Editorial The National Asthma attacks asthma
E&H@&
The significant worldwide increase in asthma severity and mortality has evoked increasing concern from the medical community.’ * To enhance early recognition, as well as appropriate therapeutic intervention of asthma, the NHLBI established the NAEP. Its Coordinating Committee, chaired by the NHLBI director, Dr. Claude Lenfant, is comprised of representatives of nearly 30 lay and professional organizations dedicated to the understanding and treatment of asthma. The NAEP convened an Expert Panel to develop guidelines for the diagnosis and treatment of asthma. Several committees of the NAEP will help disseminate the report. These committees include a Professional Education Committee, chaired by Dr. Robert Barbee, Public and Patient Education Committee, chaired by Dr. Alan Luskin, and the School Health Committee, chaired by Dr. William Pierson. Asthma is reversible, episodic, airway obstruction. That it can be fatal is not appreciated by most people, including many clinicians. However, with appropriate therapy, patients with asthma can expect to control their asthma symptoms, prevent acute exacerbations, attain activity levels of their choice, and maintain normal pulmonary function. Asthma is a chronic disease with acute exacerbations. It requires continuous medical care with four major components: (I) patient education that fosters a partnership among the patient, the patient’s family, and the medical care provider, (2) preventive and environmental control measures to avoid factors that trigger acute exacerbations, (3) comprehensive pharmacologic therapy, and (4) the use of objective measures to assess the severity of asthma and to monitor the course of asthma therapy. The airway hyperresponsiveness characteristic of asthma is currently considered consequent to airway of inflammation.‘,4 Thus, the early institution of aggressive therapy to reduce and preferably prevent the inflammatory response as well as to reverse bronchospasm is central to the asthma management recommended by the panel. The possibility that regularly scheduled, daily &-agonist therapy may accentuate airway hyperresponsiveness and the lack of high potency, inhaled corticosteroid agents in the United States make the challenge to define appropriate therapy increasingly difficult. The emphasis for treatment of acute exacerbations 468
f+oq)ram
1”u-..l.-ll.l1 NAEP: NHLBI:
National Asthma Education Program
National Heart, Lung. and Blood Institute
of asthma, according to the expert panel report, is on the rapid reversal of airway obstruction with intensive @,-agonist therapy, the early institution of corticosteroid therapy, and the addition of theophylline for hospitalized patients. Patients with asthma must be cognizant of early asthma deterioration, preferably before the onset of wheezing, to initiate appropriate therapeutic programs. Objective parameters of assessment, such as peak expiratory flow rate measurements, should be used to detect the earliest deterioration in lung function as well as to monitor the effects of the asthma treatment. Objective measurements will also guide appropriate selection of prophylactic or maintenance therapy for asthma, including anti-inflammatory agents, such as cromolyn sodium and inhaled corticosteroids. ’ * The NAEP Expert Panel report emphasizes that it is important to consider treatment of inflammation as part of the primary therapy for patients with moderate and severe asthma. The report is organized into chapters that elaborate on each of these elements of care. The guidelines for the diagnosis and management of asthma were developed with the understanding that specific therapeutic regimens must be adjusted to the individual needs of each patient, as determined by the patient and clinician. Thus, this report is designed principally to provide insight into asthma management for clinicians (physicians as well as nurses providing regular asthma care). It is hoped it will also be useful to patients, parents, and other asthma care providers. that is, respiratory therapists, health educators, and social workers. We hope, through this report, to encourage an informed collaboration among these professionals and patients with asthma that may lead to effective asthma management and a reduction in asthma severity and mortality. The final report of the Expert Panel of NAEP was accomplished through an extensive development, re-
VOLUME NUMBER
87
NAEP attacks asthma
469
2
view, and approval process. Members of the panel include asthma care specialists from a variety of disciplines: pediatrics, internal medicine, allergy, pulmonology, nursing, and behavioral medicine. The members are: William Bailey, MD, Eugene Bleecker, MD, William Busse, MD, Elliott Ellis, MD, David Evans, PhD, Christopher Fauta, MD, Susan JausonBjerklie, PhD, RN, Floyd Malveaux, MD, PhD, Shirley Murphy, MD, Harold Nelson, MD, and Gail Shapiro, MD. The final report is expected to be released in the spring of 1991. Copies will be available through the NHLBI and will be disseminated through the Coordinating Committee organizations in the early summer.
REFERENCES WeissKB, WagenerDK. Changingpatternsof asthmamortality. JAMA 1990;264:1683-7. Buist AS, Vollmer WM. Reflectionson the rise in asthmamorbidity and mortality. JAMA 1990;264:1719-20. Holgate ST, Beasley R, Twentyment OP. The pathogenesisand significance of bronchial hyperresponsivenessin airways disease. Clin Sci 1987;73:561-72. 4. Busse WW. The role of inflammation in asthma:a new focus. J Rev Respir Dis 1989;10:72-80. 5. BarnesPJ. A new approachto the treatmentof asthma.N Engl J Med 1989;321:1517-27. 6. Hargreave FE, Dolovich J, NewhouseMT. The assessmentand treatmentof asthma:a conferencereport [Rostrum]. J ALLERGY CLIN IMMUNOL 1990;85: 1098- 1111.
Albert L. Sheffer,MD Chair, Expert Panel on Management of Asthma 110 Francis St. Boston, MA 02215
ANNOUNCEMENT AMERICAN BOARD OF ALLERGY AND IMMUNOLOGY A Conjoint Board of the American Board of Internal Medicine and the American Board of Pediatrics CERTIFICATION EXAMINATION and
RECERTIFICATION EXAMINATION Tuesday, Oct. 8, 1991 Washington, D.C., and Denver, Colo. Registration: through March 31, 1991 Completedapplications must be Postmarkedby March 3 1, 1991, to avoid a late, nonrefundable penalty fee of $250.00. No applications will be acceptedafter June 30, 1991. Pleaseaddressall requeststo Herbert C. Mansmann, Jr., MD, American Board of Allergy and Immunology, 3624 Market St., University City Science Center, Philadelphia, PA 19104; phone 2151349-9466.
E&H@&
The significant worldwide increase in asthma severity and mortality has evoked increasing concern from the medical community.’ * To enhance early recognition, as well as appropriate therapeutic intervention of asthma, the NHLBI established the NAEP. Its Coordinating Committee, chaired by the NHLBI director, Dr. Claude Lenfant, is comprised of representatives of nearly 30 lay and professional organizations dedicated to the understanding and treatment of asthma. The NAEP convened an Expert Panel to develop guidelines for the diagnosis and treatment of asthma. Several committees of the NAEP will help disseminate the report. These committees include a Professional Education Committee, chaired by Dr. Robert Barbee, Public and Patient Education Committee, chaired by Dr. Alan Luskin, and the School Health Committee, chaired by Dr. William Pierson. Asthma is reversible, episodic, airway obstruction. That it can be fatal is not appreciated by most people, including many clinicians. However, with appropriate therapy, patients with asthma can expect to control their asthma symptoms, prevent acute exacerbations, attain activity levels of their choice, and maintain normal pulmonary function. Asthma is a chronic disease with acute exacerbations. It requires continuous medical care with four major components: (I) patient education that fosters a partnership among the patient, the patient’s family, and the medical care provider, (2) preventive and environmental control measures to avoid factors that trigger acute exacerbations, (3) comprehensive pharmacologic therapy, and (4) the use of objective measures to assess the severity of asthma and to monitor the course of asthma therapy. The airway hyperresponsiveness characteristic of asthma is currently considered consequent to airway of inflammation.‘,4 Thus, the early institution of aggressive therapy to reduce and preferably prevent the inflammatory response as well as to reverse bronchospasm is central to the asthma management recommended by the panel. The possibility that regularly scheduled, daily &-agonist therapy may accentuate airway hyperresponsiveness and the lack of high potency, inhaled corticosteroid agents in the United States make the challenge to define appropriate therapy increasingly difficult. The emphasis for treatment of acute exacerbations 468
f+oq)ram
1”u-..l.-ll.l1 NAEP: NHLBI:
National Asthma Education Program
National Heart, Lung. and Blood Institute
of asthma, according to the expert panel report, is on the rapid reversal of airway obstruction with intensive @,-agonist therapy, the early institution of corticosteroid therapy, and the addition of theophylline for hospitalized patients. Patients with asthma must be cognizant of early asthma deterioration, preferably before the onset of wheezing, to initiate appropriate therapeutic programs. Objective parameters of assessment, such as peak expiratory flow rate measurements, should be used to detect the earliest deterioration in lung function as well as to monitor the effects of the asthma treatment. Objective measurements will also guide appropriate selection of prophylactic or maintenance therapy for asthma, including anti-inflammatory agents, such as cromolyn sodium and inhaled corticosteroids. ’ * The NAEP Expert Panel report emphasizes that it is important to consider treatment of inflammation as part of the primary therapy for patients with moderate and severe asthma. The report is organized into chapters that elaborate on each of these elements of care. The guidelines for the diagnosis and management of asthma were developed with the understanding that specific therapeutic regimens must be adjusted to the individual needs of each patient, as determined by the patient and clinician. Thus, this report is designed principally to provide insight into asthma management for clinicians (physicians as well as nurses providing regular asthma care). It is hoped it will also be useful to patients, parents, and other asthma care providers. that is, respiratory therapists, health educators, and social workers. We hope, through this report, to encourage an informed collaboration among these professionals and patients with asthma that may lead to effective asthma management and a reduction in asthma severity and mortality. The final report of the Expert Panel of NAEP was accomplished through an extensive development, re-
VOLUME NUMBER
87
NAEP attacks asthma
469
2
view, and approval process. Members of the panel include asthma care specialists from a variety of disciplines: pediatrics, internal medicine, allergy, pulmonology, nursing, and behavioral medicine. The members are: William Bailey, MD, Eugene Bleecker, MD, William Busse, MD, Elliott Ellis, MD, David Evans, PhD, Christopher Fauta, MD, Susan JausonBjerklie, PhD, RN, Floyd Malveaux, MD, PhD, Shirley Murphy, MD, Harold Nelson, MD, and Gail Shapiro, MD. The final report is expected to be released in the spring of 1991. Copies will be available through the NHLBI and will be disseminated through the Coordinating Committee organizations in the early summer.
REFERENCES WeissKB, WagenerDK. Changingpatternsof asthmamortality. JAMA 1990;264:1683-7. Buist AS, Vollmer WM. Reflectionson the rise in asthmamorbidity and mortality. JAMA 1990;264:1719-20. Holgate ST, Beasley R, Twentyment OP. The pathogenesisand significance of bronchial hyperresponsivenessin airways disease. Clin Sci 1987;73:561-72. 4. Busse WW. The role of inflammation in asthma:a new focus. J Rev Respir Dis 1989;10:72-80. 5. BarnesPJ. A new approachto the treatmentof asthma.N Engl J Med 1989;321:1517-27. 6. Hargreave FE, Dolovich J, NewhouseMT. The assessmentand treatmentof asthma:a conferencereport [Rostrum]. J ALLERGY CLIN IMMUNOL 1990;85: 1098- 1111.
Albert L. Sheffer,MD Chair, Expert Panel on Management of Asthma 110 Francis St. Boston, MA 02215
ANNOUNCEMENT AMERICAN BOARD OF ALLERGY AND IMMUNOLOGY A Conjoint Board of the American Board of Internal Medicine and the American Board of Pediatrics CERTIFICATION EXAMINATION and
RECERTIFICATION EXAMINATION Tuesday, Oct. 8, 1991 Washington, D.C., and Denver, Colo. Registration: through March 31, 1991 Completedapplications must be Postmarkedby March 3 1, 1991, to avoid a late, nonrefundable penalty fee of $250.00. No applications will be acceptedafter June 30, 1991. Pleaseaddressall requeststo Herbert C. Mansmann, Jr., MD, American Board of Allergy and Immunology, 3624 Market St., University City Science Center, Philadelphia, PA 19104; phone 2151349-9466.
