Updated Asthma Guidelines

Every five years, guidelines for physicians who diagnose and treat asthma are updated by the NAEPP's Expert Panel to incorporate newly published evidence from research studies. Last weekend in San Diego I attended the largest allergy meeting in the world, the annual congress of the AAAAI, where the 2007 update of the asthma guidelines was presented by some of the panel members. The full 600-page document is available for downloading and public comments before March 15. One of the panel members, only half-joking, said that the only people who have commented on previous drafts are employees of asthma drug companies who believe that their drug should have received more emphasis. About 20 of the 4000 allergists at the meeting stood at the microphones to ask questions of the panel members during the final 30 minutes of the session.

Here are some key differences between the 2007 guidelines and previous editions.

• Current asthma treatments do not prevent disease progression.
• Even patients with intermittent asthma can have severe asthma attacks (exacerbations). S
• Single steps taken to reduce indoor allergen levels (such as just buying an air cleaner or just using allergen-proof bedding) are generally ineffective.
• Formaldehyde and VOCs (chemicals that smell funny) can worsen asthma.
• Every patient with asthma should have a written asthma action plan which includes both daily management and early recognition of asthma exacerbations.
• When a patient is regularly taking an ICS, but still has inadequate asthma control (remains in the yellow zone), the addition of a LABA (like salmeterol or formoterol) may be a better option than doubling the daily ICS dose.

Recommended emergency room management of asthma attacks was updated.

• Levalbuterol (Xopenex) may be used instead of traditional racemic (inexpensive) albuterol.
• For severe attacks not responding to traditional therapy, magnesium sulfate or heliox therapy should be considered.
• Ipratropium (Atrovent) is no longer recommended for hospital inpatient asthma therapy.
• A primary goal of ER therapy (before the patient is sent home with an ICS and other therapy) is an FEV1 of more than 70% of the predicted (normal) value.

Sadly, it may take years before the doctors who treat you for asthma incorporate these new guidelines into their routine practice. For example, large studies have shown that fewer than half of patients were taking an ICS (the best asthma controller therapy) during the three months after an asthma attack.

Related Topics:

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WebMD Video: Asthma and Ozone

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