Adult Asthma Consensus Guidelines Update 2003
Several sets of Canadian guidelines for the diagnosis and management of asthma have been published over the past 15 years, dealing with the initial treatment of asthma, add-on therapies in the treatment of asthma and asthma education. The 2003 update of the guidelines for adults has recently been published. Work on the update involved various stakeholders, including medical specialists and patient groups, who met for two days in Montreal, Quebec in June of 2003. The "adult" group met under the auspices of the Canadian Thoracic Society while the "paediatric" group met under the auspices of the Canadian Network for Asthma Care. (The new paediatric guidelines should be released shortly.)
These asthma guidelines are primarily directed to physicians, both specialists and general practitioners. Our purpose here is to highlight the main points so that patients and their families will be able to understand the basics of proper care. This will not only permit them to better assess their own medical care but may also improve compliance. We know that asthma is, in general, often not well controlled, so it is crucial that everyone involved with asthma, professionally or personally, be informed about the most up-to-date approach.
Highlights regarding the medical management of asthma
Treatment with inhaled corticosteroid(ICSs) should be considered early, even in patients who report asthma symptoms fewer than three times per week. The reason: the early use of ICSs was associated with better control of symptoms but, most important, a significant 44% reduction in severe exacerbations of asthma. Note: mild asthma is defined as intermittent symptoms of asthma requiring a short or fast acting beta-agonist at least twice weekly to control symptoms.
No evidence was found to support the use of combination therapy in those with mild, symptomatic asthma who have not previously been treated with ICSs.
For those patients who cannot or will not use ICSs, Leukotriene receptor antagonists (LTRAs) are an alternative. However, LTRAs used alone are less effective than low doses of ICSs.
Doses of ICSs as recommended in mild asthma are safe.
Additional recommendations were made. Of special note to patients are the importance of asthma education in adults, the need for written self-management plans for patients, and regular follow up.
Over the coming year the Canadian Network for Asthma Care will disseminate the updated guidelines throughout Canada, to physicians and the public. CNAC is dedicated to the promotion of asthma care and education in Canada with the ultimate goal of reducing illness and death caused by this common chronic condition.
More information about the updated adult guidelines can be found in the Canadian Respiratory Journal, Volume 11 supplement May/June 2004.
What is meant by "well controlled" asthma?
- Daytime symptoms of asthma less than four days per week
- Night-time symptoms less than one night per week
- Normal physical activity
- Mild, infrequent exacerbations
- No absenteeism due to asthma
- Fewer than four doses per week needed of a fast-acting beta2 -agonist, apart from one dose/day before exercise
There are additional objective breathing tests that every asthmatic should have done regularly, at least 2 or 3 times a year, in the doctor's office. Proper control means:
- Forced expiratory volume in 1 s or peak expiratory flow at 90% of personal best or greater
- Daytime variability in peak expiratory flow of less than 10% to 15%
If your asthma is not well-controlled, see your doctor! A wide variety of therapies exist and it pays to keep going back to your doctor until you reach a satisfactory level of control.
from Allergy & Asthma News, Issue 1 2005