Guidelines for the Diagnosis & Management of Asthma

In October 2009, the National Heart Lung and Blood Institute of the National Institutes Health released the latest version of the National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 3: Guidelines on Asthma. The new guidelines stress the importance of controlling asthma and discuss new ways for monitoring asthma symptoms.

Expectations for Asthma Control

• The new guidelines describe what you should expect if you have asthma: no or few asthma symptoms, even after exercise or at night; prevention of all or most asthma episodes; to be able to participate in all activities, even strenuous exercise; to have no emergency room visits or hospital stays; to be able to use less rescue (fast-acting) asthma medicines; and to have few or no side effects from your asthma medicines.

Keep Asthma Symptoms in Check

• According to the guidelines, you must keep your asthma symptoms in check. Effective treatment depends on the right diagnosis early. If you are newly diagnosed, you will want to see your doctor every two to six weeks to ensure asthma symptoms are being managed properly. Once this is confirmed, you will be able to see your doctor every one to six months, even if you have no symptoms. You should keep an asthma diary to track your symptoms and use a peak-flow meter to measure the air flow from your lungs. This information will help your doctor decide if your treatment plan needs to be changed.

Partner With Your Doctor to Manage Asthma

• You should partner with your doctor to learn about managing your asthma. Talk to your doctor about your treatment goals and how you can reach them. Have him write an asthma-action plan for you that explains what you should do every day and when asthma symptoms worsen. Review your medicines with your doctor, so you know what they do and when you should take them. Practice using your asthma medicines with your doctor's supervision. Discuss how to track your symptoms, and make decisions about how much medicine to take. Review with your doctor your asthma triggers and things that make your asthma worse, and discuss how you can avoid them.

Use Asthma Medicines Properly and Consider Allergy Shots

• You must use your asthma medicines properly. Your doctor will work with you to find the right medication plan for you, one that will control your asthma with the least amount of medicine. Most people with asthma need quick-relief medicines such as short-acting inhaled beta2-agonists or anticholinergics. Some people with asthma are prescribed long-term medicines to be taken every day to reduce airway inflammation. These include leukotriene modifiers, cromolyn sodium and nedocromil, inhaled corticosteroids, long-acting inhaled beta2-agonists, methylxanthines, oral corticosteroids, and immunomodulators.

  You should consider getting allergy shots if your asthma is triggered by allergens that you cannot avoid. This is also known as immunotherapy. They are very helpful when asthma and allergy symptoms occur year-round and cannot be controlled easily with medicine.

Avoid Asthma Triggers

• You must avoid asthma triggers. These might include allergens such as pollen, dust mites, cockroaches, molds and animal dander; pollutants such as tobacco smoke, air pollution and other volatile organic substances; medicines such as acetaminophen and aspirin; cold air; and exercise. Health problems can also trigger asthma such as being overweight or obese, obstructive sleep apnea, acid reflux, viruses such as the common cold or flu, sinus infections, stress and anxiety or depression.

See an Asthma Specialist

• The guidelines advise that you should be seeing an asthma specialist such as an allergist or pulmonologist, if you have asthma symptoms every day and most nights, if asthma limits your activity, if you've had a life-threatening asthma attack, if you do not meet the goals of your asthma treatment after three to six months or if your doctor thinks you're not responding to treatment, if you have symptoms that are difficult to diagnose, if you have severe hay fever or sinusitis that complicates your asthma management or diagnosis, if you need more tests to find out about your asthma, if you need more instruction on your treatment plan and asthma triggers, if you may need allergy shots, if you need oral corticosteroid therapy (prednisone) or high doses of inhaled corticosteroids, if you have taken oral corticosteroids more than twice in one year for your asthma, if you have stayed in a hospital because of asthma and if you need help to identify your asthma triggers. Children up to age 4 should see an asthma specialist if they have asthma symptoms every day and three to four nights more a month, as should older children who have symptoms three days or more a week and on to two nights a month.