New Asthma Guidelines Stress Disease Control

WEDNESDAY Aug. 29, 2007 -- U.S. health officials unveiled new asthma control guidelines Wednesday that seek to make breathing easier and maintaining an active lifestyle a reality for people with the lung disease.

"Asthma control is achievable for nearly every patient," Dr. Elizabeth G. Nabel, director of the National Heart, Lung, and Blood Institute, said during a teleconference.

Nabel stressed that with proper medical care, healthy environments and better informed patients, asthma can be controlled, and people can lead active lives. "As health-care providers and patients, we really should accept nothing less," she said.

Asthma is a chronic but treatable disease that causes airways to narrow in response to allergens, making breathing difficult at times. More than 22 million Americans have asthma, including 6.5 million children under age 18, and those numbers are rising. Without proper treatment, asthma can limit a person's activities and lead to breathing complications that can result in hospitalization and even death. The disease causes some 4,000 deaths each year and almost 500,000 hospitalizations, according to the U.S. Centers for Disease Control and Prevention.

"Asthma is a major health problem in the United States," Nabel said.

The new guidelines, the first revision in a decade, were developed by the National Asthma Education and Prevention Program under the sponsorship of the National Heart, Lung, and Blood Institute.

They start by calling for a strong emphasis on monitoring asthma. One aspect of that monitoring should focus on the severity of a patient's daily symptoms. Both patients and doctors need to be aware of those daily symptoms.

Patients and doctors also need to be aware of the risk of future asthma attacks, loss of lung function and side effects from medication, Nabel said.

Nabel pointed out that since the last guidelines were issued, there has been increased understanding of asthma and better approaches to diagnosis and treatment. Although more people are being diagnosed with the disease, the number of people reporting asthma attacks has remained stable, and deaths have dropped, she noted.

To focus on the severity and future risk of asthma attacks, the new guidelines establish new age categories that enable doctors to pursue three different treatment plans. The categories are: infants to 4 years old, 5 to 11 years old, and 12 and older. The 5 to 11 age group was added (earlier guidelines combined this group with the adults), following new evidence on medications for this age group and findings that suggest children may respond differently than adults to asthma medications.

Treatment steps have also been expanded from four to six, said Dr. William W. Busse, head of the panel that developed the guidelines and chairman of the University of Wisconsin's Department of Medicine.

"In persistent asthma, inhaled corticosteroids remain the preferred foundation for anti-inflammatory therapy," Busse said during the teleconference.

The guidelines also call for allowing children to bring their rescue inhalers to school in case of an asthma attack.

Other new steps are geared to people 12 and older with severe asthma. These steps include the addition of the drug omalizumab, a monoclonal antibody that targets immunoglobulin E, which is associated with allergic reactions, Busse said.

The guidelines also stress the importance of teaching patients to self-monitor and manage their asthma. They recommend using a written asthma action plan, which features instructions for daily treatment and ways to recognize and handle worsening asthma.

"Our hope is that these guidelines will help even more asthma patients feel better so they can lead active, full lives, not restrict their activities, sleep through the night and maintain normal lung function," Nabel said.

Dr. Norman Edelman, chief medical officer at the American Lung Association, thinks the new guidelines help fill some gaps that existed in the previous guidelines. "The guidelines are tweaked; they are doing things that the first guidelines didn't cover," he said.

The age distinctions in the new guidelines are important, Edelman said. "By focusing more on children, they are trying to get the attention of pediatricians to treating children with asthma. Children, in the opinion of many people, are under-treated. They don't get as much inhaled steroids as many experts think they should," he said.

Edelman also thinks that the ability of children to have their rescue medication at school is very important and is part of the American Lung Association's recommendations for children going back to school.

Asthma attacks among children peak in September, he noted.

"Back to school is a good time to review and reassess your child's asthma," Edelman said. "If you don't have a written action plan, see your health-care provider and get one."

More information

For more on asthma, visit the U.S. National Institutes of Health.

Posted: August 2007


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