Guidelines for the Diagnosis and Management of Asthma

The National Institutes of Health Publication 07-4051, Guidelines for the Diagnosis and Management of Asthma, The EPR--3 Summary Report 2007, provides key information from the full report on the diagnosis and management of asthma. Summary information is provided on measures of assessment and monitoring, education for a partnership in asthma care, control of environmental factors and comorbid conditions that affect asthma, and medications. Key tables and figures from the full report are included for easy reference. Asthma is a chronic inflammatory disease of the airways. In the United States, asthma affects more than 22 million persons. It is one of the most common chronic diseases of childhood, affecting more than 6 million children (current asthma prevalence, National Health Interview Survey (NHIS), National Center for Health Statistics, Centers for Disease Control and Prevention, 2005) (NHIS 2005). There have been important gains since the release of the first National Asthma Education and Prevention Program (NAEPP) clinical practice guidelines in 1991. For example, the number of deaths due to asthma has declined, even in the face of an increasing prevalence of the disease (NHIS 2005); fewer patients who have asthma report limitations to activities; and an increasing proportion of people who have asthma receive formal patient education (Department of Health and Human Services, Healthy People 2010 midcourse review). Hospitalization rates have remained relatively stable over the last decade, with lower rates in some age groups but higher rates among young children 0-4 years of age. There is some indication that improved recognition of asthma among young children contributes to these rates. However, the burden of avoidable hospitalizations remains. Collectively, people who have asthma have more than 497,000 hospitalizations annually (NHIS 2005). Furthermore, ethnic and racial disparities in asthma burden persist, with significant impact on African American and Puerto Rican populations. The challenge remains to help all people who have asthma, particularly those at high risk, receive quality asthma care. Advances in science have led to an increased understanding of asthma and its mechanisms as well as improved treatment approaches. To help health care professionals bridge the gap between current knowledge and practice, the NAEPP of the National Heart, Lung, and Blood Institute (NHLBI) has previously convened three Expert Panels to prepare guidelines for the diagnosis and management of asthma. The NAEPP Coordinating Committee (CC), under the leadership of Claude Lenfant, M.D., Director of the NHLBI, convened the first Expert Panel in 1989. The charge to that Panel was to develop a report that would provide a general approach to diagnosing and managing asthma based on current science. Published in 1991, the "Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma" (EPR 1991) organized the recommendations for the treatment of asthma around four components of effective asthma management: Use of objective measures of lung function to assess the severity of asthma and to monitor the course of therapy; Environmental control measures to avoid or eliminate factors that precipitate asthma symptoms or exacerbations; Patient education that fosters a partnership among the patient, his or her family, and clinicians; Comprehensive pharmacologic therapy for long-term management designed to reverse and prevent the airway inflammation characteristic of asthma as well as pharmacologic therapy to manage asthma exacerbations. The NAEPP recognizes that the value of clinical practice guidelines lies in their presentation of the best and most current evidence available. This report presents recommendations for the diagnosis and management of asthma that will help clinicians and patients make appropriate decisions about asthma care.