Primary Care Clinical Pathway for Children with Known Asthma Diagnosis or Suspected Asthma

Concern for respiratory distress refer to Primary Care Acute Asthma Pathway
RN/MA Assessment, Vital Signs, Respiratory Rate, Spirometry in children ≥ 6 years of age
Use Asthma Order SmartSet
New Diagnosis
API, preschool age
Early frequent wheezer (≥ 3x) and 1 major
or 2 minor
Major Criteria
  • Parental MD asthma
  • MD diagnosed eczema + skin/blood test to one allergen
Minor Criteria
  • Wheezing apart from colds
  • Eosinophilia
  • Allergic sensitization to milk, egg or peanuts
  • Allergic rhinitis
  • Create Asthma Care Plan in EPIC
  • Discharge Instructions and Education
    • Provider Teaching:
      • Use EPIC Asthma Medicaid orderset as appropriate
      • Discuss medication
    • RN/Asthma Navigator Teaching:
      • Use Epic Care Assistant Teaching Tool
      • Teach device technique
      • Discuss adherence
      • Reinforce/dispense medication
Follow-up
  • Scheduled follow-up in 2-4 weeks to confirm diagnosis
  • Follow known-diagnosis pathway if confirmed diagnosis
  • Use EPIC Asthma Medicaid Order Set as appropriate
Known Diagnosis
  • Goal: Achieve Asthma Control
  • By reducing impairment and risk
  • Update Asthma Care Plan in EPIC
  • Discharge Instructions and Education
    • Provider Teaching:
      • Use EPIC Asthma Medicaid orderset as appropriate
      • Discuss medication
    • RN/Asthma Navigator Teaching:
      • Use Epic Care Assistant Teaching Tool
      • Teach device technique
      • Discuss adherence
      • Reinforce/dispense medication
Follow-up
  • Follow-up recommendations:
  • While gaining control: every 2-6 weeks
  • Monitoring Control: every 1-6 months
  • Anticipating Step-down of therapy: every 3 months
  • Referrals
    • Pulmonary & Allergy for Problematic Asthmatics (PAPA) Clinic, Allergy/Immunology, Pulmonary
  • Use EPIC Asthma Medicaid order set as appropriate
Posted: February 2020
Revised: April 2020, June 2020, January 2021, February 2021
Authors: T. Bryant-Stephens, MD; M. Jackson-Ware, RN; L. Biggs, MD; K. Dang, MD; K. Filograna, MD; A. Moore, PharmD; V. Schied, MD; S. Tomaine, DO