Mqic.org2

July 2012
Michigan Quality Improvement Consortium Guideline
Management of Asthma in Children 0 to 4 Years
Key Components
Recommendation and Level of Evidence
Assess Asthma Severity
Components of Severity
Impairment
≥ 2 in 6 months requiring oral steroids, or ≥ 4 in 1 year lasting > 1 day and have risk factors
for persistent asthma
Consider severity & interval since last exacerbation. Frequency & severity may fluctuate over time for patient of any severity class.
Recommended step for initiating treatment Re-evaluate control in 2-6 weeks and adjust therapy accordingly.
Assess Asthma Control
and step therapy up or down. Components of Control
Impairment
> 2 days/week or many times on ≤ 2 days/week Intensity of medication-related side effects does not correlate to specific levels of control, but should be considered in overall assessment of risk.
 Consider step down if well-controlled  If no clear benefit in 4-6 weeks, consider alternative diagnosis or adjust therapy [D].
 Quick relief medication for all patients: Inhaled short-acting beta2-agonist (SABA) as needed [A]. Up to 3 treatments at 20-minute intervals as needed. Short course of
oral corticosteroids may be needed.
 Use of SABA > 2 days a week for symptom control (not prevention of exercise-induced bronchospasm) indicates inadequate control and the need to step up treatment.
 Patient education and environmental control at each step.
 Persistent asthma: Daily long-term control therapy [A]; consult with asthma specialist step 4 or higher [D]; consider consultation at step 3 [D]
Intermittent
Mild Persistent
Moderate Persistent
Severe Persistent
Preferred
Preferred
Preferred
Preferred
Preferred
Preferred
Low-dose inhaled corticosteroid [A] Medium-dose inhaled Medium-dose inhaled
High-dose inhaled corticosteroid + oral corticosteroid + corticosteroid [D]
either a long-acting beta2-agonist* or montelukast [D]
Alternative
Cromolyn or Montelukast [B]
agonist* or montelukast or montelukast [D]
[D]
Warning for use of Long-acting beta-agonists (LABA). See Black Box Warning:
 Do not use LABA as monotherapy. Use only with an asthma controller such as inhaled corticosteroids (preferably combination product for children).
 Use for the shortest duration possible.
 Only use if not controlled on other drugs.
 Pediatric and adolescent patients who require the addition of a LABA to an inhaled corticosteroid should use a combination product containing both.
*Currently there are no LABAs identified for use in children 0-4 years of age.
Levels of Evidence for the most significant recommendations: A = randomized controlled trials; B = controlled trials, no randomization; C = observational studies; D = opinion of expert panel
This guideline lists core management steps. It is based on the 2007 National Asthma Education and Prevention Program Expert Panel Report 3, Guidelines for the Diagnosis and Management of Asthma, National Heart, Lung and Blood
Institute (www.nhlbi.nih.gov). Individual patient considerations and advances in medical science may supersede or modify these recommendations.
Approved by MQIC Medical Directors July 2008, 2010, 2012
MQIC.ORG

Source: http://www.mqic.org/pdf/mqic_management_of_asthma_in_children_0_to_4_years_cpg.pdf