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New AAAAI Guidelines Stress Flexibility in Asthma Therapy

Asthma • • StressOct 27, 05

Rather than a rigid treatment regimen determined by an initial assessment of disease severity, asthma therapy should be flexible, responding to changes in symptoms.

So suggest new guidelines from the American Academy of Allergy, Asthma and Immunology (AAAAI) that emphasize the dynamic nature of the disease.

Indeed, symptoms should be assessed in detail each time a patient sees a physician for asthma, and medication should be increased or decreased accordingly, said James T. Li, M.D., Ph.D., of the Mayo Clinic in Rochester, Minn., lead author of the new guidelines which are published in the November issue of the Journal of Allergy & Clinical Immunology.

“Asthma is not a static disease, and each patient reacts differently to medication, their environment, triggers, and changing allergens that affect their asthma symptoms,” Dr. Li said. “Assessing these changes requires strong communication between the doctor and patient on an ongoing basis to determine whether changes are needed in medication.”

Furthermore, patients should be not be satisfied with anything less than well-controlled or completely controlled asthma, the guidelines said. “It used to be that doctors said, ‘well, asthma is a chronic disease and you have to live with it,’” Dr. Li said. But, in fact, these days a complete or good symptom control is attainable for nearly everyone, he added.

The new guidelines build upon those published by the National Heart, Lung, and Blood Institute in 1991. They recommended an initial assessment of disease severity—mild, moderate, or severe—and a static therapy regimen based on these categories, Dr. Li said.

In contrast, the new guidelines state that asthma-management decisions should be driven by the level of asthma control. If asthma is completely or well controlled, patients may be able to take less medicine. Uncontrolled asthma requires a step-up in therapy, which may consist of increased medication use and more frequent visits to the doctor.

Attaining Optimal Asthma Control: A Practice Parameter was developed by AAAAI in conjunction with the American College of Allergy, Asthma & Immunology.

Primary source: Journal of Allergy & Clinical Immunology

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