Diagnosis and Management of
Asthma – Ages 5 and Up
INTEGRIS Health Partners
Asthma Task Force
1
IHP - Asthma Outpatient Guidelines
Patient presents with
symptoms of asthma
Establish diagnosis of
asthma and determine
level of severity.
No
Previous diagnosis of
asthma?
Yes
Acute asthma
exacerbation?
Yes
Assess severity of
asthma exacerbation
No
Evaluation:
•Medical history
•Use of validated questionnaire
•Assess asthma triggers/allergies
•Physical Examination
•Measure lung function
•At a minimum, consider spirometry every 12 months
•Consider specialty consultation
Determine level of
asthma control
Step care of
pharmacologic
treatment
Asthma Education:
•Basic facts about asthma
•How medications work
•Inhaler technique with spacer
•Written action plan based
on symptom diary
*Environmental control measures
*Emphasize need for regular followup visits
Schedule regular follow-up visits
Does ED
patient need
ED or inpatient
management?
Yes
See ED and
Inpatient
Management
of Asthma
algorithm
No
Management of asthma
exacerbation:
•Beta₂ - agonists
•Corticosteroids
Assess response to
treatment
Does patient
need ED or
inpatient
asthma
management?
No
Yes
2
Suggested Cost Effective Drugs in Treating Asthma
Low Dose Steroid Inhalers
Dosage
Frequency
Cost
Qvar
40 micrograms
2 puffs twice a day
●●
Asmanex
110 micrograms
1 puff daily
●●●
Flovent HFA
44 micrograms
2 puffs twice a day
●●●
Moderate Dose Steroid Inhalers
Dosage
Frequency
Cost
Qvar
80 micrograms
2 puffs twice/day
●●
Asmanex
220 micrograms
1 puff daily
●●●
Flovent HFA
110 micrograms
2 puffs twice/day
●●●
Pulmicort Flexhaler
90 micrograms
1 puff twice/day
●●●
High Dose Steroid Inhalers
Dosage
Frequency
Cost
Pulmicort Flexhaler
180 micrograms
1 puff twice/day
●●●
QVar
80 micrograms
4 puffs twice/day
●●●●●
Flovent HFA
220 micrograms
2 puffs twice/day
●●●●●
Asmanex
220 micrograms
2 puffs daily
●●●●●●
Pulmicort Flexhaler
180 micrograms
2 puffs twice/day
●●●●●●
Note:
Each ● represents
approximately $50 in cost. If a
drug says “minimal”, it costs <
$50. Cost is based on
prescribed dose for 1 month.
3
Suggested Cost Effective Drugs in Treating Asthma
Rescue Inhaler
Proair HFA
Cost
Minimal
Proventil HFA
●
Ventolin HFA
●
Xopenex HFA
●
Nebulizer Medications
Dosage
Albuterol
.083%
Frequency
Cost
Minimal
Accuneb
●
Budesonide
0.25 mg/2ml
1 ampule twice/day
●●●●●
Budesonide
0.5 mg/2ml
1 ampule twice/day
●●●●●●
Xopenex
1.25 mg
1 ampule every 6 hrs
●●●●●●
Note:
Each ● represents
approximately $50 in cost. If
a drug says “minimal”, it costs
< $50. Cost is based on
prescribed dose for 1 month.
4
Suggested Cost Effective Drugs in Treating Asthma
Combination Inhalers
Low Dose Steroid
Dosage
Frequency
Cost
Advair Diskus
100/50
1 puff twice/day
●●●●
Advair HFA
45/21
2 puffs twice/day
●●●●
Moderate Dose Steroid
Dosage
Frequency
Cost
Symbicort
80/4.5
2 puffs twice/day
●●●●
Dulera
100/5
2 puffs twice/day
●●●●●
Advair Diskus
250/50
1 puff twice/day
●●●●●
Advair HFA
115/21
2 puffs twice/day
●●●●●
High Dose Steroid
Dosage
Frequency
Cost
Symbicort
160/4.5
2 puffs twice/day
●●●●●
Dulera
200/5
2 puffs twice/day
●●●●●
Advair Diskus
500/50
1 puffs twice/day
●●●●●●
Advair HFA
230/21
2 puffs twice/day
●●●●●●
Note:
Each ● represents
approximately $50 in cost. If
a drug says “minimal”, it costs
< $50. Cost is based on
prescribed dose for 1 month.
5