REVIEWManaging Asthma in Primary Care: Putting New Guideline Recommendations Into Context
Section snippets
OVERVIEW OF THE UPDATED NAEPP GUIDELINES
The NAEPP, initiated by the National Heart, Lung, and Blood Institute in 1989 in response to the worsening asthmaepidemic, issued its first set of asthma management guidelines in 1991. A revised set of guidelines—the Expert Panel Report 2—was published in 1997 and was updated in 2002. These guidelines first introduced the stepwise approach to asthma therapy that is based on a 4-part classification scheme of disease severity (mild intermittent, mild persistent, moderate persistent, or severe
MAKING THE DIAGNOSIS
Correctly diagnosing asthma is the first step toward attaining disease control. In general, a diagnosis of asthma is established if episodic symptoms of airflow obstruction or airway hyperresponsiveness are present, airflow obstruction is at least partially reversible, and alternative diagnoses are excluded. The guidelines recommend the use of a detailed medical history, the results of a physical examination (focusing on the upper respiratory tract, chest, and skin), and the results of
How Are Asthma Severity and Control Assessed and Monitored?
Once the diagnosis of asthma has been established, the focus shifts to classifying asthma severity so that therapy can be initiated and to monitoring control over time so that therapy can be adjusted. According to the new guidelines, severity and control should be assessed separately, but both are classified on the basis of the domains of current impairment and future risk. Impairment is defined as “the frequency and intensity of symptoms and functional limitations the patient is experiencing
CONCLUSION
Asthma is a chronic condition that often remains uncontrolled for reasons that may be related to the disease process itself, the management decisions of clinicians, the patient's perceptions of disease control or self-management behaviors, the cost of medications, or a combination of all of these factors. Whatever the reasons for poor control, efforts to improve it can achieve a notable positive effect on the lives of patients with asthma. The most recently updated treatment guidelines from the
Acknowledgments
The author thanks Marci Mikesell, PhD, for medical writing assistance in the preparation of the submitted manuscript. Support for third-party writing assistance was provided by Genentech and Novartis.
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From 2007 to 2009, Dr Wechsler consulted for or participated in advisory boards or speakers bureaus for AstraZeneca, GlaxoSmithKline, Schering-Plough, Novartis, Genentech, Merck, MediciNova, and Sepracor.
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