CONTROL

Assess based on current controller regimen Age 0-4 Years

Assess Control - CHECK FOR M.I.C.E.. Asthma on a Page
M Medication adherence Step Down - only after symptoms are well
controlled > 3 months.
I Inhaler technique
C Comorbidities (untreated allergies, GERD, sinusitis, sleep-disordered breathing)
E Environmental exposures (especially ETS)
Well Controlled (ACT 20) Not Well Controlled (ACT 16 - 19) Very Poorly Controlled (ACT 15)
Levels of Control IF ALL OF THE BELOW IF ANY OF THE BELOW IF ANY OF THE BELOW
Symptoms 2 days/wk Symptoms > 2 days/wk Symptoms throughout day
Awakening 1x/month Awakening > 1x/month Awakening > 1x/wk
SABA (not for EIB) 2 days/wk SABA (not for EIB) > 2 days/wk SABA (not for EIB) several times/day
No interference w/ normal Some limitation in normal Extremely limited activity
activity activity Oral steroid bursts > 3/year
Oral steroid bursts 0-1/year Oral steroid bursts 2-3/year
Maintain current step Check for M.I.C.E. Check for M.I.C.E.
Recommended Actions Regular follow up 1-6 months Consider consult w/ asthma Refer to asthma specialist
Consider step down if patient specialist Step up 1-2 steps
remains well controlled 3 Step up 1 step Consider short course oral steroids
months Reevaluate in 2-6 weeks

SEVERITY Assess at baseline, without controller

Classification Oral Steroid Symptoms SABA Use
Medications
Severity Burst Nighttime Interference w/
Recommended
Based on most severe Awakenings Normal Activity
Alternative
clinical symptom ACT Score

0-1 in past yr 2days/week 2days/week Step One

Intermittent
Not Daily Not Daily SABA prn
0 x/month No Limitation
ACT 20
2 in past 6 >2days/week >2days/week Step Two reevaluate control in 2-6 wks
Mild
months Not Daily Not Daily Low-Dose ICS
Persistent 3-4 x/month Minor Limitation Flovent 44mcg 2 puffs BID
ACT 16-19 Singulair 4mg QD (1-4yrs)

2 in past 6 Daily Daily Step Three reevaluate control in 2-6 wks

Moderate Medium-Dose ICS
months
Persistent 3-4 x/month Some Limitation Flovent 110mcg 1 puff BID
Not Nightly
CONSIDER CONSULT
WITH: ACT < 16
ASTHMA SPECIALIST
2 in past 6 Continual Several Step Four reevaluate control in 2 wks
Severe
months times/day Medium-Dose ICS + LABA/Montelukast
Persistent
>1 x/week Advair HFA 115mcg 2 puffs bid (4yrs)
Extremely Flovent 110mcg 1 puff BID + Singulair 4mg QD (1-4yrs)
REFER TO: ACT < 16 Limited
ASTHMA SPECIALIST Step Five reevaluate control in 2 wks
High-Dose ICS + LABA/Montelukast
Advair HFA 230mcg 2 puffs bid (4yrs)
Flovent 220mcg 1 puff BID + Singulair 4mg QD (1-4yrs)

Step Six refer to Asthma specialist

High Dose ICS + LABA/Montelukast + oral corticosteroid
Advair HFA 230mcg 2 puffs bid (4yrs)
Flovent 220mcg 1 puff BID + Singulair 4mg QD (1-4yrs)
AND
Prednisone (0.25-2mg/kg daily, taper)
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