Asthma Guidelines Revised to Reflect Best Scientific Knowledge

For the first time in five years, a panel of asthma experts convened by the National Heart, Lung and Blood Institute has revised guidelines for the diagnosis and management of asthma. After a thorough review of the scientific literature, the National Asthma Education and Prevention Program Expert Panel altered existing guidelines for the use of inhaled steroids and other medications, and for the initiation of asthma therapy in young children. An executive summary of the panel's findings was published in June 2002. The panel's full report is being published today in a special supplement of the November 2002 issue of the Journal of Allergy and Clinical Immunology.

"Our review of the best scientific research demonstrated unequivocally that inhaled steroids are the 'gold standard' of asthma treatment, and that they are safe for children when taken in the recommended doses," said panel member Harold Nelson, MD, Professor of Medicine at National Jewish Medical and Research Center. "We just hope that physicians will take these recommendations to heart, because research has also shown that many children with persistent asthma do not receive prescriptions for inhaled steroids."

The previous guidelines recommended trying cromolyn or nedocromil as long-term controller therapy in children before beginning inhaled steroids. However, several studies showed that children and adults with mild or moderate persistent asthma who are using inhaled steroids fare better than those taking cromolyn, nedocromil, theophylline or leukotriene receptor antagonists. Patients using inhaled steroids have better lung function, less "twitchy" airways, fewer asthma symptoms, and fewer urgent care visits or hospitalizations.

The research also showed that inhaled steroids given at recommended doses do not cause 'frequent, clinically significant, or irreversible' adverse side effects. Although inhaled steroids do appear to slow growth in the first year of therapy, this effect does not appear to last and does not reduce a child's final height. Theophylline, cromolyn and leukotriene receptor antagonists are listed as alternative treatments if inhaled steroids are not well tolerated. The leukotriene receptor antagonist Singulair® has become popular in recent years because it comes in a pill that can be taken once a day.

For the first time the panel recommended the use of inhaled steroids in children as young as one year old and provided guidelines for how to evaluate incipient asthma in young children.

"Asthma presents differently in children than in adults," said panel member Stanley Szefler, MD, Director of Pediatric Pharmacology at National Jewish. "Our new report offers clinicians new information about diagnosing asthma in young children."

The panel recommended that children should be considered for long-term controller therapy with inhaled steroids if they have had more than three episodes of wheezing in the past year that lasted more than one day and affected sleep, and they have other risk factors for the development of asthma, including parental history of asthma, allergic rhinitis or atopic dermatitis. The panel concluded that there was insufficient evidence to determine if early treatment of asthma can alter the course of the disease.

If low to medium doses of inhaled steroids do not control a patient's asthma, the expert panel found that adding long-acting beta-agonists improves asthma outcomes more than increasing the dose of inhaled steroids.

Asthma is the most common chronic disease in children, afflicting 4.8 million children in the United States and approximately 17 million Americans of all ages. Asthma prevalence has more than doubled in the last 20 years and more than 5,000 people die of asthma each year.

The National Asthma Education and Prevention Program (NAEPP) was established in March 1989 to reduce asthma-related illness and death and to enhance the quality of life of people with asthma. NAEPP is convened under the auspices of the National Heart, Lung and Blood Institute and coordinates federal asthma-related activities, as designated through the Children's Health Act of 2000.