2007 Guidelines for the Diagnosis and Management of Asthma
In 2007, the National
Asthma Education and Prevention Program (NAEPP) issued a
comprehensive update to their clinical guidelines for the
diagnosis and management of asthma. The Expert Panel Report 3:
Guidelines for the Diagnosis and Management of Asthma are a set
of recommendations for ideal asthma management. They take into
account the most current asthma research and new medications available
in order to provide the best possible care.
Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and
Management of Asthma – Full Report, 2007 provides guidance
for selecting treatment based on a patient's individual needs
and level of asthma control. The guidelines emphasize that while
asthma can be controlled, the condition can change over time and
differs among individuals and by age groups. Thus, it is important
to monitor regularly the patient's level of asthma control so
that treatment can be adjusted as needed.
The full set of guidelines can be viewed at the NHLBI
website, or you can view the summary report.
Here are the 6 key messages from the EPR-3 Asthma Guidelines.
1) Inhaled corticosteroids are the most effective anti-inflammatory
medication for long term management of persistent asthma.
All patients should receive:
2) Written asthma action plan
3) Initial assessment of asthma severity
4) Review of the level of asthma control (impairment and risk)
at all follow up visits
5) Periodic, follow up visits (at least every 6 months)
6) Assessment of exposure and sensitivity to allergens and irritants
and recommendationS to reduce relevant exposures.
Here are the 4 more key messages from the EPR-3 Asthma Guidelines as identified by the
Quality Improvement and Asthma Care Subcommittee of AIM.
All patients should also receive:
7) Asthma education by a qualified health professional
8) Referral to an asthma specialist, when appropriate
9) Education regarding the danger of over-use of short-acting beta-agonists
10) Information regarding risk factors for death from asthma.
Watch a presentation on the new asthma guidelines and how they have changed from EPR2.
The Asthma Initiative of
Michigan has also put together an "Essential
Information" brochure that is free for download and use.
This brochure contains the tables "Components of severity," "Components
of Control," and the "Stepwise Approach for Managing Asthma."
For more information, please refer to the actual guidelines.
Other Essential Information and Tables from the Expert Panel Report include:
Severity, Control, and Stepwise Treatment Guidelines excerpted
from Expert Panel Report-3
Medication Dose Grids for Long Term Control and Quick Relief Medications
excerpted from Expert Panel Report-3
instruments for Assessment and Monitoring Asthma excerpted
from Expert Panel Report-3
The CDC and National Asthma Education
and Prevention Program (NAEPP) have put together a resource for
health care professionals called Key
Clinical Activities for Quality Asthma Care. This booklet was developed
to improve the implementation of the NHLBI guidelines, and contains
key clinical activities in the areas of diagnosis, classification,
follow-up care, specialty care, education, comorbidities, medications,
action plans, and self-management of asthma.
International Guidelines & Resources
Global Initiative on Asthma (GINA)
is an organization that partners with
the NHLBI, the National Institutes of Health (NIH), and the World
Health Organization (WHO) to increase awareness of asthma, and
promote programs and studies that will lead to solutions to asthma
problems worldwide. They have published a set of guidelines and
other materials, including a 2002 Workshop Report that can be
useful to health care professionals. At the GINA website, click on
documents and resources to find these materials.
Michigan Guidelines & Resources
The Michigan Quality Improvement Consortium (MQIC) has developed evidence-based guidelines that provide a simplified approach to the treatment of asthma, divided into the same age groups as the 2007 NAEPP Asthma Guidelines. Visit the MQIC
website to view this guideline.
Asthma Guideline Implementation Steps & Tools (GIST) is a provider education and practice redesign project by the Michigan Department of Community Health and statewide partners based on the 2007 NAEPP Asthma Guidelines. GIST makes it easier for primary care clinicians to use the asthma guidelines in their everyday care of patients with asthma.