What’s new in the updated asthma guidelines? Harvard Health Blog


In 2007, The Soprano It was a hit TV show, patterned jiggins were a fashion trend, and the National Asthma Education and Prevention Program (NAEPP) sponsored by the National Institutes of Health published the second edition of the Asthma Management Guidelines.

Much has changed since 2007, including in the field of crisis. NAEPP recently published a Third Edition of Asthma Management Guidelines To address these changes. This update reflects recent developments in our understanding of disease-causing mechanisms of asthma and current best practices for managing asthma symptoms. As such, updated guidelines are an important tool, as they enhance the ability of clinicians and patients to control asthma and reduce the disease’s impact on their lives.

Toll of asthma in the United States

Asthma is a chronic lung disease that affects approximately 5% to 10% of the United States population. It is characterized by symptomatic periods of wheezing, chest tightness, and shortness of breath alternating with periods of essentially normal breathing. Symptomatic episodes can be extremely debilitating and even life-threatening – every year nearly 3,500 people die of asthma, many of them children. Like many diseases, the impact of asthma is greater among minority patients and economically disadvantaged patients. There is no cure for asthma, so treatment focuses on preventing and treating attacks of worsening symptoms.

New asthma guidelines update treatment recommendations

The main focus of the updated guidelines is asthma treatment. Most asthma treatments treat two causes of asthma symptoms: airway inflammation and airway constriction. Airway inflammation in asthma is caused by an increased and / or inappropriate immune response. It is usually treated with steroids, which help control airway inflammation or swelling over time.

Airway constriction is controlled by the nerves in the airways. There are two main types of airway nerves, sympathetic and cholinergic nerves. The sympathetic nerve network, specifically the beta-2 receptor, is the most common neurological target in asthma treatment. Medicines that activate beta-2 receptors are called beta-agonists, and. They are usually given as an inhaled medication. Beta agonists are bronchodilators. They relax the muscles in the airways, allowing the narrowed airways to reopen. There are two primary types of beta agonists used in asthma: Rapid-Acting and Short-Duration Medicines (SABAs), which are used for immediate relief of symptoms; And longer-acting and (usually) delayed onset-effect drugs (LABAs), which are used in prophylaxis.

Previously, asthma patients requiring daily maintenance, or a controller, would use separate steroid and beta-agonist inhalers to control airway inflammation and constriction. Long-acting beta agonists are preferred for maintenance therapy because of their longer duration of action. But for patients who are already using steroid and LABA for maintenance therapy, using SABA for breakthrough symptoms means getting a second (if the maintenance treatment uses a steroid / LABA inhaler combination) or a third (if separate steroid inhalers and LABA inhalers are used) maintenance) Rescue spray. This approach is stressful and upsetting for patients.

The update provides guidance for the use of a new type of inhaler that combines a steroid with a long-acting beta agonist as a control and rescue drug. Use one inhaler for both preventative and rescue treatment More effective approach Who use multiple inhalers. Firstly, it is easier to use the inhaler correctly than to take multiple doses from multiple inhalers. Second, use of a combination inhaler for rescue therapy provides immediate symptom relief and increases the steroid dose. Therefore, this approach increases the amount of both anti-shrinking and anti-inflammatory drugs.

However, not all combination inhalers are suitable for this approach. To be used for both maintenance and rescue, LABA should have a quick onset of effect. One of the long-acting beta agonists, formoterol, has a rapid onset of action, and the guidelines outline effective combination therapy as a control and rescue treatment, and how to incorporate this into the treatment of asthma.

Modern evidence It has been shown that the cholinergic nerves are also important in regulating airway volume in asthma. Updated guidelines include these findings to include recommendations on the use of long-acting anti-cholinergic therapies (LAMAs), such as tiotropium (Spiriva HandiHaler) or umeclidinium (Incruse Ellipta), for asthma.

The new treatment approach targets specific inflammatory cells

More Recent studies In asthma to identify subgroups of asthma patients based on distinct inflammatory patterns. These studies have led to the development of new therapies that specifically target specific types of inflammatory cells and their products. These treatments are very specific and do not work for all asthma patients. It can sometimes trigger dangerous, even life-threatening, reactions. Updated guidance provides general guidance on when this new approach can be incorporated into a patient’s asthma management strategy. However, since this area is still new, this version of guidance does not provide specific recommendations regarding these medications.

The new guidelines also address the safe use of the leukotriene inhibitors, zileuton (Zyflo) and montelukast (Singulair). These are effective asthma treatments, but they can sometimes cause dangerous side effects. In particular, montelukast has been linked to depression. The Food and Drug Administration recently added a warning about this concern to this drug. The instructions explain how to use it safely.

Nitric oxide measurements can be used to diagnose asthma

The update also provides guidance on using new technologies to diagnose asthma. The activity of the inflammatory cells in the airways of people with asthma produces a by-product called nitric oxide, which is exhaled when a person breathes. Reliable measurements of nitric oxide in exhalation are becoming widely available, and new asthma guidelines explain how to incorporate these measurements into diagnosing asthma.


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