Update on National Asthma Guidelines Released
Arlington, Virginia -- The National
Asthma Education and Prevention Program (NAEPP) has issued an update of
selected topics in the Guidelines for the Diagnosis and Management of
Asthma.
The guidelines now recommend inhaled corticosteroids as safe,
effective and preferred first-line therapy for children as well as
adults with persistent asthma. The update continues to recommend a
"step-wise" approach to asthma management — in which
treatment is adjusted depending on disease severity — but it modifies
specific treatment recommendations at each step to reflect research over
the last five years.
Coordinated by the National Heart, Lung, and Blood
Institute (NHLBI) of the National Institutes of Health, NAEPP convenes
an expert panel as needed to ensure that the asthma guidelines reflect
the latest scientific advances. The guidelines were first published in
1991 and revised in 1997. An Executive Summary of the update report was
released recently at the NAEPP Coordinating Committee meeting. This
is the first in a series of periodic revisions on selected topics,
making the guidelines a dynamic resource for clinicians.
"NHLBI is committed to ensuring that asthma
patients benefit from the latest research findings," said NHLBI
Director Dr. Claude Lenfant. "Asthma is one of the most common
chronic health conditions in the United States, and the number of
Americans who suffer from asthma continues to rise. It is essential
that they are treated according to the best available scientific
evidence, and this update brings such evidence to clinical
practice."
The update stresses that inhaled corticosteroids are
preferred for controlling and preventing asthma symptoms, and for
improving lung function and quality of life. Inhaled steroids treat
chronic inflammation of the airways, which has been confirmed as a key
characteristic of asthma.
"We have learned a lot about the effectiveness
and safety of inhaled steroids in the past few years," said Dr.
William Busse, professor of medicine in allergy and immunology for the
University of Wisconsin Medical School and chair of the NAEPP Expert
Panel. "We have also found that inhaled steroids alone may not be
sufficient in all cases. Combination therapy — that is, adding
long-acting inhaled beta2-agonists to inhaled steroids — is more
effective than simply increasing the dose of inhaled steroids for
patients over 5 who have moderate or severe persistent asthma. But few
studies on combination therapy include young children, and additional
research is needed for this age group."
In addition, the update reflects new data that
provide reassuring evidence on the safety of inhaled steroid use at
appropriate doses in children. The expert panel reviewed studies
examining possible side effects of inhaled corticosteroids, including
slowed growth in children. The update reports that large clinical
trials have shown that the potential risk of a delay in growth linked
to inhaled corticosteroids is temporary and possibly reversible. The
expert panel also concluded that other potential concerns, such as
reduced bone mineral density, suppressed adrenal function, and
increased incidence of cataracts are not considered significant risks
for children.
"Asthma is a complex disease," adds Dr.
James Kiley, director of the NHLBI Division of Lung Diseases.
"Research has led to numerous medications that help control
asthma so that patients can live active lives. Little is known,
however, about what makes the disease become more severe and whether
treatment can prevent this progression." The Expert Panel
identified these and other areas, such as therapies for children 5
years and younger, as priorities for future studies.
According to the National Center on Health
Statistics, 11 million Americans reported having an asthma attack in
1998, including 3.8 million children. One of the leading causes of
disability and lost productivity, asthma is also responsible for 5,000
deaths each year in the U.S. NHLBI estimates that the annual direct
and indirect costs of asthma were $12.7 billion in 2000.
The 11-member NAEPP Expert Panel prepared the update
based on a systematic review of scientific evidence. The panel
includes representatives from the fields of allergy and immunology,
family practice, internal medicine, pediatrics, pharmacology, public
health, and pulmonary medicine.
The NAEPP was established in March 1989 to reduce
asthma-related illness and death and to enhance the quality of life of
people with asthma. Today, 40 major medical associations and voluntary
health organizations, plus numerous federal agencies, comprise the
NAEPP Coordinating Committee. The NAEPP also coordinates federal
asthma-related activities, as designated by Congress through the
Children's Health Act of 2000.
The guidelines update also includes:
 | Additional considerations on when to start asthma
control therapy in infants and children under age 5.
| New recommendations regarding the use of
leukotriene modifiers as alternative therapy for treating mild
persistent asthma or as combination therapy in moderate asthma.
| Reaffirmation that antibiotics should not be used
to treat acute asthma attacks except when a bacterial infection due
to another condition, such as pneumonia or sinusitis, is present.
| A review of the benefits of written action plans
for self-management of asthma. |
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