Asthma Practice Pathway

Sample Patient Progression in Asthma Pathway – November, 2013

Patient Pathway Assessment Severe Severe Severe Moderate Moderate Moderate Moderate Moderate Moderate
Severe Severe Severe Severe Severe Severe Severe Moderate Moderate
Time 2100 2200 2300 2400 0100 0200 0300 0400 0600
Albuterol Continuous Continuous Continuous Continuous Continuous * * Stop
Continuous
No treatment Treatment Treatment
Assessment CRM
Cont. Pox
BP
Temp once
CRM
Cont. Pox
BP
CRM
Cont. Pox
BP
CRM
Cont. Pox
BP
CRM
Cont. Pox
BP
CRM
Cont. Pox
BP
CRM
Cont. Pox
BP
HR/RR
Spot check Pox if on Oxygen

Enter Mod orders
HR/RR
Spot check Pox if on Oxygen
Patient Pathway Assessment Moderate Moderate Mild Mild Mild Mild Mild Mild Mild
Moderate Moderate Moderate Moderate Moderate Moderate Moderate Mild Mild
Time 0800 1000 1200 1400 1600 1800 1900 2000 2400
Albuterol Treatment Treatment Treatment Treatment Treatment * * No treatment No treatment * * Treatment * *Home Dose
Assessment HR / RR
Spot check Pox if on Oxygen
HR / RR
Spot check Pox if on Oxygen
HR / RR HR / RR HR / RR

Enter Mild orders
HR / RR HR / RR HR / RR HR / RR

**Denotes changes in treatment regime**

Transition: Severe to Moderate

  1. After 2 hrs of moderate/severe (total of 3 moderate/severe assessments) stop continuous albuterol
  2. Continue hourly assessments and document for 2 more hours
  3. Give treatment 2 hours after continuous albuterol stopped and change to moderate order set.

**If a patient will progress outside these guidelines please have a provider enter a variance order to support the change.

Transition: Moderate to Mild

  1. Must be on RA (no oxygen requirement)
  2. After 3 mild/moderate assessments- change to mild orders.
  3. Assess in 2 hours then hourly x2 hours.
  4. Give treatment on 4th hour from last treatment
  5. After 4 more hours, give home dose and continue until discharge
  6. Educate and demonstrate inhaler and spacer technique
  Severe Moderate Mild
Assessment
  • Significant work of breathing, accessory muscle use, and nasal flaring
  • Respiratory rate and heart rate increased
  • Wheezing: inspiratory and/or expiratory
  • Aeration: decreased throughout lung fields
  • Prolonged expiration present
  • Cough: weak or absent
  • FIO2: > 40%
  • Less work of breathing, accessory muscle use, and nasal flaring
  • Respiratory rate and heart rate lower
  • Wheezing: inspiratory and expiratory
  • Aeration: decreased in lower lung fields
  • No prolonged expiration
  • Cough: loose and productive
  • FIO2: 21% -40%
  • Work of breathing minimal or none
  • Respiratory rate and heart rate normal for age
  • Wheezing: minimal to none
  • Aeration: increased throughout all lung fields
  • No prolonged expiration
  • Cough: full, loose and productive
  • FIO2: 21%
Medications Continuous Albuterol Dosages

Full Dose
  • >20 kg = 3ml/hr
  • 10–20 kg = 2.25 ml/hr
  • 5 – 10 kg = 1.5 ml/hr
Additional medications
  • Atrovent - if ordered
  • Prednisone or Methylprednisolone - as ordered
Albuterol Treatment Dosages

Dose
  • >20 kg = 8 puffs q2h
  • 10–20 kg = 6 puffs q2hr
  • 5 – 10 kg = 4 puffs q2h
Additional medications
  • Discuss with provider stopping Atrovent
  • Continue Prednisone
Albuterol Treatment Dosages

First q4h
  • >20 kg = 8 puffs
  • 10-20 kg = 6 puffs
  • 5-10 kg = 4 puffs
Second q4h (Home Dose)
  • 2 puffs
  • 2 puffs
  • 2 puffs
Additional medications
  • Continue Home Dose every 4 hours until discharge
  • Continue Prednisone