Download ASTHMA GUIDELINE PICO QUESTIONS Control of Symptom

ASTHMA GUIDELINE
PICO QUESTIONS
a. Control of Symptom:
— 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
b. Optimize (normal) lung function
— (FEV1 pp; FEV1/FVC; peak flow)
c. Reduce risk of exacerbation
d. Minimize adverse effect
e. Utilization of health care
—Emergency room visits (exacerbations)
—Hospital admissions
f. Increase Working knowledge of asthma action plan
g. Improve Patient satisfaction
------------------------------------------------------------------------------------------------------Diagnosis
1.
In patients with asthma, does consultation or referral to a subspecialist
(pulmonologist/allergist) at the time of diagnosis or early in treatment vs no
consultation/referral improve symptom control, patient satisfaction and
increase patient knowledge? (18)
2.
In patients with asthma, does routine allergy testing (e.g., skin prick
testing, aeroallergens, immunotherapy) vs. no testing or testing HIGH RISK
(Severe uncontrolled Asthma, family Hx of allergies) improves outcomes in
terms of QOL through allergen avoidance or immunotherapy, patient
knowledge and adherence? (19)
3.
In adults with exercise-related symptoms of asthma only and non-diagnostic
spirometry, is formal exercise testing with pre- and post-PFTs compared
to informal exercise testing (methacholine challenge test, broncho provocation
test) better for establishing the diagnosis of EIB or exercise induced asthma?
(29)
4.
In adults with exercise-related symptoms asthma, is peak flow monitoring
to assess variability of airway obstruction compared to Spirometry better for
diagnosing of EIB or exercise induced asthma? (30)
5.
In pregnant women who were not previously diagnosed with asthma, but
who develop symptoms consistent with asthma, does assessing PFT
compared to a presumptive diagnosis (no PFT) improve patient outcome with
no harm? (33)
Prognosis
6.
In adults with asthma who present with an acute exacerbation, what
clinical predictors are best at predicting successful outpatient management?
(22)
PICO Questions – page 1
7.
In patients with difficult to control asthma, how frequently does the
management of coexisting sinusitis or GERD compared to no
management improve the control of asthma? (23)
8.
In patients with asthma who are obese, does weight loss and exercise
compared to no weight loss/exercise improve the control of asthma
symptoms? (41)
Medications
9.
10.
In active duty personnel with asthma in operational environments, is one
controller compared to other controllers better apt to control asthma
symptoms? (31)
In patients with mild persistent asthma and no evidence of allergies as triggers,
does ICS compared to Montelukast or Tilade, Intal, or other pulmonary
antiinflammatories lead to better outcome and minimimize harm? (9,15)
11.
In patients with moderate or severe uncontrolled asthma, does increasing
the dose of ICS compared to adjunctive therapy (LABA, Singulair,
Leukotriene) lead to better control of symptoms with no harm? (17)
12.
In adult patients with asthma, does tiotropium (Spiriva) compared to long
acting inhaled bronchodilators lead to improved PFT and peak flow
measures?
13.
In patients with exercise-induced asthma (bronchospasm), does taking a
preventive dose of LABA once before exercise compared to continuous qd
LABA improve symptom control? (40)
14.
In patients older than 65 years with asthma, does the use of long acting
beta adrenergic drugs compared to not using the drug reduce adverse
cardiovascular events (e.g., sudden death, acute MI, arrhythmias)? (36)
15.
In patients older than 65 years who require long term systemic corticosteroids,
does a reduced dose of corticosteroids compared to the regular dose
reduce the risk for adverse complications (osteoporosis, DM, Vavascular
necrosis of the femoral head, cataracts)? (37)
16.
In patients with mild persistent asthma, does the use of Singulair compared
to placebo result in better outcome and minimize harm? (39)
Patient Education
17.
Which strategy in the outpatient setting leads to better outcomes in terms of
decreased frequency of exacerbations, ER visits or hospitalization in patients
with Asthma?
a) Implementation of a standardized asthma care plan compared to
no standard care plan? (27)
b) Implementation of comprehensive asthma care (pt. education,
action plans and asthma educators) compared to usual care
PICO Questions – page 2
c) Implementation of group visits compared to individual patients
appointments.
d) Written action plans compared to usual care (28)
e) Providing patient education in modality other than written (e.g.,
media, computer based, internet) (26)
PICO Questions – page 3