US unveils new asthma guidelines focusing on prevention, monitoring

2 September, 2007:

The United States has released new guidelines for control of asthma.

The new guidelines seek to make breathing easier and maintaining an active lifestyle for people suffering from the lung disease.

According to Dr Elizabeth G Nabel, director of the National Heart, Lung, and Blood Institute, “asthma control is achievable for nearly every patient.”

Dr Nabel stressed that, with proper medical care, healthy environments and better-informed patients, asthma can be controlled, and people can lead active lives.

Asthma is a chronic but treatable disease that causes airways to narrow in response to allergens, making breathing difficult at times. Over 22 million Americans suffer from asthma, including 6.5 million children under the age of 18, and those numbers are rising.

Without proper treatment, asthma can limit a person’s activities and lead to breathing complications that can result in hospitalization and even death. The disease causes about 4,000 deaths each year and almost 500,000 hospitalisations in the United States, according to the US Centers for Disease Control and Prevention.

The new guidelines, the first revision in a decade, were developed by the National Asthma Education and Prevention Program under the sponsorship of the National Heart, Lung, and Blood Institute.

The asthma guidelines start by calling for a strong emphasis on monitoring asthma. One aspect of that monitoring should focus on the severity of a patient’s daily symptoms. Both patients and doctors need to be aware of those daily symptoms.

Patients and doctors also need to be aware of the risk of future asthma attacks, loss of lung function and side effects from medication.

Since the last guidelines were issued, there has been increased understanding of asthma and better approaches to diagnosis and treatment. Though more people are being diagnosed with the disease, the number of people reporting asthma attacks has remained stable, and the number of deaths has dropped, Dr Nabel said.

To focus on the severity and future risk of asthma attacks, the new guidelines contain new-age categories that enable doctors to pursue three different treatment plans. The categories are: infants to 4 years old, 5 to 11 years old, and 12 years and older.

The 5 to 11 age group was added (earlier guidelines combined this group with the adults), following new evidence on medications for this age group and findings that suggest children may respond differently than adults to asthma medications.

Treatment steps have also been expanded from ages 4 to 6, Dr William W Busse, head of the panel that developed the guidelines and chairman of the University of Wisconsin’s Department of Medicine, said.

The guidelines also call for allowing children to bring their inhalers to school to use in the event of an asthma attack.

Other new steps are geared to people aged 12 and older with severe asthma. These steps include the addition of the drug omalizumab, a monoclonal antibody that targets immunoglobulin E, which is associated with allergic reactions.

The guidelines also stress the importance of teaching patients to self-monitor and manage their asthma. They recommend using a written asthma action plan, which features instructions for daily treatment and ways to recognize and handle worsening asthma.