Guidelines for asthma released

Medications and lifestyle recommendations to improve daily asthma control and prevent attacks should be tailored to each patient, based on age and the changing course of the disease, say new guidelines released Wednesday.

"What's new is the emphasis on prevention," says Elizabeth Nabel, director of the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health. "In the past, physicians might have waited until symptoms were very severe before intervening." Now, she says, patients are urged to try preventing attacks.

One way to do that, she says, is for all patients to have a "daily action plan" that lists the environmental influences that can trigger their breathing problems, such as cigarette smoke or viral infections, along with needed medications and how they should be used.

The guidelines, created by the National Asthma Education and Prevention Program, an expert panel convened by the NHLBI, offer the first update in 10 years. Among highlights:

• Age groups: The guidelines suggest different treatments for ages 0-4, 5-11 and 12 and older. Previous guidelines had just two groups, children up to age 5 and everyone else. One reason, says pediatrician and panel member Robert Lemanske of the University of Wisconsin Hospital and Clinics is that studies now show children under 12 are best treated with low-dose inhaled corticosteroids, rather than drug combinations more effective in older children and adults. Also, says Nabel, school-age children can take inhalers to school and are "perfectly capable" of knowing when to use them.

• Monitoring: A greater emphasis is placed on assessment of the severity of each patient's asthma over time and increasing or decreasing medication accordingly. About 70 percent of asthma patients are treated by pediatricians and general practitioners rather than lung specialists, and doctors are being advised to use a new questionnaire to help determine whether the asthma is being controlled, to test lung function routinely and to make sure patients know how to use medications.

"Probably one of the most important things," Lemanske says, "is to see patients on a regular basis, not just when they're sick, but when they're doing OK," to assess current degree of illness and track severity and seasonal changes.

Asthma hospitalizations rise in the fall and peak around Thanksgiving, the panel members said.