Asthma Treatment Guidelines
The National Heart, Lung, and Blood Institute provide treatment guidelines for asthma in the United States.1 The title of the guidelines is “Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.” The National Asthma Education and Prevention Program (NAEPP) wrote these treatment guidelines in 2007. The NAEPP is a group that represents physicians, patients, and government health agencies.
What is in the guidelines?
These guidelines are more than 400 pages long. They cover a wide range of topics. The document starts by describing the body processes that lead to asthma. The guidelines recommend how to diagnose and monitor asthma. There is information about asthma triggers. It describes other health conditions that make asthma hard to control.
The guidelines explain how to choose medications based on how severe asthma is. There are guidelines for treating asthma attacks at home and in the hospital. The document includes special sections on treating children, elderly adults, athletes, and pregnant women.
How were the guidelines developed?
The current asthma treatment guidelines are an update of guidelines from 2002. The authors of the 2007 guidelines read through the new research. They rated the quality of the studies. Based on the best research, they updated the old recommendations.1
To help readers understand how strong the recommendation is, they ranked the evidence from A to D.1
- Evidence Level A means that a recommendation is based on several high quality, large studies that prove cause and effect. These studies generally came to the same conclusions.
- Evidence Level B recommendations come from smaller randomized trials, possibly in different populations or with inconsistent results.
- Evidence Level C means that the recommendation is based on lower quality and observational studies. These studies could not prove cause and effect.
- Evidence Level D is based on the opinion of experts in the field.
Do the asthma treatment guidelines work?
Following the guidelines does seem to improve patient outcomes. Although twice as many people have asthma now compared with 30 years ago, there are far fewer deaths from asthma.2 A high-quality study of adolescents with asthma showed that following the guidelines led to good asthma control for the majority of people.3
Do doctors follow the guidelines?
Studies have shown that many doctors do not always follow the treatment guidelines.4 Surveys have shown that many people should be getting more medication than what their doctor has actually prescribed.
Doctors may not be asking enough questions about how often you have symptoms or miss school or work. They may not spend enough time figuring out what triggers your asthma. Asthma action plans and spirometry are not used as often as they should be.4,5
When will the guidelines be updated next?
In 2018, a committee decided that it is time to update the US Guidelines.2 The update will require a lot of research, so it may be a while before it is available. The new Guidelines will be available online.
There are five main topics that will be addressed in the updated version:
- Taking inhaled corticosteroids as needed, rather than daily.
- Treating asthma with medications currently used for COPD, called long-acting anti-muscarinic agents.
- Using bronchial thermoplasty to treat people with severe asthma.
- Using exhaled nitric oxide to make decisions about treatment.
- The latest information about effectively reducing indoor allergens.
What other guidelines are there for asthma treatment?
International guidelines for asthma management come from the Global Initiative for Asthma (abbreviated GINA).6 These guidelines are titled “Global Strategy for Asthma Management and Prevention.” They were updated in 2020.
The American Thoracic Society also has published a number of asthma treatment guidelines.7 Topics include:
- Severe asthma
- Using exhaled nitric oxide in practice
- Exercise-induced asthma
- Obesity and asthma
- Asthma attacks