• Michigan Quality Improvement Consortium. General principles for the diagnosis and management of asthma. Southfield (MI): Michigan Quality Improvement Consortium; 2008 Jul. 1 p.

This is the current release of the guideline.

Asthma

Diagnosis
Evaluation
Management
Risk Assessment
Treatment

Allergy and Immunology
Family Practice
Internal Medicine
Pediatrics
Pulmonary Medicine

Advanced Practice Nurses
Health Plans
Physician Assistants
Physicians

• To achieve significant, measurable improvements in the management of asthma through the development and implementation of common evidence-based clinical practice guidelines
• To design concise guidelines that are focused on key management components of asthma to improve outcomes

Children and adults with the following:

• Wheezing
• History of cough (worse particularly at night), recurrent wheeze, recurrent difficulty in breathing, recurrent chest tightness
• Symptoms occur or worsen in the presence of exercise, viral infection, inhalant allergens, irritants, changes in weather, strong emotional expression (laughing or crying hard), stress, menstrual cycles
• Symptoms occur or worsen at night, awakening the patient

Diagnosis/Assessment

1. Detailed medical history, physical examination, and symptom assessment
2. Assessment of asthma severity and asthma control
3. Spirometry

Management/Treatment

1. Developing a written asthma action plan
2. Patient education regarding self-monitoring, using written asthma action plan, inhaler technique and use of devices, avoiding environmental and occupational hazards
3. Control of environmental factors
4. Treatment of comorbid conditions (e.g., obesity, obstructive sleep apnea, rhinitis and sinusitis)
5. Step-wise approach to pharmacotherapy
6. Inhaled corticosteroids
7. Omalizumab
8. Allergen immunotherapy
9. Inactivated influenza vaccine
10. Follow-up
11. Referral to asthma specialist

Not stated

Searches of Electronic Databases

The Michigan Quality Improvement Consortium (MQIC) project leader conducts a search of current literature in support of the guideline topic. Computer database searches are used to identify published studies, existing protocols and/or national guidelines on the selected topic developed by organizations such as the American Diabetes Association, American Heart Association, American Academy of Pediatrics, etc. If available, clinical practice guidelines from participating MQIC health plans and Michigan health systems are also used to develop a framework for the new guideline.

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Levels of Evidence for the Most Significant Recommendations

1. Randomized controlled trials
2. Controlled trials, no randomization
3. Observational studies
4. Opinion of expert panel

Review

Not stated

Expert Consensus

Using information obtained from literature searches and available health plan guidelines on the designated topic, the Michigan Quality Improvement Consortium (MQIC) project leader prepares a draft guideline to be reviewed by the medical directors' committee at one of their scheduled meetings. Priority is given to recommendations with [A] and [B] levels of evidence (see "Rating Scheme for the Strength of the Evidence" field).

The initial draft guideline is reviewed, evaluated, and revised by the committee resulting in draft two of the guideline. Additionally, the Michigan Academy of Family Physicians participates in guideline development at the onset of the process and throughout the guideline development procedure. The MQIC guideline feedback form and draft two of the guideline are distributed to the medical directors, as well as the MQIC measurement and implementation group members, for review and comments. Feedback from members is collected by the MQIC project leader and prepared for review by the medical directors' committee at their next scheduled meeting. The review, evaluation, and revision process with several iterations of the guideline may be repeated over several meetings before consensus is reached on a final draft guideline.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

External Peer Review
Internal Peer Review

When consensus is reached on the final draft guideline, the medical directors approve the guideline for external distribution to practitioners with review and comments requested via the Michigan Quality Improvement Consortium (MQIC) health plans (project leader distributes final draft to medical directors' committee, measurement and implementation groups to solicit feedback).

The MQIC project leader also forwards the approved guideline draft to appropriate state medical specialty societies for their input.  After all feedback is received from external reviews, it is presented for discussion at the next scheduled committee meeting. Based on feedback, subsequent guideline review, evaluation, and revision may be required prior to final guideline approval.

The MQIC Medical Directors approved this guideline in July 2008.

None provided

Through a collaborative approach to developing and implementing common clinical practice guidelines and performance measures for asthma, Michigan health plans will achieve consistent delivery of evidence-based services and better health outcomes. This approach also will augment the practice environment for physicians by reducing the administrative burdens imposed by compliance with diverse health plan guidelines and associated requirements.

Not stated

This guideline lists core management steps. Individual patient considerations and advances in medical science may supersede or modify these recommendations.

Living with Illness

Effectiveness
Patient-centeredness

• Michigan Quality Improvement Consortium. General principles for the diagnosis and management of asthma. Southfield (MI): Michigan Quality Improvement Consortium; 2008 Jul. 1 p.

2008 Jul

Michigan Quality Improvement Consortium - Professional Association

Michigan Quality Improvement Consortium

Michigan Quality Improvement Consortium Medical Director's Committee

Physician representatives from participating Michigan Quality Improvement Consortium health plans, Michigan State Medical Society, Michigan Osteopathic Association, Michigan Association of Health Plans, Michigan Department of Community Health and Michigan Peer Review Organization

Standard disclosure is requested from all individuals participating in the Michigan Quality Improvement Consortium (MQIC) guideline development process, including those parties who are solicited for guideline feedback (e.g., health plans, medical specialty societies). Additionally, members of the MQIC Medical Directors' Committee are asked to disclose all commercial relationships as well.

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI Institute on November 24, 2008. The information was verified by the guideline developer on December 4, 2008.

This NGC summary is based on the original guideline, which may be reproduced with the citation developed by the Michigan Quality Improvement Consortium.