The National Asthma Guidelines

Posted by Dr. James Liu on

The national asthma guidelines released by the National Institutes of Health (NIH) in 2009 is very useful.

1. Inhaled corticosteroids are the most effective anti-inflammatory medications for long-term management of persistent asthma.

Why? Inhaled corticosteroids treat the quietly smoldering part of asthma – inflammation. (Inflamed airways are raw, swollen and filled with mucus.) Inhaled corticosteroids are particularly well suited for people whose stubborn symptoms hang on, even after they faithfully use other medications, eliminate known allergens and irritants and rule out interrelated medical conditions such as sinus infections or gastroesophageal reflux disease (GERD). Inhaled corticosteroids are usually used daily until you and your physician feel you can decrease the dose or stop using the medication altogether.

2. All people with asthma should receive a written Asthma Action Plan.

Why? Asthma is a complex, potentially life-threatening condition. Treatment instructions, which include using multiple medications, responding to various stages of symptoms and making environmental changes, must be written in the patient’s record and the patient should get a copy. This asthma action plan will cover routine or daily treatment as well as recognizing and handling worsening symptoms. Every person with asthma deserves an individualized, written asthma action plan. If you don’t have one, make an appointment today to meet with your medical care team to develop your own asthma action plan. (Click here for a sample Asthma Action Plan template.)

3. All patients should have an initial assessment that covers impairment and risk to determine the level of therapy needed.

Why? To decide on a treatment plan, your asthma care team must look at the big picture as well as deal with your current breathing problems. It’s important to take into account how asthma affects your daily activities and to assess the risk of future symptoms or life-threatening events.

4. At planned follow-up visits, asthma patients should review their level of control with their healthcare provider based on multiple measures of current impairment and future risk in order to guide clinician decisions to either maintain or adjust therapy.

Why? Traditionally, asthma was only treated in the emergency department or when symptoms were flaring beyond your ability to stop them at home. With planned, scheduled visits, you can focus on good health and work with your medical care team to learn to intervene early and hold on to the best possible breathing levels.
These visits are all about you getting answers to the questions you have. Review your daily symptom diary. Talk about how the results of your home peak flow monitoring compare with the office lung function tests. Together, you and your physician can check the progress you’re making toward your agreed-upon goals and reassess your future risk of symptoms or life-threatening events.

5. Patients who have asthma should be scheduled for planned follow-up visits at periodic intervals in order to assess their asthma control and modify treatment, if needed.

Why? Planned follow-up visits are important or they wouldn’t be mentioned in two of these recommendations. After education and conversation, the office visit turns to assessing how or if the asthma action plan should be revised – specifically, whether or not to adjust the dose and frequency of medications. The goal: Use the least amount of medication necessary to achieve the maximum result, meaning asthma doesn’t interfere with your daily life.

6. Clinicians should review each patient’s exposure to allergens and irritants and provide a multi-pronged strategy to reduce exposure to those allergens and irritants that make a patient’s asthma worse.

Why? Controlling asthma symptoms involves much more than prescribing medications. That’s why the guidelines direct clinicians to ask about your exposures to common inhalants known to cause airway inflammation, such as airborne particles of pet dander, tobacco smoke, mold, dust mites, cockroaches, pollen and other pollutants at home, work, school and play.

It may take a set of allergy-proofing measures to make a difference – no single, quick solution will do it all – but many people find they decrease their symptoms and the need for daily medications after eliminating the environmental culprits.

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