Let’s Talk Asthma Guidelines

A few years ago, I wrote “10 Best Asthma Discoveries Of All Time.” Number six on that list was the creation of asthma guidelines. So, what are asthma guidelines? How did they come to be? How do they benefit asthmatics? Here’s what to know.

How did the idea of guidelines come about?

The 40 years before 1969 saw asthma rates increased from 0.53% to 4.8%. Researchers believed these statistics far underestimated the actual number of people with asthma.² During the 1980s, the number of children diagnosed with asthma rose so fast that asthma experts grew increasingly concerned.¹ One study showed that, between 1989 and 1994, there was a 92% increase in the number of children diagnosed with asthma.^2/

Coinciding with this increase was an increase in the number of people with poorly controlled asthma and an increase in the asthma mortality rate. This was despite the availability of rescue medicine like albuterol and asthma controller medicines like inhaled corticosteroids.²

So, the 1980s is described as the decade of the asthma epidemic. And it benefited asthmatics because it inspired asthma experts from all over the world to get together and share all that they knew about our disease.¹

This inspired the birth of asthma guidelines. In 1989, the first asthma guidelines were published by the Thoracic Society of Australia and New Zealand.³ The name was changed to the National Asthma Council (NAC). The most recent update was in 2019.

The first asthma guidelines

In 1990, The British Thoracic Society created the first asthma guidelines in Britain. These are updated in 1993.¹ These guidelines are now updated with the Scottish Intercollegiate Guidelines Network (SIGN). The most recent update was in 2019 by BTS/ SIGN.^3-4

In 1991, the first asthma guidelines were introduced to the U.S. by the National Asthma Education Program (NAEP) under the National Heart, Lung, and Blood Institute (NHLBI). These are updated in 1997, 2002, 2007, and 2020.^1,4-5

In 1995, The Global Initiative For Asthma (GINA) published its asthma guidelines. They are sponsored by NHLBI and the World Health Organization (WHO). Since 2002, these guidelines have been updated every year.^1,5-6

In 2003, the National Institute for Health and Care Excellence (NICE) published its asthma guidelines in the United Kingdom. The latest updates came in 2017 and 2020.⁴

Evidence over opinion

The first asthma guidelines were based on the “consensus of expert opinion.” However, this changed in the late 1990s. Since then, all updates to them are based on evidence as opposed to opinion.⁷

GINA guidelines

The GINA asthma guidelines are written for physicians. Their goal is to help physicians in various countries create their own guidelines. They also offer a pocket guide and a patient information packet.⁵

NICE guidelines

The NICE asthma guidelines are written to help physicians manage their patients with mild to moderate asthma. The NHLBI guidelines are written for physicians and their patients. Their goal is to help patients work together with their physicians to manage their asthma best.⁵

What is the goal of asthma guidelines?

A few years ago, I discussed with a person in charge of public relations at National Jewish Health in Denver. She explained to me the importance of these guidelines. She said that before creating asthma guidelines, physicians at research hospitals like National Jewish had access to the most recent asthma wisdom. But this same wisdom was slow to make its way to regional physicians.

One goal of creating asthma guidelines was to help all physicians, regardless of location, gain access to all the best asthma wisdom.

Likewise, before the advent of guidelines, many strategies were being used to manage asthma. In many cases, how asthma was treated varied from one doctor to the next. So, a second goal is to “standardize” how asthma is approached.⁷

A third goal is to help all doctors become better capable of diagnosing, managing, and treating their asthma patients. Of course, the overall goal is to help asthmatics obtain good asthma control and have a good quality of life.

What to make of this?

Asthma guidelines have now been around for 30 years. They play a huge role in helping doctors stay on the same page regarding how they approach asthma. Studies show they improve how doctors manage their asthmatic patients, and this has benefited many asthmatics (myself included) obtain better control and improve quality of life.⁸