The National Asthma Education and P...

The National Asthma Education and Prevention Program (NAEPP) has issued guidelines for reducing asthma symptoms and preventing exacerbations. The recommendations are available online at wwwcdc gov/mmwr/preview/mmwrhtml/rr5206a1.htm.

The NAEPP identified four composings of asthma management--assessment and monitoring, controlling factors that contribute to asthma severity, pharmacotherapy, and education for partnership in care--and unraveled the following 10 key clinical activities:

1 Establish diagnosis using a history and physical examination documenting an episodic pattern of respiratory symptoms and from spirometry that indicates partially reversible airflow obstruction. Infants and children younger than five years should be treated as having suspected asthma formerly alternative diagnoses are ruled out

2 Classify severity. After the patient's asthma is stable, severity is classified according to the plain of medication required to maintain treatment goals.

3 Schedule routine follow-up care. The first follow-up visit should be scheduled within individual month after initial diagnosis, with routine visits each one to six months and spirometry at least each one or two years after treatment is initiated and the symptoms and peak expiratory be molten have stabilized.

4 Assess for referral to subspecialty care. Referral is make acceptableed in the following circumstances:

* A single life-threatening asthma exacerbation be met withs or the initial diagnosis is unrelenting persistent asthma.

* Treatment goals for the patient's asthma are not being met

* The diagnosis is unclear or additional diagnostic testing is indicated.

* The patient has a history suggesting that asthma is being provok by the agency of occupational factors, an environmental inhalant, or an ingested substance.

* The patient is younger than three years with moderate or morose persistent asthma.

* The patient is a candidate for immunotherapy.

* The patient or family requires additional education or guidance in managing asthma complications or therapy, following the treatment plan, or avoiding asthma triggers.

* The patient requires continuous oral corticosteroid therapy or high-dose inhaled corticosteroids, or has required more than brace courses of oral corticosteroids in single year.

5. approve measures to control asthma triggers of the like kind as tobacco smoke, house dust mites, cockroaches, and cat and dog allergens.

6 Treat or debar all comorbid conditions, including allergic rhinitis, sinusitis, gastroesophageal ebb disease, and sensitivity to certain medicines like as aspirin, nonsteroidal anti-inflammatory unsalable articles and beta blockers can exacerbate asthma symptoms.

7 Prescribe medications according to severity. Evidence indicates that daily, long-term rule medications are necessary to obstruct exacerbations and chronic symptoms. Inhaled corticosteroids are preferr because they are the greatest in quantity effective anti-inflammatory medication available for treating the underlying inflammation of persistent asthma. All patients with asthma require a short-acting bronchodilator medication for managing acute symptoms or exacerbations when they occur; plain exacerbations require the addition of systemic (oral) corticosteroids to treat the increased inflammation.

one time therapy goals are achieved, a gradual reduction in treatment should be carefully undertaken to identify the minimum dose required to maintain control

8 Monitor use of beta-agonist mix with drugss Patients whose need for a short-acting inhaled beta-agonist increases probably have inadequately controll asthma. as it was patients may need short-acting inhaled beta-agonist during upper respiratory viral infections and exercise-induced bronchoconstriction. Using more than single in kind canister of short-acting beta-agonist by month is considered above awaited use.

9. bring to maturity a written asthma management plan. Writing an asthma management plan helps clarify expectations for treatment and provides patients with an easy respect for remembering how to manage their asthma. The action plan should include written instructions onward recognizing symptoms and signs of worsening asthma; taking appropriate medicines (i.e., emblem dose, frequency); recognizing when to try to find medical care; and monitoring answers to medications. Symptom-based plans may be equally effective as plans based onward peak flow monitoring, although a certain patient preferences and circumstances (eg inability to recognize or report signs and symptoms of worsening asthma) may warrant a choice of peak emanate monitoring.

10. Provide routine education forward patient self-management. Effective asthma education is evolveed in a patient-provider partnership, tailored to the individual patient's needinesss relative to cultural or ethnic beliefs and practices. At a minimum, sufficient asthma education enlists and encourages family support, includes instructions in succession self-management skills, and is integrated with routine ongoing care.

COPYRIGHT 2003 American Academy of Family Physicians

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