by Gale Jurasek

In 2002, the National Asthma Education and Preventions Program (NAEPP) issued an updated version of the Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma. Recently, the CDC, in collaboration with the NAEPP, issued a companion to that report, detailing 10 key clinical activities for quality asthma care, along with steps to help implement them. The CDC's recommendations include:

Diagnosis of asthma and its level of severity should be made when the patient first seeks medical attention for symptoms. For adults and children older than 5, asthma can be diagnosed using physical examination, medical history, and spirometry (results should indicate reversible obstruction). Since spirometry is not feasible in children younger than 5, young children with asthma symptoms should be treated as having suspected asthma.

Routine follow-up is important because patients can experience changes in symptoms or severity. The first follow-up visit should occur one month after initial diagnosis. Thereafter, routine visits should be scheduled every one to six months, depending on asthma severity and the patient's symptom control.

The following circumstances indicate the need for referral to specialty care:

• A single life-threatening asthma attack.

• Treatment goals that are not being met.

• Atypical symptoms that make an asthma diagnosis unclear.

• A history of asthma that is provoked by environmental factors.

• A diagnosis of severe, persistent asthma.

• Need for additional diagnostic testing.

• A patient younger than 3 with moderate or severe persistent asthma.

• The patient is eligible for immunotherapy.

• The patient or family requires additional education or guidance on medications, symptom management, or adherence.

• The patient requires continuous oral or high-dose inhaled corticosteroids or has had more than two courses of oral corticosteroids in one year.

Comorbid conditions, such as allergic rhinitis, sinusitis, gastroesophageal reflux, and sensitivity to certain medications (including aspiring, β-blockers, and nonsteroidal anti-inflammatory drugs), should be treated to prevent exacerbations.

Medications should be prescribed according to asthma severity. All patients with persistent asthma, regardless of severity, need daily long-term control medication. Inhaled corticosteroids are the most effective because they reduce the underlying inflammation. At each patient visit, use of inhaled ß-agonists should be reviewed and additional long-term control therapy initiated if needed.

A written asthma management plan should be developed for all patients. The plan should include tips on how to recognize worsening asthma, how to use medications appropriately, when to seek medical care, and how to monitor treatment response.

The full text of "Key Clinical Activities for Quality Asthma Care" is available online at the Centers for Disease Control site.