Asthma Treatments

The National Asthma Education and Prevention Program (NAEPP) issued the first comprehensive update of clinical guidelines for the diagnosis and management of asthma in 2007. The guidelines emphasized the importance of asthma control and introduced new approaches for monitoring asthma.

Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma – Full Report, 2007 provided new guidelines for asthma treatments based on a patient's individual needs and level of asthma control. The guidelines emphasized that while asthma can be controlled, the condition can change over time and differs among individuals and by age groups. Thus, it is important to monitor regularly the patient's level of asthma control so that treatment can be adjusted as needed.

Key Features of Asthma Treatments

Assessment and Monitoring: The guidelines stressed that some patients can still be at high risk even if they experience few day-to-day effects of asthma. Therefore, it recommended a new approach to assessing and monitoring asthma by using multiple measures of the patient's level of current impairment (frequency and intensity of symptoms, low lung function, and limitations of daily activities) and future risk (risk of exacerbations, progressive loss of lung function, or adverse side effects from medications).

Patient Education: Teaching patients the skills to self-monitor and manage asthma and to use a written asthma action plan, which should include instructions for daily treatment and ways to recognize and handle worsening asthma is a vital component of asthma treatments.

Control Of Environmental Factors: Multiple approaches to limit exposure to allergens and other substances that can worsen asthma are recommended over single steps, which are rarely sufficient. Treating chronic problems such as rhinitis and sinusitis, gastroesophageal reflux, overweight or obesity, obstructive sleep apnea, stress, and depression may help improve asthma control.

Medications: Always use a stepwise approach to control asthma, in which medication doses or types are stepped up as needed and stepped down when possible. Treatment is adjusted based on the level of asthma control. Asthma treatments are different for three age groups: 0-4 years, 5-11 years, and 12 years and older, since they react differently to asthma medications.

Long Term Asthma Treatments

Those with persistent asthma (in other words, those who have symptoms more than twice a week during the day or more than twice a month at night) need both long-term control medications to control asthma and prevent exacerbations, as well as quick relief medications for symptoms as needed. Inhaled corticosteroids continue to be the most effective long-term control medication across all age groups.

New recommendations on asthma treatments include leukotriene receptor antagonists and cromolyn for long term control; long acting beta agonists as adjunct therapy with inhaled corticosteroids; omalizumab for severe asthma; and albuterol, levalbuterol, and corticosteroids for acute exacerbations.

 At A Glance

• The Guidelines for the Diagnosis and Management of Asthma 2007 set new guidelines for asthma treatments based on a patient's needs and level of asthma control.
• Patients need the skills to self-monitor and manage asthma and to use a written asthma action plan
• Always use a stepwise approach to control asthma, in which medication doses or types are stepped up as needed and stepped down when possible.