Guidelines for the Diagnosis and Treatment of Asthma

2007 National Guidelines

The NHLBI asthma guidelines have changed!

In August, the National Asthma Education and Prevention Program (NAEPP) issued the first comprehensive update in a decade of clinical guidelines for the diagnosis and management of asthma. The Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma are a set of recommendations for ideal asthma management. They take into account the most current asthma research and new medications available in order to provide the best possible care.

Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma – Full Report, 2007 provides new guidance for selecting treatment based on a patient's individual needs and level of asthma control. The guidelines emphasize that while asthma can be controlled, the condition can change over time and differs among individuals and by age groups. Thus, it is important to monitor regularly the patient's level of asthma control so that treatment can be adjusted as needed.

The full set of guidelines can be viewed at the NHLBI website , or you can view the summary report.

Here are the 6 key messages from the EPR-3 Asthma Guidelines.

Most Important:
1) Inhaled corticosteroids are the most effective anti-inflammatory medication for long term management of persistent asthma.

All patients should receive:
2) Written asthma action plan
3) Initial assessment of asthma severity
4) Review of the level of asthma control (impairment and risk) at all follow up visits
5) Periodic, follow up visits (at least every 6 months)
6) Assessment of exposure and sensitivity to allergens and irritants and recommendation to reduce relevant exposures.

Here are the 4 more key messages from the EPR-3 Asthma Guidelines as identified by the Quality Improvement and Asthma Care Subcommittee of AIM.

All patients should also receive :
7) Asthma education by a qualified health professional
8) Referral to an asthma specialist, when appropriate
9) Education regarding the danger of over-use of short-acting beta-agonists
10) Information regarding risk factors for death from asthma.

Watch a presentation on the new asthma guidelines and how they have changed from EPR2.

The Asthma Initiative of Michigan has also put together an " Essential Information " brochure that is free for download and use.  This brochure contains the tables "Components of severity," "Components of Control," and the "Stepwise Approach for Managing Asthma."  For more information, please refer to the actual guidelines.

Essential Information Trifold (8.5 x 11 size)

Essential Information Trifold (11 x 17 size)

Other Essential Information and Tables from the Expert Panel Report include:

Classifying Severity, Control, and Stepwise Treatment Guidelines excerpted from Expert Panel Report-3

Asthma Medication Dose Grids for Long Term Control and Quick Relief Medications excerpted from Expert Panel Report-3

Validated instruments for Assessment and Monitoring Asthma excerpted from Expert Panel Report-3

The CDC and National Asthma Education and Prevention Program (NAEPP) have put together a resource for health care professionals called Key Clinical Activities for Quality Asthma Care. This booklet was developed to improve the implementation of the NHLBI guidelines, and contains key clinical activities in the areas of diagnosis, classification, follow-up care, specialty care, education, comorbidities, medications, asthma action plans, and self-management of asthma.

International Guidelines & Resources
Global Initiative on Asthma (GINA) is an organization that partners with the NHLBI, the National Institutes of Health (NIH), and the World Health Organization (WHO) to increase awareness of asthma, and promote programs and studies that will lead to solutions to asthma problems worldwide. They have published a set of guidelines and other materials, including a 2002 Workshop Report that can be useful to health care professionals. At the GINA website, click on documents and resources to find these materials.

Michigan Guidelines & Resources
The Michigan Quality Improvement Consortium (MQIC) has created an evidence-based, one-page guideline that provides a simplified approach to the treatment of asthma in adults and children older than 5 years old. Visit the MQIC website to view this guideline.