An overview of asthma management
- Christopher H Fanta, MD
Christopher H Fanta, MD
- Professor of Medicine
- Harvard Medical School
- Section Editors
- Robert A Wood, MD
Robert A Wood, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Pediatric Allergy
- Professor of Pediatrics
- Johns Hopkins University School of Medicine
- Bruce S Bochner, MD
Bruce S Bochner, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Adult Allergy; Asthma
- Samuel M Feinberg Professor of Medicine
- Northwestern University Feinberg School of Medicine
This overview topic presents the components and goals of asthma management. It is applicable to both children and adults. The information herein is consistent with "The National Asthma Education and Prevention Program: Expert Panel Report 3, Guidelines for the Diagnosis and Management of Asthma – Full Report 2007" . Similar guidelines have been published by the Global Initiative for Asthma (GINA) .
The diagnosis of asthma and more detailed management issues are reviewed elsewhere. (See "Diagnosis of asthma in adolescents and adults" and "Asthma in children younger than 12 years: Initial evaluation and diagnosis" and "Asthma in children younger than 12 years: Treatment of persistent asthma with controller medications" and "Treatment of intermittent and mild persistent asthma in adolescents and adults" and "Treatment of moderate persistent asthma in adolescents and adults".)
COMPONENTS OF ASTHMA MANAGEMENT
The successful management of patients with asthma includes four essential components:
●Routine monitoring of symptoms and lung function
●Patient education to create a partnership between clinician and patientTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- National Asthma Education and Prevention Program: Expert panel report III: Guidelines for the diagnosis and management of asthma. Bethesda, MD: National Heart, Lung, and Blood Institute, 2007. (NIH publication no. 08-4051). www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm (Accessed on May 31, 2016).
- Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA). www.ginasthma.org (Accessed on January 30, 2015).
- British Guideline on the Management of Asthma. https://www.brit-thoracic.org.uk/guidelines-and-quality-standards/asthma-guideline/ (Accessed on May 27, 2014).
- Bateman ED, Reddel HK, Eriksson G, et al. Overall asthma control: the relationship between current control and future risk. J Allergy Clin Immunol 2010; 125:600.
- Juniper EF, O'Byrne PM, Guyatt GH, et al. Development and validation of a questionnaire to measure asthma control. Eur Respir J 1999; 14:902.
- Vollmer WM, Markson LE, O'Connor E, et al. Association of asthma control with health care utilization and quality of life. Am J Respir Crit Care Med 1999; 160:1647.
- Boulet LP, Boulet V, Milot J. How should we quantify asthma control? A proposal. Chest 2002; 122:2217.
- Nathan RA, Sorkness CA, Kosinski M, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol 2004; 113:59.
- Patino CM, Okelo SO, Rand CS, et al. The Asthma Control and Communication Instrument: a clinical tool developed for ethnically diverse populations. J Allergy Clin Immunol 2008; 122:936.
- Schatz M, Kosinski M, Yarlas AS, et al. The minimally important difference of the Asthma Control Test. J Allergy Clin Immunol 2009; 124:719.
- Liu AH, Zeiger RS, Sorkness CA, et al. The Childhood Asthma Control Test: retrospective determination and clinical validation of a cut point to identify children with very poorly controlled asthma. J Allergy Clin Immunol 2010; 126:267.
- Meltzer EO, Busse WW, Wenzel SE, et al. Use of the Asthma Control Questionnaire to predict future risk of asthma exacerbation. J Allergy Clin Immunol 2011; 127:167.
- Eisner MD, Yegin A, Trzaskoma B. Severity of asthma score predicts clinical outcomes in patients with moderate to severe persistent asthma. Chest 2012; 141:58.
- Jia CE, Zhang HP, Lv Y, et al. The Asthma Control Test and Asthma Control Questionnaire for assessing asthma control: Systematic review and meta-analysis. J Allergy Clin Immunol 2013; 131:695.
- Rank MA, Bertram S, Wollan P, et al. Comparing the Asthma APGAR system and the Asthma Control Test™ in a multicenter primary care sample. Mayo Clin Proc 2014; 89:917.
- Osborne ML, Pedula KL, O'Hollaren M, et al. Assessing future need for acute care in adult asthmatics: the Profile of Asthma Risk Study: a prospective health maintenance organization-based study. Chest 2007; 132:1151.
- Enright PL, Lebowitz MD, Cockroft DW. Physiologic measures: pulmonary function tests. Asthma outcome. Am J Respir Crit Care Med 1994; 149:S9.
- Crapo RO. Pulmonary-function testing. N Engl J Med 1994; 331:25.
- Pennock BE, Cottrell JJ, Rogers RM. Pulmonary function testing. What is 'normal'? Arch Intern Med 1983; 143:2123.
- Irvin, CG, Eidelman, D. Airways mechanics in asthma. In: Rhinitis and Asthma, Holgate, S, Busse, W (Eds), Blackwell Scientific Publications, Boston 1995.
- National Asthma Education Program. Expert panel report on diagnosis and management of asthma. U.S. Government Printing Office; NIH Publication No. 92-2113A, Washington D.C., 1992.
- Standardization of Spirometry, 1994 Update. American Thoracic Society. Am J Respir Crit Care Med 1995; 152:1107.
- Lung function testing: selection of reference values and interpretative strategies. American Thoracic Society. Am Rev Respir Dis 1991; 144:1202.
- Smith HR, Irvin CG, Cherniack RM. The utility of spirometry in the diagnosis of reversible airways obstruction. Chest 1992; 101:1577.
- Yawn BP, Enright PL, Lemanske RF Jr, et al. Spirometry can be done in family physicians' offices and alters clinical decisions in management of asthma and COPD. Chest 2007; 132:1162.
- Kikuchi Y, Okabe S, Tamura G, et al. Chemosensitivity and perception of dyspnea in patients with a history of near-fatal asthma. N Engl J Med 1994; 330:1329.
- Bijl-Hofland ID, Cloosterman SG, van Schayck CP, et al. Perception of respiratory sensation assessed by means of histamine challenge and threshold loading tests. Chest 2000; 117:954.
- Castro M, Zimmermann NA, Crocker S, et al. Asthma intervention program prevents readmissions in high healthcare users. Am J Respir Crit Care Med 2003; 168:1095.
- Gibson PG, Coughlan J, Wilson AJ, et al. Self-management education and regular practitioner review for adults with asthma. Cochrane Database Syst Rev 2000; :CD001117.
- Janson SL, McGrath KW, Covington JK, et al. Individualized asthma self-management improves medication adherence and markers of asthma control. J Allergy Clin Immunol 2009; 123:840.
- Harding SM. Recent clinical investigations examining the association of asthma and gastroesophageal reflux. Am J Med 2003; 115 Suppl 3A:39S.
- Klemets P, Lyytikäinen O, Ruutu P, et al. Risk of invasive pneumococcal infections among working age adults with asthma. Thorax 2010; 65:698.
- Fanta CH. Asthma. N Engl J Med 2009; 360:1002.
- Thomas A, Lemanske RF Jr, Jackson DJ. Approaches to stepping up and stepping down care in asthmatic patients. J Allergy Clin Immunol 2011; 128:915.
- Nelson HS. Beta-adrenergic bronchodilators. N Engl J Med 1995; 333:499.
- Shim C, Williams MH Jr. Bronchial response to oral versus aerosol metaproterenol in asthma. Ann Intern Med 1980; 93:428.
- Shim C, Williams MH Jr. Comparison of oral aminophylline and aerosol metaproterenol in asthma. Am J Med 1981; 71:452.
- Haahtela T, Järvinen M, Kava T, et al. Comparison of a beta 2-agonist, terbutaline, with an inhaled corticosteroid, budesonide, in newly detected asthma. N Engl J Med 1991; 325:388.
- Dutoit JI, Salome CM, Woolcock AJ. Inhaled corticosteroids reduce the severity of bronchial hyperresponsiveness in asthma but oral theophylline does not. Am Rev Respir Dis 1987; 136:1174.
- Juniper EF, Kline PA, Vanzieleghem MA, et al. Effect of long-term treatment with an inhaled corticosteroid (budesonide) on airway hyperresponsiveness and clinical asthma in nonsteroid-dependent asthmatics. Am Rev Respir Dis 1990; 142:832.
- Bateman ED, Bousquet J, Keech ML, et al. The correlation between asthma control and health status: the GOAL study. Eur Respir J 2007; 29:56.
- COMPONENTS OF ASTHMA MANAGEMENT
- GOALS OF ASTHMA TREATMENT
- Reduce impairment
- Reduce risk
- MONITORING PATIENTS WITH ASTHMA
- Symptom assessment
- - Assessment of impairment
- - Assessment of risk
- Monitoring pulmonary function
- - Office monitoring
- - Home monitoring
- Novel forms of monitoring
- PATIENT EDUCATION
- Asthma action plan
- CONTROLLING TRIGGERS AND CONTRIBUTING CONDITIONS
- PHARMACOLOGIC TREATMENT
- Categories of asthma severity
- - Intermittent
- - Mild persistent
- - Moderate persistent
- - Severe persistent
- Initiating therapy during an acute exacerbation
- Initiating therapy in previously untreated patients
- Adjusting medication in patients already on controller therapy
- - Intermittent (Step 1)
- - Mild persistent (Step 2)
- - Moderate persistent (Step 3)
- - Severe persistent (Step 4 or 5)
- EFFICACY OF ASTHMA MANAGEMENT
- WHEN TO REFER
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS