Basic and clinical research continues to reveal new insights that are dramatically increasing the ability to provide quality care to patients with asthma. Despite these advances, results of a recent nationwide survey of healthcare professionals and patients with asthma show that asthma care in the United States is suboptimal. Substantial proportions of patients have daily symptoms, frequent exacerbations and requirement for emergency care, and significant activity limitations because of asthma. These findings are troublesome in view of the availability of effective therapies that can control asthma in most patients. In 2002, the National Asthma Education and Prevention Program (NAEPP) updated their 1997 guidelines for asthma management in efforts to address the shortcomings in asthma care in the United States and to give healthcare providers practical guidance reflecting the most recent research.
This issue of Advanced Studies in Medicine, comprises 2 review articles based on the course curriculum for the Hopkins Symposia Series titled "Evolution of Asthma Therapy to Improve Outcomes," as well as a case study. The issue considers recent developments in asthma management in the context of the 1997 guidelines and the 2002 updated guidelines. The first article, "The NHLBI Guidelines: Where Do We Stand and What Is the New Direction From the NAEPP?" reviews the 1998 data that in part prompted revision of the 1997 NAEPP guidelines and discusses the 2002 revisions intended to improve asthma management. The 2002 revision to the NAEPP guidelines will potentially help to address some of the shortfalls in asthma care—but only if its recommendations are incorporated into day-to-day clinical practice. The 2002 revision emphasizes the importance of dual-controller therapy with both anti-inflammatory and bronchodilating properties for persistent asthma and reinforces the favorable risk-benefit ratio of inhaled corticosteroids in children.
In the second article titled "Asthma Management: Optimizing Treatment for a Disease of Variable Intensity," Dr David Stempel considers the management of patients with mild asthma in the context of the NAEPP guidelines. Growing evidence shows that patients who, based on selected indices, appear to have mild asthma may actually have more severe disease. Furthermore, studies show that patients with mild asthma—even those meeting criteria for having mild intermittent asthma that, according to guidelines, does not warrant daily controller therapy—benefit significantly from daily therapy with inhaled corticosteroids or combinations of inhaled corticosteroids and long-acting beta agonists. Dr Stempel challenges healthcare providers to assess more carefully patients with seemingly mild asthma to ensure that goals of asthma therapy are being fulfilled in this patient population. He also provides a case report of a patient with seemingly mild asthma who benefitted from daily controller therapy, stressing the need for multiple measures of asthma severity when determining treatment.
The information in this issue will help to improve the ability of healthcare workers to provide quality care for patients with asthma.
*Associate Professor of Medicine; Clinical Director, Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, and Medical Director, Asthma and Allergy Diseases, Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland.