Asthma

ÎAsthma control goals: > Minimal/no chronic symptoms day or night > Minimal/no exacerbations > No limitations on activities; no school/work missed > PEFR > 80% of personal best > Minimal use of inhaled short-acting β2 > Minimal/no adverse effects from medications > Prevent chronic and troublesome symptoms > Maintain near "normal" lung function > Prevent recurrent exacerbations of asthma and minimize the need for emergency room visits or hospitalization -agonists (SABA) (≤ 2x/week) > Provide optimal pharmacotherapy with minimal or no adverse effects > Meet patient's and family's expectations of, and satisfaction with, asthma care New Directions in Asthma Management ÎAsthma management should be individualized because of a variability in response to therapy, comorbidities, spectrum of asthma triggers, and patient goals. > Although they are the most potent and consistently effective long-term control medication for asthma, the sensitivity, and thus clinical response to ICS therapy, is variable among patients. ÎCurrent asthma treatment with anti-inflammatory therapy, including inhaled corticosteroids (ICS), does not appear to prevent disease progression. ÎRecommendations for long-term management of asthma are now segmented into 3 separate age groups: children from 0-4 and 5-11 years of age, and youths ≥ 12 years of age and adults. ÎIn patients ≥ 12 years of age, adding a LABA† to a low-dose ICS should receive equal weighting to increasing the ICS dose alone. Assessment and Management of Asthma ÎNow based on evaluation of severity (intensity of disease), control (degree to which manifestations of asthma are minimized and goals met), and responsiveness (ease with which asthma therapy achieves control). > Severity and control of asthma are defined and assessed by separately evaluating its effects on a patient in the following domains: ▶ Impairment – the frequency and intensity of symptoms, and the functional limitations on quality of life and functional capacity ▶ Risk – the likelihood of exacerbations, progressive decline in lung function, or adverse effects of medication ÎFor initiating therapy in a treatment naive patient, emphasize classifying severity. ÎFor monitoring and adjusting therapy, emphasize assessing control. > The hallmarks of control are: symptoms, exacerbations, and quality of life over time. > Because response to asthma therapy, as well as asthma intensity, can vary over time, assessment of control and treatment adjustments must be made over time. ▶ Periodic assessment of control should be done at 1- and 6-month intervals. ▶ Monitoring of control should be ongoing. †BLACK BOX WARNING: Long-acting β2 -adrenergic agonists may increase the risk of asthma-related death. They should never be used alone in children or adults with asthma. Please see product labeling for information on this warning. An FDA Medication Guide should be distributed to patients starting a new prescription. 1

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