Montana Public Health : Prevention Opportunities Under the Big Sky 2008 Jan

Cover Montana Public Health : Prevention Opportunities Under the Big Sky 2008 Jan
Montana Public Health : Prevention Opportunities Under the Big Sky 2008 Jan
Montana. Dept. of Public Health And Human Services
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New guidelines from the National Heart, Lung and Blood Institute (NHLBI) recommend a stepwise approach to managing asthma in the clinical setting (see recommendations be- low).^ New Asthma Control Program: To help address the burden of asthma in Montana, the state legislature has provided funds to DPHHS to establish a new asthma control program. Initially, the program will develop a surveillance system to monitor emergency department use for asthma and establish an advisory group to as- sist DP...HHS in developing and implementing effective asthma control strategies. Program staff are currently compiling existing asthma data into an asthma burden report for the state that will be available in Spring 2008.
Clinical Recommendations: Stepwise Approach to managing asthma in patients age 12 and older LlntermittenP Asthma Stepi Preferred SABA PRN Persistent Asthma: Daily IVIedication Consult with asthma specialist at Step 4 care or higher Step 2 Preferred Low dose ICS Alternative Cromolyn LIRA, nedocromil or theophylline Step 3 Preferred Low dose ICS +LABA Alternative Low-dose ICS + either LIRA, theophylline or "ep4 eferred idium dose S +LABA ternative "idium-dose S + either ■RA, theophyl- Steps Preferred High dose ICS +LABA Consider omalizumab for patients with allergies Step 6 Preferred High dose ICS +LABA+ oral corticosteroid And Consider omalizumab for patients with allergies Step up if needed (First, check adherence, envi- ronmental control comorbidities) I a re r Assess control tep down possible (asthma is well controlled for > 3 months) At each step, patient education, environmental control, management of comorbidities.


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