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Updated Asthma Guidelines from the NIH The National Asthma Education and Prevention Program is a health initiative of the National Institutes of Health, akin to its educational programs in high blood pressure and high cholesterol management. The asthma program was begun in 1990 to raise awareness about asthma as a potentially serious medical condition. As part of this nationwide endeavor, a panel of medical experts was assembled to draft guidelines for the optimal management of asthma in children and adults. Dr. Albert Sheffer of Partners Asthma Center chaired the first Expert Panel, which released its Guidelines for the Diagnosis and Management of Asthma in 1991. A revision of these Guidelines was released by the second Expert Panel in 1997. This month the National Asthma Education and Prevention Program has released a summary of its 2002 Update of Selected Topics. The full version has yet to be published. If you have access to the Internet, you can view the Quick Reference Summary of the 2002 Update by going to nhlbi.nih.gov and clicking on Clinical Guidelines on Asthma: Update 2002. Topics chosen for updating were those in which scientific research has provided new information or those for which there have been particular concerns among patients and healthcare providers. The updates are grouped into three categories: Medications, Monitoring, and Prevention. The new recommendations regarding medications for treating asthma are discussed here. Topics in Monitoring and Prevention will be reviewed in the next issue of Breath of Fresh Air. Use of inhaled steroids in children: The Expert Panel indicates that inhaled steroids are the most effective controller medication for children. They improve lung function, reduce symptoms, reduce the need for courses of oral steroids prednisone or prednisolone ; , and lessen the risk of asthma attacks requiring urgent care. The group also indicated that long-term controller therapy was appropriate for infants and young children with repeated episodes of wheezing and disturbed sleep; with symptoms requiring quick-relief bronchodilators more than twice per week; or with severe asthma attacks less than 6 weeks apart. At the same time, the report notes that new evidence indicates that low-to-medium doses of inhaled steroids are safe, even in children. In particular, it is unlikely that inhaled steroids in these doses have long-term effects on bone growth or a child's final height. Likewise, the risk of harmful effects of inhaled steroids on other organs, particularly the eyes, was deemed insignificant. Combination therapy Combining an anti-inflammatory medication with a long-acting bronchodilator has proven particularly effective for control of moderate or severe asthma. For persons with moderate asthma needing additional controller therapy beyond low-to-medium doses of inhaled steroids, it was felt that first-choice therapy is addition of a long-acting inhaled beta-agonist bronchodilator salmeterol [Serevent] or formoterol [Foradil] ; . This combination was recommended for adults and children over age 5 years. Antibiotics for acute asthmatic attacks Respiratory infections often trigger severe asthma attacks. Most often, the cause of the respiratory infection is a virus, not a bacteria. As you know, antibiotics are ineffective against viral infections. As a result, the Expert Panel indicated that antibiotics are not recommended for routine treatment of severe asthma attacks -- unless fever and discolored sputum or nasal drainage point to pneumonia or bacterial sinusitis in addition to the attack of asthma and serzone.
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