New Asthma Guidelines: What You Should Know

If you or a relative suffers from asthma, it is important to know that quality care depends on the following:

• education in self-management skills,
• keeping asthma symptoms controlled,
• reducing exposure to environmental factors that worsen asthma, and
• taking medications as prescribed.

With the right care, you can prevent hospitalizations, urgent visits to the doctor, and missed days at school or work. The National Heart, Lung, and Blood Institute's (NHLBI) National Asthma Education and Prevention Program (NAEPP) periodically reviews clinical studies on asthma, considers the findings, and translates them into guidelines for doctors to treat patients. The NAEPP recently released its third set of asthma guidelines, offering the most up-to-date information and expert advice for clinicians on managing asthma.

"The goal is to control asthma so that patients can live active, full lives while minimizing their risk of asthma attacks and related problems," says William W. Busse, M.D., who heads the University of Wisconsin Department of Medicine and chairs the Expert Panel that established the new guidelines.

The report gives health care professionals new ways for selecting treatment based on a patient's individual needs and level of asthma control. The guidelines emphasize that while it can be controlled, asthma can change over time. It also differs among individuals and by age groups. Therefore, it is important to monitor regularly a patient's level of asthma control so that treatment can be adjusted as needed. The guidelines focus on four components of asthma care: measures to assess and monitor asthma, patient education, control of environmental factors and other conditions that can worsen asthma, and medications.

"Overall, these components have stood the test of time. Many of the earlier recommendations have been solidly confirmed by additional research," says Dr. Busse. "For instance, inhaled corticosteroids are still the best long-term control treatment for all asthma patients. The evidence is even stronger that they are generally safe and are the most effective medication at reducing inflammation, a key component of asthma."

The report also describes current research to improve asthma management, such as new ways for monitoring asthma control. Tailoring treatment based on the particular characteristics of a patient's asthma or genetic makeup are also areas of research.

"The research is helping to identify the genes influencing how well certain patients respond to certain asthma medications," says James Kiley, Ph.D., director of the NHLBI Division of Lung Diseases. "This is helping us move toward more personalized treatment, based on a patient's individual characteristics."

What differences should patients now expect in asthma care?

• You should receive a written asthma action plan that describes both how to control asthma long-term AND handle asthma attacks.
• You will need quick-relief medication for symptoms, and daily long-term control medication. The new guidelines conclude that inhaled corticosteroids are of most benefit. Other medications may also be helpful. Doctors and patients need to work together to develop the best, individualized plan.
• Your doctor will help identify which allergens or irritants are important. The guidelines stress that multiple measures are necessary to control exposure to allergens and irritants.
• You should get regular "asthma check-ups" to monitor your asthma control. Visits at least every six months are recommended because asthma varies from season to season and can change as you grow older. Monitoring allows your doctor to increase—or decrease—medications, as warranted.
• During doctor visits, your doctor will ask you about your symptoms, use of medication, and how often attacks occur. You will have a lung function test. Be sure to ask any question or discuss any concern you may have about your treatment. This way, you and your doctor can work out the best plan for you.

The new guidelines emphasize that asthma education shouldn't just happen in the doctor's office. Education and "asthma friendly" policies throughout the community—in clinics, schools, workplaces, pharmacies, patient homes, and recreation programs—will help all people with asthma receive the best possible care.

Contributers: Virginia Taggart, M.P.H., Patricia Noel, Ph.D., and James Kiley, Ph.D., National Heart, Lung, and Blood Institute (NHLBI)

Fall 2007 Issue: Volume 2 Number 4 Page 15