Experts Release New Asthma Care Guidelines

MONDAY Nov. 12, 2007 -- Asthma control and prevention of attacks are the focus of new national asthma guidelines released by the U.S. National Heart, Lung, and Blood Institute's National Asthma Education and Prevention Program (NAEPP).

The 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, said 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, said in a prepared statement. "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."

The guidelines place a new emphasis on doctor-patient partnerships and ongoing asthma monitoring and management. Among the specific recommendations:

  • 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.
  • Every 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 a nurse, with input from the patient, and shared with all those who interact with the patient, such as family members, teachers and coaches.
  • Asthma care should include education that takes into account a patient's cultural background and literacy level. Patients should play an active role in managing their asthma.
  • Asthma treatment based on severity is now classified in six steps, rather than the four steps used in previous guidelines. A stepwise approach is still recommended, with medication increased when asthma symptoms worsen 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," Foggs said.

The new guidelines -- the first major update in a decade -- 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," H. William Kelly, professor emeritus, department of pediatrics, University of New Mexico Health Sciences, Albuquerque, said in a prepared statement.

"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," Kelly said.

Based on research suggesting that children ages 5 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 5 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.

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

The new guidelines were to be presented Sunday at the annual meeting of the American College of Allergy, Asthma and Immunology, in Dallas.

More information

The U.S. Centers for Disease Control and Prevention has more about asthma.

Posted: November 2007


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