II. Criteria

  1. Moderate limitation with normal activity
  2. Daily symptoms
    1. Daily Beta Agonist use
    2. Exacerbations exceed twice per week (may last days)
    3. Nocturnal symptoms more than once per week (but not nightly)
  3. Pulmonary Function Tests
    1. FEV1 or PEF between 60-80% predicted
    2. FEV1 to FVC ratio decreased 5% from normal
    3. PEF variability >30%

III. Management

  1. Asthma Education
  2. Long-acting (use both agents)
    1. Long-Acting Bronchodilators (e.g. Salmeterol)
      1. Consider weaning off in well controlled Moderate Asthma (see below)
    2. Inhaled Corticosteroids
      1. Start with medium dose Corticosteroid when stepping up to combine with long-acting Bronchodilator
        1. May decrease to a low-dose Corticosteroid once Asthma well controlled
      2. Avoid eliminating Corticosteroid completely
        1. Associated with poorer outcomes
        2. Lemanske (2001) JAMA 285:2594-603 [PubMed]
  3. Short-acting
    1. Rescue with beta agonist
  4. Adjunctive agents: Leukotriene agents
    1. Leukotriene Receptor Antagonist (e.g. Montelukast)
    2. Leukotriene Synthesis Inhibitors (e.g. Zileuton or Zyflo)

IV. Management: Stepping down therapy in well controlled Moderate Asthma

  1. Indications
    1. Albuterol rescue Inhaler use no more than 2 times weekly while on combination long-acting agents
  2. Protocol
    1. Step 1
      1. Decrease dose of Inhaled Corticosteroid
      2. Continue the long-acting Bronchodilator
    2. Step 2
      1. Continue the Inhaled Corticosteroid at either low dose (or at increased dose)
      2. Stop the long-acting Bronchodilator (e.g. Salmeterol or Serevent)
    3. Step 3
      1. Restart the long-acting Bronchodilator if Albuterol rescue Inhaler required more than 2 times weekly
  3. References
    1. (2012) Presc Lett 19(11): 62

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Ontology: Moderate persistent asthma (C1960047)

Concepts Disease or Syndrome (T047)
ICD10 J45.40 , J45.4
SnomedCT 427295004
English Moderate persistent asthma, Moderate persistent asthma (disorder), moderate persistent asthma (diagnosis), moderate persistent asthma, Moderate persistent asthma NOS
Spanish asma persistente moderada (trastorno), asma persistente moderada