As asthma affects about 6% of the U.S. population, there is a need to provide guidelines to standardize care to asthmatics to get patients to feel the best they can. Recently, an expert panel of the National Institutes of Health released updated guidelines on care of adults and children with asthma. In this entry I would like to review some changes in these recently updated guidelines.
The group of experts, part of the National Asthma Education and Prevention Program (NAEPP), reviews the most up-to-date literature and clinical science on defining asthma severity and approaches to treatment. Initially started in the early 1990s, the panel reports release guidelines on diagnosis and treatment of asthma. This is particularly helpful for both specialists and general practitioners taking care of asthma patient.
In light of recent research on the role of respiratory viral infections as triggering wheeze in infants and toddlers and the need to better tailor age-appropriate treatment, the panel expanded age categories from two to three. Treatment recommendations are for infants/toddlers (through age 4), children (ages 5 to 11), and young adults/adults (ages 12 and up).
The key changes are revised recommendations in the infant group, where the decision to start long-term controller medications is based on more frequent flares of asthma causing difficulty with daily functioning or sleep disturbance. This is due to the fact that many young children who wheeze with a viral infection may not continue to have asthma in later childhood. As usual, whether your child would benefit from long-term controller medication will be determined by a detailed assessment by your child's doctor.
Focus on control
Previous NAEPP guidelines have focused treatment strategy primarily on determining underlying disease severity based on symptoms and lung function tests. There has been awareness that determining underlying severity on an ongoing basis, and in some cases with different health care providers, can be challenging.
The new 2007 guidelines have shifted treatment approach to focus on current degree of asthma control as a main guide to adjusting treatment. In addition, the guidelines have expanded their recommendations on treatment of frank exacerbations of asthma, including care in the Emergency Room, hospital, and in follow-up.
Guidelines are just that -- they apply to larger patient groups and not for each individual patient. While they improve our understanding and approach for providing the best care to asthmatics, there is no replacement for individual patient care with your doctor. You should feel free to ask them if the new guidelines might lead to changes in your asthma treatment and control.