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Annotations Does patient meet CPG Criteria?

Does patient meet CPG Criteria?

Criteria for inclusion in the CPG:

  • Patients should be treated according to the recommendations of the CPG when they are admitted with a diagnosis of asthma (ICD9 code of 493.xx) or when they meet the clinical criteria for having asthma. ( Do it)

Clinical criteria for determining whether a patient has asthma if the diagnosis has not already been made includes all of the following:

  • The presence of lower airway obstruction as manifested by any of the following: wheezing (particularly if expiratory), prolonged expiratory phase, intercostal or subcostal retractions AND
  • The airway obstruction that varies either by history or in response to administration of a bronchodilator and/or corticosteroid AND
  • A credible history of airway obstruction that has occurred at least one or two times previously so that it is recurrent AND

Exclusion of other diagnoses that could mimic asthma by reasonable means. For an acute episode as is relevant to the current CPG, such diagnoses could include (but are not limited to):

  • Aspiration
  • Foreign body
  • Bacterial pneumonia
  • Bronchiolitis
  • Croup
  • Congestive heart failure
  • Inhalation injury

Criteria for exclusion from the CPG

The following patients should be excluded from this CPG if they have the following conditions that may complicate treatment of an asthma episode. ( Do it)

  • Severe gastroesophageal reflux (GER)
  • Wheezing associated infection in an infant under 2 years without a prior history of asthma
  • Cystic Fibrosis
  • HIV with possible Pneumocystis carinii pneumonitis
  • Patients with a history of chronic aspiration
  • Bronchopulmonary dysplasia
  • Tracheomalacia
  • A history of extensive lower airway surgery

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.

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