The US national guidelines for the diagnosis and management of asthma have been updated this week as a result of the most comprehensive review of the last 10 years. Issued by the National Asthma Education and Prevention Program (NAEPP), the clinical guidelines explain the importance of asthma control and introduce new monitoring approaches.
Called Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma – Full Report, 2007, the guide is available from the National Heart, Lung and Blood Institute (NHLBI) who coordinated the NAEPP expert panel that overhauled the document to reflect the latest scientific advances. The panel comprised 18 unpaid experts chosen for their scientific and clinical knowledge and experience.
NHLBI Director Dr Elizabeth G. Nabel said:
“Asthma is one of the most common health problems in the United States, and it can significantly affect patients’ lives, at school, at work, at play, and at home.”
“It is essential that asthma patients benefit from the best available scientific evidence, and these guidelines bring such evidence to clinical practice,” added Nabel.
EPR-3 expands on the management of childhood asthma (with an extra age group), covers new medications, explains how to measure and monitor asthma, recommends how to educate patients outside of the doctor’s surgery and advises how to control environmental triggers of the condition and other things that can make it worse.
It explains how to select the best treatment based on the needs of the patient and the level of control required. EPR-3 stresses that although asthma can be controlled, it can change over time and is different in different people and age groups. Regular monitoring is important as is adjusting the treatment as the patient’s needs change.
Chairman of the Expert Panel, and chairman of the University of Wisconsin Department of Medicine, Dr William W. Busse said:
“The goal of asthma therapy is to control asthma so that patients can live active, full lives while minimizing their risk of asthma exacerbations and other problems.”
Speaking about the expanded sections of the guide which build on previous editions in 1991 and 1997 and bring in new topics released in 2002, Busse said that:
“Overall, these components have stood the test of time, and many of the earlier recommendations have been solidly confirmed by additional research throughout the years.”
One such example is the medications section, as Busse goes on to explain:
“For instance, inhaled corticosteroids are still the best long-term control treatment for asthma patients of all ages because we have even stronger evidence that they are generally safe and are the most effective medication at reducing inflammation, a key component of asthma.”
The main updates in the new EPR-3 guidelines cover:
- Assessing and Monitoring: now includes multiple measures of impairment (for example symptom frequency and intensity, low lung function, and limitation of daily activity) and the need to assess future risk (exacerbations, loss of lung function, medication side effects).
- Educating Patients: stresses importance of teaching self-monitoring and management, using a written action plan (including daily instructions and how to recognize when the asthma is getting worse). Recommends expanding outreach to include pharmacies, schools, community centres, and patients’ homes.
- Controlling Environmental Triggers and Other Conditions: expands on how to limit exposure to allergens and other substances. Describes how treating other chronic conditions can help control asthma such as rhinitis and sinusitis, gastroesophageal reflux, overweight or obesity, obstructive sleep apnea, stress and depression.
- Using Medication: emphasizes that overall approach to asthma control should be stepwise and in terms of medication this means doses and types should be stepped up as needed. This also means they should be stepped down as needed too. Patients with persistent asthma (symptoms more than twice a week in the day or more than twice a month at night) need both long term and quick relief medications. Reaffirms inhaled corticosteroids as the most effective long-term control medication for all ages and recommends a range of new treatment options using other drugs.
- Stepwise Management Charts: these now cover three age groups, 0-4 years, 5-11 years, and 12 years and over. The 5-11 group is new, before it was merged with adults but new evidence on medication effects shows children don’t respond in the same way as adults.
- Research and Asthma Management Improvements: updates on current research programmes, monitoring asthma in new ways such as testing using sputum and exhaled air, tailoring treatment based on genetic makeup.
Director of the NHLBI Division of Lung Diseases, Dr James Kiley said there was a move toward personalizing treatment because:
“Research is beginning to help us identify genes that influence how well certain patients respond to certain asthma medications.”
The US Centers for Disease Control and Prevention (CDC) estimates that 22 million Americans have asthma, including 6.5 million children under 18.
Asthma is a chronic but treatable condition that narrows the airways and makes breathing difficult at times. If untreated it can severely limit a person’s life, lead to exacerbation and hospitalization and in severe cases, death. According to the CDC some 4,000 Americans die every year from asthma exacerbations.
A summary of EPR-3 is expected later this year.
Written by: Catharine Paddock