Student Health Services

• Symptoms less than or equal to 2 times a week
• Asymptomatic and normal PEF between exacerbations
• Exacerbations brief (from a few hours to a few days); intensity may vary

• Symptoms greater than 2 times a week but less than 1 time a day
• Exacerbations may affect activity

• Daily Symptoms
• Daily use of inhaled short-acting beta2-agaonists
• Exacerbations affect activity
• Exacerbations greater than or equal to 2 times a week; may last days

• Continual Symptoms
• Limited Physical Activity
• Frequent exacerbations

• FEV-1 or PEF
• Greater than or equal to 80% predicted
• PEF variability less than 20%

• FEV-1 or PEF
• Greater than or equal to 80% predicted
• PEF variability 20-30%

• FEV-1 or PEF > 60% to < 80% predicted
• PEF variability greater than 30%

• FEV-1 or PEF less than or equal to 60% predicted
• PEF variability greater than 30%

One daily medication:

• Anti-inflammatory: either inhaled corticosteroid (low doses) or cromolyn or nedocromil (children usually begin with a trial of cromolyn or nedocromil).
• Sustained-release theophylline to serium concentrations of 5-15 mcg/mL is an alternative, but not preferred, therapy.
• Zafirlukast or zileuton may also be considered for patients greater than 12 years of age, although their position in therapy is not fully established.

Daily medication:

• Either Anti-inflammatory: inhaled cortico-steroid (medium dose)
• or Inhaled corticosteroid (low-medium dose) and add a long-acting bronchodilator, especially for nighttime symptoms: either long-acting inhaled beta2-agonist, sustained-release theophylline, or long-acting beta2-agonist tablets.

If needed:

• Anti-inflammatory: inhaled cortico-steroids (medium-high dose) and
• Long-acting bronchodilator, especially for nighttime symptoms: either long-acting inhaled beta2-agonist, sustained-release theophylline, or long-acting beta2-agonist tablets

Daily medications:

• Anti-inflamamatory; inhaled corticosteroid (high dose) and
• Long-acting bronchodilator; either long-acting inhaled beta2 agonist, sustained-release theophylline, or long-acting beta2 agonist tablets and
• Corticosteroid tablets or syrup long-term (make repeat attempts to reduce systemic steroids and maintain control with high-dose ihaled steroids)

• Short-acting broncho-dilator: inhaled beta2-agonists as needed for symptoms.
• Intensity of treatment will depend on severity of exacerbation.
• Use of short-acting inhaled beta2-agonists more than 2 times a week may indicate the need to initiate long-term-control therapy.

• Short-acting broncho-dilator: inhaled beta2-agonists as needed for symptoms.
• Intensity of treatment will depend on severity of exacerbation.
• Use of short-acting inhaled beta2-agonists on a daily basis, or increasing use, indicates the need for additional long-term-control therapy.

• Short-acting broncho-dilator; Inhaled beta2-agonists as needed for symptoms.
• Intensity of treatment will depend on severity of exacerbation.
• Use of short-acting inhaled beta2-agonists on a daily basis, or increasing use, indicates the need for additional long-term- control therapy.

• Short-acting bronchodilator; inhaled beta2-agonists as needed for symptoms.
• Intensity of treatment will depend on severity of exacerbation.
• Use of short-acting inhaled beta2-agonists on a daily basis, or increasing use, indicates the need for additional long-term- control therapy.

• Teach basic facts about asthma
• Teach inhaler /spacer/holding chamber technique
• Discuss roles of medications
• Develop self-management plan
• Develop action plan for when and how to take rescue actions, especially for patients with a history of severe exacerbations
• Discuss appropriate environmental control measures to avoid exposure to known allergens and irritants.

Step 1 actions plus:

• Teach self-monitoring
• Refer to group education if available
• Review and update self- management plan

Step 1 actions plus:

• Teach self- monitoring
• Refer to group education if available
• Review and update self-management plan

Steps 2 and 3 actions plus:

• Refer to individual education/counseling