Docs Pore Over New Asthma Guidelines

Some doctors say the 400-page guide will improve clinical practice.

Aug. 29, 2007 — -- In a move to breathe new life into decade-old asthma guidelines, federal health officials with the National Asthma Education and Prevention Program proposed the first-ever recommendations specific to children ages 5-11.

But some physicians said that the guidelines may add little to current practice and that they are skeptical as to whether medical professionals in the field will actually comb through the 400-page document for guidance.

The new set of recommendations had its supporters. Dr. Harold Nelson, professor of medicine at the National Jewish Medical and Research Center, in Denver, said, "The main message is that patients with asthma should be able to lead a normal life and these guidelines will help them achieve that."

"Hopefully … these guidelines will lead to a shift in primary care doctors' understanding that long-term control is key and to maintain close contact with the patient," said Dr. John Fahrenholz, assistant professor of medicine at Vanderbilt University in Nashville, Tenn.

And while the guidelines created a new category of treatment for many younger patients, for most patients it encouraged doctors to focus on the symptoms of individuals rather than separating patients into broad treatment groups.

These groups "were hard to use … because [patients] just don't stay in one category," said Dr. Carl Lauter, director of the Division of Allergy and Clinical Immunology at William Beaumont Hospital in Royal Oak, Mich. "One of the main changes to these guidelines is the emphasis on control of asthma and … the way a patient feels."

But, according to Dr. Alan Leff, professor of medicine at the University of Chicago, "Most physicians who treat asthma are unfamiliar with the guidelines, and those who know about them do not really read them."

Nelson said a briefer version of the guidelines is on the way, and it will likely be available in December.

"[The briefer version] will be much more accessible to the primary care physician," he said.

A Closer Look at Asthma

Asthma is a chronic disease that makes breathing difficult because of a narrowing of the airway passages. The disease affects 22 million people in the United States, including 6.5 million children, according to the Centers for Disease Control and Prevention.

Of these, the CDC says, about 3,780 die from the condition every year.

However, since the original guidelines were published in 1991, more patients are being diagnosed and the number of deaths from asthma has decreased.

Asthma can cause mild symptoms or can affect people on a daily basis, but what doctors emphasize is that asthma is a very treatable condition— and with the right care, patients can lead active lifestyles.

To this end, the new guidelines emphasize patient self-monitoring and use of written action plans so that patients know how to manage their asthma flares.

Lauter noted that patients can use action plans that are "individualized for each patient and help patients decide when they should call their doctor, or … when not to call their doctor and just go to the emergency room."

To assist with this effort, the guidelines encourage physicians to educate their patients on how to recognize worsening disease and use their medications as instructed.

Something for the Kids

As the treatment of asthma varies by age group, physicians applauded the fact that the new guidelines feature recommendations specifically for children in the 5-11 age group.

Fahrenholz said that this is important, as "most studies of new asthma medications are done in teenagers or adults; only some are done in the 6-12 age group."

The guidelines also included a new treatment recommendation for those with severe asthma — a drug called Omalizumab that blocks the effects of antibodies that are responsible for the symptoms seen in asthma.

But for all age groups, drugs known as inhaled corticosteroids remain the best long-term treatment to control asthma, physicians said.