The great majority of the nearly 23 million people with asthma, including 6.5 million children, can avoid serious symptoms and disability if they follow the latest guidelines to keep their disease under control.
Highlights of the 2007 asthma guidelines from the National Heart, Lung and Blood Institute's National Asthma Education and Prevention Program (NAEPP) were presented during the Annual Meeting of the American College of Allergy, Asthma and Immunology (ACAAI) in an effort not only to increase awareness of the new recommendations, but to help make sure they get put into practice.
“Asthma is not an event, it is a chronic disease that can be managed so that symptoms are controlled and severe attacks are prevented,” said Michael B. Foggs, M.D chief of asthma, allergy and immunology, Advocate Health Care, Chicago. “The guidelines underscore the fact that people who are diagnosed with asthma do not have to suffer breathing difficulties or cut back on their activities. We want to make this a reality for all asthma patients.”
Asthma occurs when the linings of the airways become inflamed and swollen and muscle spasms constrict airflow to the lungs. An “asthma attack” is characterized by labored or restricted breathing, a tight feeling in the chest, coughing and wheezing. The condition can develop quickly and may vary in severity from mild discomfort to life-threatening attacks in which breathing stops altogether. Each year, nearly 4,000 asthma deaths occur in the United States and the disease accounts for a half million hospitalizations, most of which can be prevented with appropriate care.
According to the NAEPP report, under-diagnosis and inadequate treatment are significant contributors to poor asthma control and the worsening of asthma severity. The new guidelines, the first major update in a decade, include the latest information on the best way to manage the chronic disease. Highlights include emphasis on ongoing monitoring and management of asthma, routine use of inhaled corticosteroids as the standard of care for most patients with chronic persistent asthma, distinguishing between managing acute and chronic asthma, and the identification of new risk factors for the disease.
Ongoing Monitoring and Management
According to Dr. Foggs, the guidelines put a new emphasis on the physician-patient partnership and ongoing monitoring and management. Specific recommendations include: :
- All patients with asthma should be monitored by a doctor every one to six months, regardless of how severe their condition is and whether they are experiencing symptoms.
- patient should have a written asthma action plan with instructions for daily treatment and what to do if symptoms become worse. The action plan should be developed by a doctor or nurse, with input from the patient, and shared with all those who interact with the patient such as family members, teachers and coaches.
- Education that takes into account cultural background and literacy should be part of asthma care, and patients should play an active role in managing their condition.
- Asthma treatment based on severity is classified in six steps, rather than four in previous guidelines. A stepwise approach to treatment is still recommended, with medication stepped up or increased when asthma symptoms increase and stepped down, if possible, when asthma is under control.
“When patients and physicians work together to follow these guidelines, asthma symptoms can be prevented and patients can participate in all activities, and not miss days of work or school because of asthma. No one should expect anything less,” Dr. Foggs said.
Appropriate Medication Therapy
Anti-inflammatory medications should be routinely prescribed for long-term control of chronic persistent asthma. “Low to medium dose inhaled corticosteroids are very safe, and remain the first line of treatment for preventing asthma symptoms,” said H. William Kelly, PharmD, professor emeritus, department of pediatrics, University of New Mexico Health Sciences, Albuquerque. “Unfortunately, they are not prescribed as often as they should be.
“Some people confuse these safe medications with the risky anabolic steroids used by some athletes to improve performance. When used appropriately, corticosteroids are safe and effective in controlling asthma,” Dr. Kelly said.