Complete control - new guidelines for asthmatics

A Mayo Clinic allergist and his colleagues have announced that they are revising the old classification of asthma patients by disease severity to determine treatment, and moving to a new expectation for all asthma patients: excellent symptom control.

Every year, nearly 500,000 Americans with asthma are hospitalized, and more than 4,000 die from disease-related causes.

It is a chronic condition that occurs when the main air passages of the lungs, the bronchial tubes, become inflamed, then muscles of the bronchial walls tighten and extra mucus is produced, causing the airways to narrow.

This can lead to everything from minor wheezing to severe difficulty in breathing.

James Li, M.D., Ph.D., Mayo Clinic allergist and lead author of the paper says they are revising the old classification of asthma patients by disease severity to determine treatment and moving to a new expectation for all asthma patients: excellent symptom control.

He believes it is all about quality of life, and says waking up in the middle of the night wheezing, constantly using rescue medications, having to excuse themselves from sports teams or needing to leave work due to an attack, is no life. He says people with asthma can expect to control the asthma, not to have the asthma control them.

According to new guidelines complete or total control is also a realistic goal for a subset of patients.

Dr. Li representing the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma and Immunology contends this is not just an ideal and the new goals can align with patients’ disease reality.

Previous national practice guidelines for physicians treating asthmatics, have patients classified as having mild, moderate or severe asthma, and treatment was based on disease severity.

Dr. Li says this is a limited approach as asthma changes over time and individuals require different treatment, and there is a need for continual reassessment of a patient’s asthma and the possible medication adjustment of medication.

According to Dr. Li, asthma treatment should be individualized to achieve the target symptom control, because not all patients respond similarly to medication.

This customized approach requires regular visits to the doctor.

Asthmatics who have not attained well or completely controlled asthma should see their doctors for a detailed assessment of asthma control (including lung function tests), confirmation of the diagnosis of asthma, assessment of asthma triggers (including allergy) and individualized treatment.

Well-controlled or excellent control of asthma is defined by the paper’s authors as follows:

• Asthma symptoms twice a week or less
• Rescue bronchodilator used twice a week or less
• No night or early morning awakening due to asthma symptoms
• No limitations on exercise, work or school due to asthma
• Well-controlled asthma by patient and physician assessment
• Normal or personal-best pulmonary function tests

The authors also insist that with proper symptom assessment and treatment, complete or total control is possible for a significant group of asthmatics.

Dr. Li says that well-controlled asthma is the recommended target for all patients with asthma, but complete control may be attainable and appropriate for many patients.

Complete or total control of asthma is defined by Dr. Li and colleagues as follows:

• Full activity and exercise
• No asthma symptoms during the day or at night
• No need for ‘as needed’ Albuterol
• No missed work or school due to asthma
• Normal lung function

The new guidelines for treating asthma are published in the November issue of the Journal of Allergy and Clinical Immunology.