Update on National Asthma Guidelines Released

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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 today 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.

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.

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. 

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