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 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.