• University of Michigan Health System. Asthma. Ann Arbor (MI): University of Michigan Health System; 2006 Feb. 16 p. [15 references]

This is the current release of the guideline.

This guideline updates a previous version: University of Michigan Health System. Asthma. Ann Arbor (MI): University of Michigan Health System; 2004 Sep. 15 p.

Note from the National Guideline Clearinghouse (NGC): The following key points summarize the content of the guideline. Refer to the full text for additional information, including detailed information on diagnosis, six-part asthma management program, dosing and cost of drugs as well as charts for predicted average peak expiratory flows.

The levels of evidence [A-D] are defined at the end of the "Major Recommendations" field.

• A high index of suspicion for asthma is essential. A history of both symptoms and symptom triggers should be obtained. [C]
• Objective evaluation of airflow obstruction is key to the diagnosis, classification, and management of the disease. Goals of treatment should include not only symptomatic relief, but normalization of lung function [C].
• Therapy should focus on long-term suppressive therapy. Anti-inflammatory agents (in particular inhaled corticosteroids) are the cornerstone of therapy for moderately and severely affected patients. Inhaled beta2-agonists should represent "rescue" agents in most instances [B].
• Patient education should emphasize how to identify and avoid environmental triggers of asthma and smoking cessation. Patients with moderate or severe asthma should be able to measure their peak expiratory flow rate (PEFR) at home and modify their therapy or seek help based on their performance relative to their personal best peak flow value. Self-management is fundamental to successful therapy [A], so a structured asthma education program should be considered.

Definitions:

Levels of Evidence for the Most Significant Recommendations

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

An algorithm is provided in the original guideline document for the management of asthma.

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations).

• University of Michigan Health System. Asthma. Ann Arbor (MI): University of Michigan Health System; 2006 Feb. 16 p. [15 references]

This guideline was partially adapted from:

National Heart, Lung, and Blood Institute "Expert panel report 2: guidelines for the diagnosis and management of asthma". Bethesda (MD): U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung and Blood Institute; 1997 Jul.

It also uses material from the 2004 update for asthma in pregnancy, NIH Publication No. 05-3279.

1996 Dec (revised 2006 Feb)

University of Michigan Health System - Academic Institution

Internal funding for University of Michigan Health System (UMHS) guidelines is provided by the Office of Clinical Affairs. No external funds are used.

Asthma Guideline Team

Team Leader: Lee Green, MD MPH, Family Medicine

Team Members: James L. Baldwin, MD, Allergy; F. John Brinley, MD, General Internal Medicine; James A Freer, MD, Emergency Medicine; Cyril M. Grum, MD, Pulmonary & Critical Care Medicine; Martin E. Hurwitz, MD, Pediatrics & Communicable Diseases; Cary E. Johnson, PharmD, College of Pharmacy; Benjamin Song, MD, Pediatrics & Communicable Diseases

Guidelines Oversight Team: Connie J. Standiford, MD; William E Chavey, MD; R. Van Harrison, PhD

The University of Michigan Health System endorses the Guidelines of the Association of American Medical Colleges and the Standards of the Accreditation Council for Continuing Medical Education that the individuals who present educational activities disclose significant relationships with commercial companies whose products or services are discussed. Disclosure of a relationship is not intended to suggest bias in the information presented, but is made to provide readers with information that might be of potential importance to their evaluation of the information.

Team Member; Company; Relationship

James L Baldwin, MD (none)

F John Brinley, MD (none)

Cary E Johnson, PharmD (none)

James A Freer, MD (none)

Lee A Green, MD, MPH (none)

Cyril M Grum, MD (none)

Martin E Hurwitz, MD, Glaxo-Smith-Kline, Merck, Pfizer, Speaker's bureau; Astra-Zeneca, Glaxo-Smith-Kline, Merck, Novartis, Sub-investigator; Pfizer, Stockholder

Benjamin Song, MD, Pfizer, Consultant; Glaxo-Smith-Kline, Merck, Pfizer, Speaker's bureau

This is the current release of the guideline.

This guideline updates a previous version: University of Michigan Health System. Asthma. Ann Arbor (MI): University of Michigan Health System; 2004 Sep. 15 p.

This summary was completed by ECRI on August 21, 2000. The information was verified by the guideline developer on November 22, 2000. This NGC summary was updated on November 8, 2004. The updated information was verified by the guideline developer on December 7, 2004. This summary was updated by ECRI on December 5, 2005 following the U.S. Food and Drug Administration (FDA) advisory on long-acting beta2-adrenergic agonists (LABA). This NGC summary was updated by ECRI on February 23, 2006. The updated information was verified by the guideline developer on March 17, 2006.

This NGC summary is based on the original guideline, which is copyrighted by the University of Michigan Health System (UMHS).