Please feel free to either copy and paste the template below, or you can download it at the link below.
Let me know if you have any updates or corrections.
**Start of Template**
A/P
Patient reports a history of asthma for many years
Is currently taking: {_}
Has taken: {_}
Has not had a PFT done recently
Not currently experiencing any symptoms
Assessment of severity:
—Intermittent Asthma: Symptom frequency < 2/week, < 2 nighttime wakings per month, no interference with daily activities
—Mild Persistent: Symptoms frequency > 2 times/week, but not daily, nighttime wakings 3-4 times per month, minor limitation in daily activities
—Moderate Persistent: Daily symptoms, waking 1 time per week at night, some limitations in activities
—Severe persistent: daily symptoms, waking every night, extreme limitation in activities
Step Treatment for Asthma:
—Step 1: Intermittent: No daily therapy, SABA or ICS/Formoterol as needed
—Step 2: Mild persistent: Low dose daily ICS and SABA PRN, or Daily ICS/Formoterol and use ICS Formoterol for flares
—Step 3: Moderate Persisitent: Daily and rescue therapy of low dose ICS/formoterol, or daily medium dose ICS and SABA as rescue
—Step 4: Moderate/severe persistent: Medium dose ICS/formoterol for daily and rescue, or medium dose ICS/LABA daily and SABA for rescue
—Step 5: Severe Persistent: Medium to high dose ICS/Formoterol, LAMA (tiotropium) daily, and SABA for rescue
—Step 6: Consider adding biologics, patient should be with pulm at this point
Patients severity is currently: {_}
-continue current medications of: {_}
– consider adding monteleukast,
The above was based on GINA guidelines for the management of outpatient Asthma.
**End of Template**