Be a control freak: Allergists outline new focus for asthmatics

ROCHESTER, Minn. -- A Mayo Clinic allergist and colleagues representing the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma and Immunology announce they are revising the old classification of asthma patients by disease severity to determine treatment and moving to a new expectation for all asthma patients: excellent symptom control. Complete or total control is also a realistic goal for a subset of patients, according to new guidelines for treating asthma published in the November issue of Journal of Allergy and Clinical Immunology.

"People with asthma can expect to control the asthma: not to have the asthma control them" says James Li, M.D., Ph.D., Mayo Clinic allergist and lead author of the paper. "It’s all about asthmatics’ quality of life: waking up in the middle of the night wheezing, constantly using rescue medications, having to excuse themselves from sports teams or needing to leave work due to an attack -- that’s no life"

Dr. Li contends this is not just pie-in-the-sky thinking, but that these new goals can align with patients’ disease reality. "It’s definitely not only a goal and an ideal, but most people with asthma can have well or completely controlled asthma" he says. "People with asthma should not be satisfied with less than well or completely controlled asthma. We want to empower patients by letting them know this is the goal. We want them to know if they are not reaching this goal, they should see their doctors"

With the heretofore national practice guidelines for physicians treating asthmatics -- in use for about 15 years -- patients have been classified as having mild, moderate or severe asthma; treatment was based on disease severity.

"It’s become clear, however, that there are limitations to this approach as asthma changes over time and individuals require different treatment" says Dr. Li. "The present classification of asthma severity tends to promote the erroneous idea that asthma ’class’ is static. In fact, asthma symptoms, sleep disturbance, rescue medication use and pulmonary function may change significantly over time, which highlights the need for continual reassessment of a patient’s asthma and the need for possible medication adjustment"

Asthma treatment should be individualized to achieve the target symptom control, according to Dr. Li, because not all patients respond similarly to medication. This customized approach requires regular visits to the doctor. Asthmatics who have not attained well or completely controlled asthma should see their doctors for a detailed assessment of asthma control (including lung function tests), confirmation of the diagnosis of asthma, assessment of asthma triggers (including allergy) and individualized treatment.

Well-controlled or excellent control of asthma is defined by the paper’s authors as follows:

* Asthma symptoms twice a week or less
* Rescue bronchodilator used twice a week or less
* No night or early morning awakening due to asthma symptoms
* No limitations on exercise, work or school due to asthma
* Well-controlled asthma by patient and physician assessment
* Normal or personal-best pulmonary function tests

The authors also assert that with proper symptom assessment and treatment, complete or total control is possible for a significant group of asthmatics.

"While well-controlled asthma is the recommended target for all patients with asthma, complete control may be attainable and appropriate for many patients" says Dr. Li.

Complete or total control of asthma is defined by Dr. Li and colleagues as follows:

* Full activity and exercise
* No asthma symptoms during the day or at night
* No need for ’as needed’ Albuterol
* No missed work or school due to asthma
* Normal lung function

Asthma is a chronic condition that occurs when the main air passages of the lungs, the bronchial tubes, become inflamed. The muscles of the bronchial walls tighten and extra mucus is produced, causing the airways to narrow. This can lead to everything from minor wheezing to severe difficulty in breathing. Each year, nearly 500,000 Americans with asthma are hospitalized, and more than 4,000 die from disease-related causes.

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