Guidelines for the Diagnosis and Management of Asthma

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American Institutes for Research Heather Banks, M.A., M.A.T. Senior Editor Patti Louthian Senior Desktop Publisher Karen L. Soeken, Ph.D. Methodologist Mary Tierney, M.D. Project Manager viii Guidelines for the Diagnosis and Management of Asthma
Preface The Expert Panel Report 3 (EPR—3) Summary Report 2007: Guidelines for the Diagnosis and Management of Asthma was developed by an expert panel commissioned by the National Asthma Education and Prevention Program (NAEPP) Coordinating Committee (CC), coordinated by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. Using the 1997 EPR—2 guidelines and the 2002 update on selected topics as the framework, the expert panel organized the literature review and updated recommendations for managing asthma long term and for managing exacerbations around four essential components of asthma care, namely: assessment and monitoring, patient education, control of factors contributing to asthma severity, and pharmacologic treatment. Subtopics were developed for each of these four broad categories. The EPR—3 Full Report and the EPR—3 Summary Report 2007 have been developed under the excellent leadership of Dr. William Busse, Panel Chair. The NHLBI is grateful for the tremendous dedication of time and outstanding work of all the members of the expert panel, and for the advice from an expert consultant group in developing this report. Sincere appreciation is also extended to the NAEPP CC and the Guidelines Implementation Panel as well as other stakeholder groups (professional societies, voluntary health, government, consumer/patient advocacy organizations, and industry) for their invaluable comments during the public review period that helped to enhance the scientific credibility and practical utility of this document. Ultimately, the broad change in clinical practice depends on the influence of local primary care physicians and other health professionals who not only provide state-of-the-art care to their patients, but also communicate to their peers the importance of doing the same. The NHLBI and its partners will forge new initiatives based on these guidelines to stimulate adoption of the recommendations at all levels, but particularly with primary care clinicians at the community level. We ask for the assistance of every reader in reaching our ultimate goal: improving asthma care and the quality of life for every asthma patient with asthma Gregory Morosco, Ph.D., M.P.H. Director Division for the Application of Research Discoveries National Heart, Lung, and Blood Institute James Kiley, Ph.D. Director Division of Lung Diseases National Heart, Lung, and Blood Institute Preface ix
Page 1 and 2: SUMMARY REPORT 2007 National Asthma
Page 3 and 4: Contents Acknowledgments iii Prefac
Page 5 and 6: Acknowledgements National Asthma Ed
Page 7 and 8: Development of the guidelines was f
Page 9: Robert Zeiger, M.D. Kaiser Permanen
Page 13 and 14: Introduction More than 22 million A
Page 15 and 16: New emphasis on multifaceted approa
Page 17 and 18: Figure 1. SUMMARY OF RECOMMENDED KE
Page 19 and 20: Figure 1. SUMMARY OF RECOMMENDED KE
Page 21 and 22: Asthma Definition and Implications
Page 23 and 24: Diagnosis of Asthma To establish a
Page 25 and 26: FIGURE 3. SUGGESTED ITEMS FOR MEDIC
Page 27 and 28: Managing Asthma Long Term GOAL OF T
Page 29 and 30: FIGURE 4. SAMPLE PATIENT SELF-ASSES
Page 31 and 32: Develop an active partnership with
Page 33 and 34: FIGURE 6. SAMPLE ASTHMA ACTION PLAN
Page 35 and 36: FIGURE 7. DELIVERY OF ASTHMA EDUCAT
Page 37 and 38: these particles do not remain airbo
Page 39 and 40: Animal Dander Some people are aller
Page 41 and 42: Quick-relief medications are used t
Page 43 and 44: FIGURE 10. AEROSOL DELIVERY DEVICES
Page 45 and 46: The stepwise approach and recommend
Page 47 and 48: individual drug efficacy studies in
Page 49 and 50: of particular relevance (impairment
Page 51 and 52: ■ Albuterol is the preferred SABA
Page 53 and 54: FIGURE 12. ASSESSING ASTHMA CONTROL
Page 55 and 56: FIGURE 14. CLASSIFYING ASTHMA SEVER
Page 57 and 58: FIGURE 16. STEPWISE APPROACH FOR MA
Page 59 and 60: FIGURE 17. USUAL DOSAGES FOR LONG-T
Page 61 and 62:
FIGURE 18. ESTIMATED COMPARATIVE DA
Page 63 and 64:
FIGURE 19. USUAL DOSAGES FOR QUICK-
Page 65 and 66:
Managing Exacerbations Asthma exace
Page 67 and 68:
FIGURE 21. MANAGEMENT OF ASTHMA EXA
Page 69 and 70:
FIGURE 22. DOSAGES OF DRUGS FOR AST
Page 71 and 72:
FIGURE 23a. EMERGENCY DEPARTMENT—
Page 73:
For More Information The National H
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