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Asthma management decision support

Pulmonary Medicine

Asthma Management

Guideline-mapped workflow for the management of adult patients with asthma.

Use this tool to support diagnosis confirmation, initial treatment selection, follow-up care, and severe asthma escalation.

Contributors

Abhimanyu Chandel, MD MAS
Ryan Fashempour, MD

1) Diagnostic Confirmation Context

Management phase Age

Typical variable respiratory symptoms are present (wheeze, dyspnea, chest tightness, or cough with variable triggers) Clinical improvement to ICS meets diagnostic criteria

Baseline Spirometry

Pre-BD values

Pre-BD FEV1 (L) Pre-BD FVC (L) Pre-BD FEV1 % predicted Pre-BD FVC % predicted

Post-BD values

Post-BD FEV1 (L) Post-BD FVC (L)

Asthma therapies were withheld prior to spirometry

Bronchodilator washout reference

SABA	4-6 h
SAMA	12 h
LABA	24 h
Ultra-LABA	36 h
LAMA	36-48 h

ICS and leukotriene modifiers usually do not need to be withheld. For combination inhalers, use the longest-acting component and follow local lab protocol.

Bronchoprovocative Testing

Bronchoprovocation result

Diagnostic Helper

GINA diagnosis in adults should combine typical symptoms with objective evidence of variable expiratory airflow. Bronchodilator responsiveness is counted if either the traditional threshold or the ATS/ERS predicted-value threshold is met.

BD response: -- Objective support: --

2) Symptom Burden and GINA Control

Initial Track 1 Starting-Point Inputs

Daytime symptom frequency Night waking frequency

The patient is starting or restarting treatment during an acute exacerbation or shortly after urgent clinical worsening

Red-flag presentation today (severe respiratory distress, cyanosis, altered mental status, silent chest, or unstable oxygenation)

GINA Symptom Control Checker (Last 4 Weeks)

Daytime asthma symptoms more than twice per week Any night waking due to asthma Reliever use more than twice per week Any activity limitation due to asthma

Control: --

3) Exacerbation History (Previous 12 Months)

Exacerbations requiring oral corticosteroids Enter an explicit 0 if none occurred. Exacerbations requiring hospitalization Enter an explicit 0 if none occurred.

Exacerbation counts: --

Prior ICU admission, intubation, or other life-threatening asthma exacerbation Exacerbations remain a persistent active problem despite current therapy

5) Preventive Care Status

Pneumococcal vaccine status RSV vaccine status

Zoster vaccine status Tdap or tetanus booster within the last 10 years

Influenza vaccine status COVID vaccine status

6) Current Maintenance Status

Current asthma maintenance regimen

Asthma Management

1) Diagnostic Confirmation Context

Baseline Spirometry

Pre-BD values

Post-BD values

Bronchoprovocative Testing

Diagnostic Helper

2) Symptom Burden and GINA Control

Initial Track 1 Starting-Point Inputs

GINA Symptom Control Checker (Last 4 Weeks)

3) Exacerbation History (Previous 12 Months)

4) Biomarkers, Phenotype, and Modifiers

Medication Considerations

Phenotypic Considerations

5) Preventive Care Status

6) Current Maintenance Status

Assessment Summary

Recommended Management Steps

Medication Details

Biologic Guidance

Preferred Agents

Secondary Agents

Specific Considerations

Preventive Care and Vaccination

Rationale Trace

Safety Checks

Non-Pharmacologic Core Bundle

Copy/Paste Clinical Note