The Science Journal of the American Association for Respiratory Care

1997 OPEN FORUM Abstracts

Guidelines for Diagnosis and Management of Asthma: The Expert Panel Report II

Allen T. Lusken, MD, Tuesday, December 9, 1997.

Asthma is a chronic inflammatory airways disease characterized by bronchial hyperresponsiveness and recurrent symptoms which can adversely effect quality of life. It is thought that inadequate treatment causes progression and the development of irreversible structural changes in the airways of patients with asthma. Pharmacologic therapy in asthma is designed to prevent and reverse symptoms; maintain normal or near-normal pulmonary function, promote normal levels of activity, prevent asthma exacerbations and the need for emergency room visits or hospitalizations, minimize adverse effects of drugs, and meet patients' and their families' expectations of optimal care. Medications designed to provide long-term control and prevent the development of asthma symptoms include inhaled corticosteroids, cromolyn/nedocromil, and leukotriene modifiers. Inhaled corticosteroids are long-term control of chronic asthma. Cromolyn and nedocromil are useful initial anti-inflammatory interventions in children and milder allergic asthma. Leukotriene modifiers either block the synthesis of leukotrienes or function as leukotriene receptor antagonists. Leukotriens are potent pro-inflammatory mediators produced in asthma, and currently clinical experience will determine their overall role in asthma care.

In addition to anti-inflammatory agents, other agents such as long-acting beta-agonists and methylxanthines can be used as adjunctive therapy with anti-inflammatory agents to improve long-term control in more severe asthma. Short-acting inhaled beta-agonists are designated quick relief medications because they reverse acute airflow obstruction and relieve asthma symptoms.

It is important to objectively assess asthma in order to adjust pharmacologic therapy to the severity level of asthma. This step-wise approach to pharmacologic therapy is designed to maintain optimal control of asthma. The amount and frequency of administration of asthma medications is determined by asthma severity and is aimed at reducing bronchial inflammation and preventing exacerbations. Current recommendations are to initiate therapy at the higher level to control inflammation and asthma symptoms. After control is established, therapy can be reduced (step-down) while monitoring asthma to determine the minimum medication levels necessary to maintain optimal control. Avoidance of allergens, irritants, and other asthma triggers is an important component of overall therapy. Regular follow-up visits are necessary, and therapeutic approaches must be integrated with an education program based on a strong patient/physician partnership.

AARC 50th Anniversary, December 6 - 9, 1997, New Orleans, Louisiana.

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