Guidelines

The National Heart, Lung, and Blood Institute’s National Asthma Education and Prevention Program (NAEPP) developed updated guidelines in 2007. Its Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, resulted from a relatively transparent, evidence-based review of the literature. The relevant evidence was ranked as follows:

  • Evidence Category A: Randomized controlled trials with a rich body of data,
  • Evidence Category B: Randomized controlled trials with a limited body of data,
  • Evidence Category C: Nonrandomized trials and observational studies,
  • Evidence Category D: Panel consensus judgment.24

The goal is to update recommendations for managing asthma long term and for managing exacerbations by focusing on four essential components of asthma care: assessment and monitoring, patient education, control of factors contributing to asthma severity, and pharmacologic treatments.

The goals25 of asthma therapy include reducing impairment and reducing risk.

Reducing impairment includes:

  • Prevent symptoms
  • Infrequent use of inhaled SABA for quick symptom relief
  • Maintain optimal pulmonary function
  • Maintain normal activity levels
  • Meet patient and family expectations

Reduce risk:

  • Prevent recurrent exacerbations of asthma and minimize the need for hospital visits
  • Prevent progressive loss of lung function
  • Provide optimal pharmacotherapy

Figure 126 provides a framework for classifying patients and initiating treatment as appropriate. There are four levels of asthma severity: intermittent, mild persistent, moderate persistent, and severe persistent. The levels of asthma severity are based on the following components:

  • Symptoms
  • Nighttime awakenings
  • SABA use for symptom control
  • Interference with normal activity
  • Lung function as expressed by peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1), and PEF variability (a measure that compares the PEF obtained in the morning with the PEF obtained later in the day).

History of Asthma Guidelines27

The NAEPP’s Guidelines for the Diagnosis and Management of Asthma were first published in 1991 in a landmark report that redefined the commonly held views about asthma. The following lists the updates to the original report:

1989 – NHLBI establishes the NAEPP and convenes first expert panel.

1991Expert Panel Report (EPR): Guidelines for the Diagnosis and Management of Asthma (EPR)released.

1997Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma (EPR-2)released.

2002Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma—Update on Selected Topics 2002 (EPR-Update 2002) released.

2007Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (EPR-3)released.