6. Asthma Outpatient Management

Initial visit tables/ Follow-up tables/ Step therapy tables

Initial visit Tables/ Follow up Tables/ Step Therapy tables are included. These tables are used to highlight the similarities and differences between EPR & GINA. They are intended to guide clinical management along with other resources in this guide. We recommend review of these tables when deciding on outpatient medication management of asthma.

• Asthma Guidelines Comparison Table
• Asthma Stepwise Table
• Asthma Follow Up Chart

Fractional Exhaled Nitric Oxide (FeNO)

Measurement of the fraction of nitric oxide in exhaled breath is used to assess for type 2 (eosinophilic) inflammation in airways. It is not recommended to diagnosis asthma but is conditionally recommended by the EPR4 as an adjunct to the evaluation of those who are 5 years and older for whom the diagnosis of asthma is uncertain using history, exam, and spirometry or if spirometry cannot be performed appropriately. It should NOT be used alone to diagnose asthma.  

Addition of FeNO is also conditionally recommended as part of ongoing asthma monitoring and management for those 5 years and older. It is likely most useful in those who require anti-inflammatory therapies, have atopy, require frequent assessments. FeNO has only been shown to prevent exacerbations if used every 2-3 months; it has not been shown to be a useful assessment of adherence to ICS (Reference EPR4).