agonists: Foradil (inhaled formoterol), Serevent (inhaled salmeterol). These
are not recommended as monotherapy for asthma and are non-formulary
b. Mast cell stabilizer: Cromolyn.
c. Step therapy options: Singulair (montelukast), Accolate (zafirlukast), Symbicort (inhaled
budesonide / formoterol), and Dulera (formoterol/ mometasone).
C. Indicator Monitored by PHC: The following indicator will be monitored for measurement of adherence
to this guideline (as reference from HEDIS measure: Medication Management for People with Asthma).
1. The percentage of members 5–64 years of age during the measurement year who were identified as
having persistent asthma and were dispensed appropriate medications that they remained on during
the treatment period. Two rates are reported:
a. The percentage of members who remained on an asthma controller medication for at least 50%
of their treatment period.
b. The percentage of members who remained on an asthma controller medication for at least 75%
of their treatment period.
VII.
REFERENCES:
A. PHC has adopted the asthma guidelines entitled, Expert Panel Report 3 (EPR3): Guidelines for the
Diagnosis and Management of Asthma published in 2007 (as updated through 2008) by the National
Institute of Health, National Heart, Blood and Lung Institute. A copy of the guideline is available at
http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm
VIII.
DISTRIBUTION:
A. HS Department UM Staff
B. PHC Provider and Practitioner Manuals
C. PHC Department Directors.
IX.
POSITION RESPONSIBLE FOR IMPLEMENTING PROCEDURE:
X.
REVISION DATES:
Medi-Cal
10/17/01; 09/18/02, 12/17/03; 04/20/05; 06/20/07; 08/18/10; 02/15/12; 02/19/14
Healthy Kids
08/18/10; 02/15/12; 02/19/14
PREVIOUSLY APPLIED TO:
PartnershipAdvantage
MPXG5001 - 06/20/2007 to 01/01/2015
Healthy Families
MPXG5001 - 08/18/2010 to 03/01/2013
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Clinical Practice Guidelines for the Diagnosis & Management of