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Physicians may want to take a deep breath before treating asthma patients with the old bag of tricks. The latest approaches for treating asthma include updated National Asthma Guidelines and a new Web-based program aimed at applying the new guidelines.

Late last year, the National Asthma Education and Prevention Program (NAEPP) issued the first update in 10 years to clinical guidelines for diagnosing and managing asthma. Changes to the guidelines include an expanded section on childhood asthma, guidance on medications, recommendations on patient education and advice for controlling environmental factors that can cause asthma symptoms, according to the NAEPP.

Dr. Shoab Nazir of the University of Arkansas for Medical Sciences (UAMS) said multifaceted approaches including added emphasis on patient education and participation, control of environmental factors that exacerbate asthma and treatment of comorbid conditions that affect asthma control such as gastroesophageal reflux, obesity, obstructive sleep apnea, rhinitis, sinusitis and depression have been included in the newer guidelines.

“Patients need to make sure that they fully understand the disease process and actively participate in their care by effectively partnering (with) their treating provider to make the best use of the newer guidelines,” Nazir said.
The NAEPP updates provide guidance for deciding treatment based on individual patient needs. “The guidelines emphasize, that while asthma can be controlled, the condition can change over time and differs among individuals and by age groups. Thus, it is important to monitor regularly the patient’s level of asthma control so that treatment can be adjusted as needed,” the NAEPP states.

Nazir, who is an assistant professor of medicine and the associate program director Pulmonary & Critical Care Fellowship at UAMS, named four changes to the guidelines that he noted as the most important:

1. Sub-categorization of the pediatric population into three groups rather than two, highlighting the variability of the disease, the treatment, and the amount of available evidence with age.

2. Simplifying the stepwise approach by expanding to six steps.

3. Adding an immunomodulator category.

4. Allowing early use of a combination of a long-acting beta agonist (LABA, an inhaled bronchodilator) and an inhaled corticosteroid (ICS).

After being diagnosed with asthma around age 9, Dedra Riggs, now 32, of Walnut Ridge, said her asthma treatment was “as personalized as possible” but involved a lot of trial and error, testing which medications worked during certain seasons of the year and which medications she seemed to “outgrow.”

Riggs said her asthma symptoms were misdiagnosed as allergies, until she developed a constant cough and severe shortness of breath.

Nazir said nearly 50 percent of children with asthma will have asthma symptoms in their adult life, adding that females, those with a lower performance on lung function tests and those who smoke have a higher likelihood of continuing to suffer from asthma in their adulthood.

Riggs was lucky — she has not had to take asthma medication since about age 20, and has not had to use an inhaler since age 22. She noticed a decrease in symptoms when she moved to Jonesboro to attend Arkansas State University, but the symptoms have not returned since she moved back to Walnut Ridge.

A high school teacher, Riggs now must witness the negative effects asthma has on her students. “We (teachers) are made aware of all of our students’ medical conditions which could interfere with or flare up during class and we might have to treat them.” One student in particular, who she has taught for four years, has severe asthma. “He is constantly absent, sick at home or the hospital,” she said. “It has really affected his grades and ability to get into a good college.”

Physicians treating patients with asthma also may want to consider a new Web-based tool in their approach to treatment.

Announced in March at the annual American Academy of Allergy Asthma & Immunology (AAAAI) meeting, ASTHMA IQ is a Web-based program that helps allergists and immunologists learn about the key components of new medical asthma guidelines and apply them in everyday practice.

ASTHMA IQ is an acronym for Asthma Specialist Tool to Help Manage Asthma and Improve Quality.

“ASTHMA IQ contains decision-support features that provide specific feedback based on patient’s age, asthma impairment, and asthma risk,” Dr. Thomas Casale stated in the AAAAI news release.

Casale is president of the AAAAI and professor of Medicine and Medical Microbiology and Immunology and chief of Allergy/Immunology at Creighton University in Omaha.

“ASTHMA IQ can help physicians identify the most appropriate severity or control level and initiate or adjust therapies,” said Casale.

ASTHMA IQ is available free to AAAAI members.

Asthma costs Americans approximately $20 billion in healthcare costs annually and affects 23 million Americans, according to statistics from AAAAI.



May 2008

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