New Asthma Guidelines Partner You With Your Physician

< Nov. 14, 2007 -- Asthma control and prevention of attacks are the focus of new national asthma guidelines released by the US National Heart, Lung, and Blood Institute's National Asthma Education and Prevention Program (NAEPP). These are the first new guidelines released in a decade on asthma care.

The approximately 23 million Americans - including 6.5 million children - with asthma can avoid serious symptoms and disability if they follow these latest guidelines to keep their asthma under control, say the experts who wrote the guidelines.

"Asthma is not an event, it is a chronic disease that can be managed so that symptoms are controlled and severe attacks are prevented," Dr. Michael B. Foggs, Chief of Asthma, Allergy, and Immunology at Advocate Health Care in Chicago, says.

"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."

Regular Monitoring is Crucial

The guidelines place a new emphasis on doctor-patient partnerships and ongoing asthma monitoring and management.

Experts thoroughly reviewed the body of scientific medical literature available as a basis for the recommendations.

The central points of the guidelines involve primarily four main areas of asthma management. They are:

• assessment and monitoring

• patient education

• control of environmental factors and other asthma triggers

• medications

Practical Tips for Care

Specifically, the guidelines include some practical points for asthma care. For example, all patients with asthma should be followed by a doctor every one to six months, no matter how severe their condition is and whether or not they are having any symptoms.

Also, every patient should have a written asthma action plan with instructions for daily treatment and how to proceed 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, including family members, teachers, and coaches.

Education for each patient should be geared to his/her appropriate literacy level and cultural background. And patients should always play an active role in managing their asthma.

A stepwise approach to treatment is recommended, with six steps, instead of the previously recommended four. Medication should be increased when asthma symptoms are worse and decreased, 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. Figgs says.

Medications Can Be Managed Safely

The new guidelines also highlight the routine use of inhaled corticosteroids as the standard of care for most patients with chronic persistent asthma.

"Low- to medium-dose inhaled corticosteroids are very safe and remain the first line of treatment for preventing asthma symptoms. Unfortunately, they are not prescribed as often as they should be," Dr. H. William Kelly, Professor Emeritus, Department of Pediatrics, University of New Mexico Health Sciences, Albuquerque, says.

"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 states.

Based on research suggesting that children ages five to 11 may respond somewhat differently to medications than adults, children in this age group were singled out as a separate category by the guideline authors.

For many children ages five to 11, asthma can be controlled with a low daily dose of inhaled corticosteroid, rather than combination treatments, such as long-acting beta agonists, required by many adult asthma patients.

A beta agonist is a medication that dilates the airways by relaxing the muscles around them. These airways may tighten during an asthma attack. Normally, these medications act quickly and can relieve symptoms, like shortness of breath, in minutes. However, they may only be effective for up to four hours.

The guidelines also stress the need for patients to take their controller medications even when they do not have asthma symptoms. Patients also need to be taught how to use inhalers properly so the medication reaches their lungs.

The guidelines were presented recently at a meeting of the American College of Allergy, Asthma and Immunology.

Always consult your physician or your child's physician for more information.