Elsevier

Mayo Clinic Proceedings

Volume 84, Issue 8, August 2009, Pages 707-717
Mayo Clinic Proceedings

REVIEW
Managing Asthma in Primary Care: Putting New Guideline Recommendations Into Context

https://doi.org/10.4065/84.8.707Get rights and content

Many patients with asthma are treated in the primary care setting. The primary care physician is therefore in a key position to recognize poorly controlled asthma and to improve asthma management for these patients. However, current evidence continues to show that, for a substantial number of patients, asthma control is inadequate for a wide variety of reasons, both physician-related and patient-related. The most recently updated treatment guidelines from the National Asthma Education and Prevention Program were designed to help clinicians, including primary care physicians, manage asthma more effectively with an increased focus on achieving and maintaining good asthma control over time. The current review is intended to assist primary care physicians in improving asthma control among their patients; this review clarifies the new guidelines and provides a specialist's perspective on diagnosis, appropriate therapy, disease control surveillance, and appropriate referral when necessary. This discussion is based primarily on the new guidelines and the references cited therein, supplemented by the author's own clinical experience.

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.

REFERENCES (29)

  • L Cox et al.

    American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma and Immunology Joint Task Force Report on omalizumab-associated anaphylaxis

    J Allergy Clin Immunol

    (2007)
  • KR Chapman et al.

    Suboptimal asthma control: prevalence, detection and consequences in general practice

    Eur Respir J

    (2008)
  • ST Holgate et al.

    Asthma out of control? A structured review of recent patient surveys

    BMC Pulm Med

    (2006)
  • R Horne et al.

    Can asthma control be improved by understanding the patient's perspective?

    BMC Pulm Med

    (2007)
  • Cited by (0)

    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.

    This article is freely available on publication, because the authors have chosen the immediate access option.

    View full text