| NAEPP Expert Panel Report
Guidelines for the Diagnosis and Management
of Asthma–Update on Selected Topics 2002*
The National Asthma Education and Prevention Program (NAEPP) keeps clinical practice guidelines up to date by identifying selected topics on asthma that warrant intensive review based on the level of research activity reflected in the published literature or the level of concern
in clinical practice. The NAEPP Expert Panel identified key questions about asthma management and used a systematic review of the evidence, conducted by the Agency for Healthcare
Research and Quality Evidence Practice Center, to prepare answers and update recommendations for clinical practice. The NAEPP Expert Panel Report: Guidelines for the Diagnosis and Managment of Asthma—Update on Selected Topics 2002 (EPR—Update 2002) presents up-to-date recommendations on:
- Medications—long-term management of asthma in children with mild or moderate persistent asthma, combination therapy in moderate persistent asthma, and use of antibiotics to treat acute exacerbations of asthma
- Monitoring—written action plans compared to medical management alone, and peak flow-based compared to symptom-based written action plans
- Prevention—effects of early treatment on the progression of asthma
Keep in mind the goals of the updated guidelines:
- Minimal or no chronic symptoms day or night
- Minimal or no exacerbations
- No limitations on activities; no school/work/parent's work missed
- Peak Flows greater than 80% of personal best
- Minimal use of short-acting inhaled beta 2 -agonist (< 1x per day, < 1 canister/month)
- Minimal or no adverse effects from medications
If your child isn't meeting these goals, you may want to see your Pediatrician or an asthma specialist to review your child's treatment regimen and consider a change in his medications, with a step up in his medications.
Other updates in the new treatment guidelines include:
- Inhaled corticosteroids should be used in infants and young children who have had more than 3 episodes of wheezing in the past year that lasted more than 1 day or affected sleep and who have risk factors for the development of asthma (parental history of asthma or physician-diagnosed atopic dermatitis or two of the following: physician-diagnosed allergic rhinitis, wheezing apart from colds, peripheral blood eosinophilia).
- Inhaled corticosteroids improve health outcomes for children with mild or moderate persistent asthma, and the potential but small risk of delayed growth is well balanced by their effectiveness.
- Strong evidence from clinical trials consistently indicates that use of long-acting inhaled beta2 -agonists (like Serevent) added to low-to-medium doses of inhaled corticosteroids leads to improvements in lung function and symptoms and reduced need for quick relief, short-acting beta2 -agonists.
- Antibiotics are not recommended for the treatment of acute asthma exacerbations except as needed for comorbid conditions—e.g., for those patients with fever and purulent sputum, evidence of pneumonia, or suspected bacterial sinusitis.
- The use of written action plans as part of an overall effort to educate patients in self-management is recommended, especially for patients with moderate or severe persistent asthma and patients with a history of severe exacerbations.
- Peak flow monitoring for patients with moderate or severe persistent asthma should be considered because it may enhance clinician-patient communication and may increase patient and caregiver awareness of the disease status and control.
Notes
- The stepwise approach is intended to assist, not replace, the clinical decisionmaking required to meet individual patient needs.
- Classify severity: assign patient to most severe step in which any feature occurs.
- There are very few studies on asthma therapy for infants.
- Gain control as quickly as possible (a course of short systemic corticosteroids may be required); then step down to the least medication necessary to maintain control.
- Provide parent education on asthma management and controlling environmental factors that make asthma worse (e.g., allergies and irritants).
- Consultation with an asthma specialist is recommended for patients with moderate or severe persistent asthma. Consider consultation for patients with mild persistent asthma.
Next page > Asthma Guidelines for Kids
NIH Publication No. 02-5075 July 2002
*Updates the NAEPP Expert Panel Report 2 (NIH Publication No. 97-4051).
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