New Asthma Guidelines Emphasize Need for Regular Monitoring, Disease Control

The National Asthma Education and Prevention Program, or NAEPP, recently issued revised clinical practice guidelines on preventing and managing asthma that underscore the importance of regular monitoring to help patients achieve and maintain control of their asthma, reduce their risk for exacerbations, and slow or halt disease progression. It's the first comprehensive update of the NAEPP guidelines in a decade, says a news release from NIH's National Heart, Lung and Blood Institute, or NHLBI, which coordinates the program.

"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," says NHLBI Director Elizabeth Nabel, M.D., in the news release. "It is essential that asthma patients benefit from the best available scientific evidence, and these guidelines bring such evidence to clinical practice."

The revised guidelines were developed by an expert panel that included FP Barbara Yawn, M.D., of Rochester, Minn. Yawn is director of research at the Olmsted Medical Center in Rochester and adjunct professor of family and community health at the University of Minnesota, Minneapolis. She also is a member of the U.S. Preventive Services Task Force and has represented family medicine's perspective in numerous other clinical projects dealing with asthma and chronic obstructive pulmonary disease.

The guidelines focus on four aspects of asthma care: assessing and monitoring asthma, educating patients about their disease and how to participate in self-management, controlling environmental factors and other conditions that can worsen asthma, and using medications.

Specifically, the guidelines call for using multiple measures of a patient's current degree of impairment -- such as frequency and intensity of symptoms, lung function, and ability to perform daily activities -- to provide a "snapshot" of his or her condition at any one point in time. But the new recommendations also factor in the patient's level of future risk, including the risk of exacerbations, progressive loss of lung function and adverse effects from medications used, because, according to the guidelines, patients can be at high risk for frequent exacerbations even if they have few day-to-day effects of asthma.

The revised guidelines also reemphasize the importance of teaching patients the skills they need to self-monitor and manage their asthma, as well as how to use a written asthma action plan that includes instructions for routine daily therapy and information on how to recognize and handle asthma exacerbations.

The guidelines encourage the use of multiple approaches to limit patients' exposure to allergens and other substances that can worsen asthma. Common comorbidities among asthma patients also are covered, and the guidelines note that treating chronic problems such as rhinitis and sinusitis, gastroesophageal reflux, overweight or obesity, obstructive sleep apnea, stress, and depression may help improve asthma control.

Finally, the guidelines continue to urge clinicians to adopt a stepwise approach to helping patients control their asthma, including adjusting the types and doses of medications prescribed according to the level of disease control achieved. Management recommendations are listed by patient age: 0-4 years, 5-11 years, and 12 years and older. This revision of earlier NAEPP guidelines also discusses new medications, known as immunomodulators, that now are available for long-term control of asthma. The report outlines new data on the safety of long-acting beta-agonists, or LABAs, and describes a new role for LABAs in therapy.

The full guidelines report, Guidelines for the Diagnosis and Management of Asthma (EPR-3), is available on NHLBI's asthma clinical guidelines Web page; an executive summary is expected in December.