Aggressive New Asthma Tactics

Aug. 29, 2007 - New NIH asthma guidelines promise to make a child's asthma milder and to prevent severe asthma attacks before they happen.

The guidelines come from a panel of asthma experts convened by the National Heart, Lung, and Blood Institute (NHLBI). They closely follow the 2002 update of the original 1997 guidelines.

But two major changes represent a fundamental shift in the goals of asthma treatment, panel chairman William W. Busse, MD, chairman of the department of medicine at the University of Wisconsin-Madison, said in a news conference.

Those changes: a new focus on reducing asthma severity and a new emphasis on keeping asthma symptoms under control.

"We firmly believe that asthma control can be achieved in nearly every patient with asthma," Busse said. "We anticipate, expect, and hope these new recommendations will pave way to control of asthma, reduction of risks, and continuing efforts to cure this disease."

NHLBI Director Elizabeth G. Nabel, MD, expressed similar optimism.

"Asthma affects over 22 million Americans, including 6.5 million children, but there is one truth: Asthma control is achievable for nearly every patient," she said at the news conference. "As health care providers, we should accept nothing less."

New Changes

What will change from a patient's point of view?

If their primary care doctor is following the new guidelines, asthma patients can expect a much more thorough evaluation of their disease. Doctors will no longer be satisfied if they hear a patient is doing well -- they'll use questionnaires, lung-function tests, and medication checks to see exactly how well a person is keeping asthma under control.

"If we do this, the impairments from disease will be reduced quite significantly," Busse said.

Panel member Robert F. Lemanske, MD, professor of pediatrics and medicine at the University of Wisconsin-Madison, noted that the new guidelines now have separate recommendations for children aged 0-4 years, 5-11 years, and 12 and older.

"Preschool kids are much different than kids who enter school -- and both differ from the adolescent period -- in terms of treatment approaches, adherence, and so on," Lemanske said at the news conference. "This will give us a better handle on the different things that can happen to children at different ages."

It's hoped that by keeping asthma under tighter control, more kids will avoid the surge of hospitalizations that happens every September and October. The reason for this is that kids catch colds when they go back to school. This triggers severe asthma attacks, noted panel member Homer A. Boushey, MD, professor of medicine at the University of California, San Francisco.

"Taking inhaled corticosteroids is not only important for improving daily function, but also for preventing asthma attacks," Boushey said at the news conference. "That is what we want people to think about: Remember to take your inhaled corticosteroids. By doing this, we hope to reduce these peaks of exacerbation."

Boushey noted that many parents confuse inhaled corticosteroids -- which have very few system-wide effects -- with the anabolic steroids abused by athletes.

"Inhaled corticosteroids really are quite safe, even in growing children," he said. "These drugs are effective and safe, and we should encourage their use."

"These guidelines represent the best and most up-to-date science," Nabel said. "They now provide critical guidance to patients and their families and to others in the community, including the school community."

The guidelines are available on the NHLBI web site.