Recommendation Language
Selecting Initial Therapy Conditional: 0–4 Years of Age: Initiating Long-Term Control Therapy. The
Expert Panel concludes that initiating daily long-term control therapy: and#14;
Is recommended for reducing impairment and risk of exacerbations in infants
and young children who had four or more episodes of wheezing in the past year
that lasted more than 1 day and affected sleep AND who have risk factors for
developing persistent asthma: either (1) one of the following: parental history of
asthma, a physician diagnosis of atopic dermatitis, or evidence of sensitization
to aeroallergens OR (2) two of the following: evidence of sensitization to foods,
≥4 percent peripheral blood eosinophilia, or wheezing apart from colds
(Evidence A).
Codable Components Fully-Specified Concept Name
Asthma Asthma (disorder)
daily long-term control therapy
reducing impairment and risk of Asthma control steps (procedure)
exacerbations in infants and young Exacerbation of asthma (disorder)
children
four or more episodes of wheezing Asthmatoid wheeze (finding)
affected sleep Asthma disturbing sleep (finding)
developing persistent asthma Severe persistent asthma (disorder)
Moderate persistent asthma (disorder)
Mild persistent asthma (disorder)
parental history of asthma Family history: Asthma (situation)
physician diagnosis of atopic Atopic dermatitis (disorder)
Sensitization Sensitization (observable entity)
aeroallergens Plant producing aeroallergens (organism)
foods Foods (substance)
≥4 percent peripheral blood Asthmatic pulmonary eosinophilia (disorder)
eosinophilia
wheezing apart from colds Finding of sound of breathing (finding)
Recommendation Language
Selecting Initial Therapy (3) Conditional: 0–4 Years of Age: Initiating Long-Term Control Therapy. The
Expert Panel concludes that initiating daily long-term control therapy: Should be
considered for reducing risk in infants and young children who have a second
asthma exacerbation requiring systemic corticosteroids within 6 months
(Evidence D). Recognition of these children and treatment with daily low-dose
ICS therapy can significantly reduce overall symptom burden and the
frequency of exacerbations, even though such treatment will not alter the
underlying severity of asthma in later childhood
Codable Components Fully-Specified Concept Name
Asthma excerbation Exacerbation of asthma (disorder)
Corticosteroids Corticosteroids and derivatives (substance)
Therapy Therapy (regime/therapy)
Recommendation Language
Control of the impairment domain is Conditional: The Expert Panel recommends the following actions if control of
not achieved and maintained the impairment domain is not achieved and maintained at any step of care:
Patient adherence and technique in using medications correctly should be
assessed and addressed as appropriate (Evidence C).
Fully-Specified Concept Name
Codable Components
Adherence to rules and boundaries (observable
Patient adherence entity)
control of impairment domain Impairment (finding)
Administration of prescribed medications and
using medications correctly solutions (procedure)
Recommendation Language
Consider referral to an asthma Conditional: The Expert Panel recommends referral to an asthma specialist
specialist for consultation or comanagement of the patient if (Evidence D): — There are
difficulties achieving or maintaining control of asthma. — A child 0–4 years of
age requires step 3 care or higher (step 4 care or higher for children 5–11
years of age) to achieve and maintain control or if additional education is
indicated to improve the patients’ management skills or adherence. Referral
may be considered if a child 0–4 years of age requires step 2 care or a child
5–11 years of age requires step 3 care. — The patient has had an exacerbation
requiring hospitalization. — Immunotherapy or other immunomodulators are
considered, or additional tests are indicated, to determine the role of allergy.
Fully-Specified Concept Name
Codable Components
asthma specialist for consultation Respiratory disease specialist (occupation)
consultation Consultation (procedure)
control of asthma Asthma control steps (procedure)
Step 2 care Asthma control step 2 (procedure)
Step 3 care Asthma control step 3 (procedure)
Step 4 care Asthma control step 4 (procedure)
exacerbation Exacerbation of asthma (disorder)
immunotherapy Immunotherapy (procedure)
immunomodulators Immunomodulator (product)
education (asthma) Asthma education (procedure)
Recommendation Language
Maintaining control Conditional: The Expert Panel recommends that once well-controlled asthma
is achieved and maintained for at least 3 months, a reduction in pharmacologic
therapy—a step down— can be considered helpful to identify the minimum
therapy for maintaining well-controlled asthma (Evidence D).
Fully-Specified Concept Name
Codable Components
pharmacological ?? Pharmacological stimulation (qualifier value)
step down Step down change in asthma management plan
Recommendation Language
managing exacerbations due to viral Conditional: If the symptoms are mild, SABA (every 4–6 hours for 24 hours,
respiratory infections longer with a physician consult) may be sufficient to control symptoms and
improve lung function.
Fully-Specified Concept Name
Codable Components
Symptoms are mild Mild asthma (disorder)
SABA ??
control symptoms Symptom control (regime/therapy)
improve lung function ??
Recommendation Language
Step 2 Care, Children 0–4 Years of Age Imperative: Theophylline is not recommended as alternative treatment
febrile illness in children less than 5 years of age and the need to closely
monitor and control serum concentrations.
Fully-Specified Concept Name
Codable Components
Step 2 care Asthma control step 2 (procedure)
Theophylline Theophylline (product)
alternative treatment Treatment stopped - alternative therapy undertaken
erratic metabolism Defective metabolism (finding)
viral infections Specific viral infections (disorder)
febrile illness Febrile disorder (disorder)
closely monitor Asthma monitor offer default (finding)
Serum Serum (substance)
Recommendation Language
Treatment: Special Issues for Children Conditional: The Expert Panel recommends that, when initiating daily long-
5–11 Years of Age term control therapy for mild or moderate persistent asthma, the choice of
medication includes consideration of treatment effectiveness, the domain of
particular relevance to the patient’s asthma (impairment, risk, or both), the
individual patient’s history of previous response to therapies, the ability of the
patient and family to use the medication correctly, anticipated patient and
family adherence to the treatment regimen, and cost
Fully-Specified Concept Name
Codable Components
mild persistent asthma Mild persistent asthma (disorder)
moderate persistent asthma Moderate persistent asthma (disorder)
medication Asthma medication review (procedure)
treatment effectiveness ??
Impairment Impairment (finding)
ability of the patient and family to Unable to use medication (finding)
use medication correctly
Able to use medication (finding)
treatment regimen Knowledge level: treatment regimen (observable
treatment cost ??
patient's history with reponse to ??
therapies
Recommendation Language
CLASSIFY ASTHMA SEVERITY Imperative: Assessment of severity requires assessing the following
components of current impairment: Symptoms — Nighttime awakenings —
Need for SABA for quick relief of symptoms — Work/school days missed —
Ability to engage in normal daily activities or in desired activities — Quality-of-
life assessments Lung function, measured by spirometry: FEV1, FVC (or
FEV6), FEV1/FVC (or FEV6 in adults).
Fully-Specified Concept Name
Codable Components
Asthma severity Asthma severity (regime/therapy)
nightime awakenings Awakening (qualifier value)
work days missed Number of days off work (observable entity)
school days missed School attendance (observable entity)
ability to engage in activities Ability to engage in a hobby (observable entity)
quality of life assessments Quality of life scale (assessment scale)
lung function Lung volume, function (observable entity)
spirometry Spirometry (procedure)
FEV1 Expected forced expired volume in 1 second
FVC Forced vital capacity (FVC) after bronchodilation
FEV1/FVC Expected FEV1/FVC ratio (observable entity)
FEV6 ??
Recommendation Language
MEASURES FOR PERIODIC Imperative: The Expert Panel recommends that the frequency of visits to a
ASSESSMENT AND MONITORING OF clinician for review of asthma control is a matter of clinical judgment; in general,
ASTHMA CONTROL patients who have intermittent or mild persistent asthma that has been under
control for at least 3 months should be seen by a clinician about every 6
months, and patients who have uncontrolled and/or severe persistent asthma
and those who need additional supervision To help them follow their treatment
plan need to be seen more often
Fully-Specified Concept Name
Codable Components
frequency of visits to a clinician ??
review of asthma control ??
clinical judgement ??
intermittent asthma Intermittent asthma (disorder)
mild persistent asthma Mild persistent asthma (disorder)
be seen by a clinician about every 6 ??
months
Severe persistent asthma Severe persistent asthma (disorder)
uncontrolled and/or severe ??
persistent asthma
additional supervision to help follow Treatment plan given (finding)
treatment plan
More often Frequency (attribute)
Recommendation Language
Monitoring Signs and Symptoms of Imperative: The Expert Panel recommends that the detailed symptoms history
Asthma should be based on a short (2–4 weeks) recall period
Fully-Specified Concept Name
Codable Components
detailed symptoms history History of (contextual qualifier) (qualifier value)
short recall period Memory recall (observable entity)
Recommendation Language
Monitoring Signs and Symptoms of Imperative: Consider long-term daily peak flow monitoring for: — Patients who
Asthma have moderate or severe persistent asthma (Evidence B). — Patients who
have a history of severe exacerbations (Evidence B). — Patients who poorly
perceive airflow obstruction and worsening asthma (Evidence D). — Patients
who prefer this monitoring method (Evidence D).
Fully-Specified Concept Name
Codable Components
Peak flow monitoring Peak expiratory flow rate monitoring
Moderate persistent asthma Moderate persistent asthma (disorder)
Severe persistent asthma Severe persistent asthma (disorder)
Severe exacerbations Exacerbation of asthma (disorder)
Recommendation Language
Monitoring Signs and Symptoms of Imperative: The Expert Panel recommends that health care providers should
Asthma routinely assess the effectiveness of patient–clinician communication
(Evidence D).
Fully-Specified Concept Name
Codable Components
Peak flow monitoring Communication (attribute)
Effectiveness Effectiveness (qualifier value)
Action Type
erm Control Therapy. The Prescribe
erm control therapy: and#14;
k of exacerbations in infants
es of wheezing in the past year
ND who have risk factors for
e following: parental history of
s, or evidence of sensitization
ence of sensitization to foods,
ezing apart from colds
Concept ID SNOMED ID CTV3 ID
195967001 D2-00036 H33..
302220000 P2-20006 Xa8Hn
281239006 D2-00076 Xa1hD
18197001 F-23316 XU8d6
170631002 F-02E2E 663N.
426656000 F-04F40 XUfiX
427295004 F-04F3F XUfiW
426979002 F-04F3E XUfiV
160377001 G-01D0 XUPnb
24079001 D0-10130 M111.
416167002 F-A0004 XUd9f
41970007 L-D0102 XUDjP
255620007 C-F0125 X7943
233691007 D2-60402 X102G
301285005 F-230FE Xa7v8
Action Type
erm Control Therapy. The Prescribe
erm control therapy: Should be
children who have a second
eroids within 6 months
reatment with daily low-dose
ptom burden and the
eatment will not alter the
Concept ID SNOMED ID CTV3 ID
281239006 D2-00076 Xa1hD
304275008 F-B0204 Xa9uS
276239002 P0-007D1 XU3pa
Action Type
following actions if control of Educate/counsel
tained at any step of care:
ations correctly should be
ce C).
Concept ID SNOMED ID CTV3 ID
225854008 F-009D9 Ua2Ac
40226000 F-00120 XUDMx
370773004 P2-45110 XUUct
Action Type
erral to an asthma specialist Refer/consult
f (Evidence D): — There are
hma. — A child 0–4 years of
higher for children 5–11
f additional education is
kills or adherence. Referral
quires step 2 care or a child
atient has had an exacerbation
her immunomodulators are
etermine the role of allergy.
Concept ID SNOMED ID CTV3 ID
41672002 J-06123 XaBpM
11429006 P2-00130 Xa1qL
302220000 P2-20006 Xa8Hn
182728008 P2-20009 8795
182729000 P2-2000A 8796
182730005 P2-2000B 8797
281239006 D2-00076 Xa1hD
76334006 P2-69200 8C3..
108940007 C-7B000 XU2Es
401135008 P0-00988 XUZEX
Action Type
t once well-controlled asthma Prescribe
a reduction in pharmacologic
ul to identify the minimum
vidence D).
Concept ID SNOMED ID CTV3 ID
258059001 R-41D08 X7A0a
390878008 P0-0060C XaIQE
Action Type
very 4–6 hours for 24 hours, Prescribe (statement)
to control symptoms and
Concept ID SNOMED ID CTV3 ID
370218001 F-00D4D XUUTn
225353007 P0-00097 Ua1Qa
Action Type
s alternative treatment Prescribe not
and the need to closely
Concept ID SNOMED ID CTV3 ID
182728008 P2-20009 8795
66493003 C-69510 c43..
182868002 F-04478 8B396
63569001 F-60002 XUHzV
186741005 DE-3000C A79..
416113008 DF-00778 XUcuk
185730004 F-000E0 9OJ3.
67922002 T-C2500 X79cw
Action Type
t, when initiating daily long- Conclude (consider)
ent asthma, the choice of
fectiveness, the domain of
airment, risk, or both), the
o therapies, the ability of the
y, anticipated patient and
cost
Concept ID SNOMED ID CTV3 ID
426979002 F-04F3E XUfiV
427295004 F-04F3F XUfiW
63569001 F-60002 XUHzV
40226000 F-00120 XUDMx
408366001 F-04A06 XaJKc
408365002 F-04A05 XaJKb
405117005 F-04B54 XUaEU
Action Type
essing the following Inquire
— Nighttime awakenings —
Work/school days missed —
sired activities — Quality-of-
rometry: FEV1, FVC (or
Concept ID SNOMED ID CTV3 ID
170642006 P0-00630 663V.
421355008 G-7004 XUe7x
40226000 F-00120 XUDMx
300755007 F-040CC Xa7hZ
273725009 G-E236 XM0hX
17785005 F-25500 XU8Y3
127783003 P2-25101 5882
310520004 F-25571 XaCJK
407561008 F-25622 XaJ3K
310360002 F-034D0 XaCFR
Action Type
the frequency of visits to a Monitor
of clinical judgment; in general,
asthma that has been under
clinician about every 6
or severe persistent asthma
lp them follow their treatment
Concept ID SNOMED ID CTV3 ID
426979002 F-04F3E XUfiV
300755007 F-040CC Xa7hZ
426656000 F-04F40 XUfiX
314705003 F-00E5E XaFDq
260864003 G-C097 X9047
Action Type
the detailed symptoms history Inquire
eriod
Concept ID SNOMED ID CTV3 ID
392521001 G-0355 XUXaN
363889007 F-0433A XUSyU
Action Type
monitoring for: — Patients who Monitor
dence B). — Patients who
e B). — Patients who poorly
ma (Evidence D). — Patients
Concept ID SNOMED ID CTV3 ID
401004000 P0-00975 XaIxD
427295004 F-04F3F XUfiW
426656000 F-04F40 XUfiX
281239006 D2-00076 Xa1hD
Action Type
health care providers should Monitor
cian communication
Concept ID SNOMED ID CTV3 ID
263536004 G-C2A9 XC01S
426656000 F-04F40 XUfiX