Attaining optimal asthma control: A practice parameter - 18/08/11

Doi : 10.1016/j.jaci.2005.08.017

James T. Li, Chief Editors:MD, PhD, John Oppenheimer, MD, I. Leonard Bernstein, MD, Richard A. Nicklas, MD

David A. Khan, Joint Task Force Reviewers:MD, Joann Blessing-Moore, MD, David M. Lang, MD, Jay M. Portnoy, MD, Diane E. Schuller, MD, Sheldon L. Spector, MD, Stephen A. Tilles, MD, Dana V. Wallace, MD

Abstract

These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology.

The American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI) have jointly accepted responsibility for establishing “Attaining optimal asthma control: A practice parameter.” This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or the ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma and Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion.

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Plan

Contributors

Chief Editors

Joint Task Force Reviewers

Reviewers

Classification of Recommendations and Evidence

Category of Evidence

Strength of Recommendation

Preface

Summary Statements

Asthma Severity and Asthma Control

Summary Statement 1. Asthma symptoms do not always correlate with asthma severity. There are limitations to classifying asthma severity in patients already being treated. (B)

Summary Statement 2. Management based on asthma control encompasses the principles of chronic disease management, including periodic assessment, goal (outcome) orientation, and individualization of therapy. (B)

Assessment of Asthma Control

Summary Statement 3. Asthma control can be expected to change over time. Asthma control should be assessed at every clinical encounter for asthma, and management decisions should be based on the level of asthma control. (B)

Summary Statement 4. Asthma control is based on asthma symptoms, sleep disturbance, use of rescue medication, limitations of daily activity, patient and physician overall assessment, and lung function. (A)

Summary Statement 5. Asthma should be considered well controlled if (1) asthma symptoms are twice a week or less; (2) rescue bronchodilator medication is used twice a week or less; (3) there is no nocturnal or early morning awaking; (4) there are no limitations of work, school, or exercise; (5) the patient and physician consider their asthma well controlled; and (6) the patient’s PEF or FEV₁ is normal or his or her personal best. (B)

Summary Statement 6. Complete or total control of asthma can be defined as (1) no asthma symptoms; (2) no rescue bronchodilator use; (3) no nighttime or early morning awakening; (4) no limitations on exercise, work, or school; (5) complete control of asthma by patient and physician assessment; and (6) normal or personal best PEF or FEV₁. (A)

Summary Statement 7. In addition to the assessment of asthma control, there are several important activities that should be accomplished during the periodic visit for asthma, including assessment of psychosocial status, assessment of adherence-compliance, assessment of medication use and side effects, assessment of asthma triggers, review of written asthma action plan (as appropriate), and confirmation of asthma diagnosis. (B)

Step Care Based on Asthma Control

Summary Statement 8. A patient’s asthma control for a specific clinical encounter should be determined as well controlled or not well controlled. (B)

Summary Statement 9. A more detailed assessment of asthma should be conducted, especially for patients whose asthma is not well controlled. (B)

Summary Statement 10. The step care of asthma should be based on asthma control. (A)

Physician’s Role in Attaining Asthma Control

Summary Statement 11. Asthma management driven by level of asthma control demands a close partnership between physician and patient. (B)

This parameter was edited by Dr Nicklas in his private capacity and not in his capacity as a medical officer with the Food and Drug Administration. No official support or endorsement by the Food and Drug Administration is intended or should be inferred.
Disclosure of potential conflict of interest: J. Li had consultant arrangements with Roche, Novartis, and Glaxo; has received grants from Astra Zeneca, Glaxo, and Schering; and has received honoraria from Merck, Astra Zeneca, and Glaxo. I. Bernstein has stock in Glaxo. J. Oppenheimer has consultant arrangements with Sepracor, Glaxo, Astra Zeneca, and Roche; has received grants from Sepracor, Glaxo, Astra Zeneca, Schering Sanofi, Boehringer Ingelheim, and Merck; and is on the speaker’s bureau for Sepracor, Glaxo, Schering Sanofi, and Boehringer Ingelheim. R. Nicklas—none disclosed.
Reprints requests: Joint Council of Allergy, Asthma and Immunology, 50 N Brockway St, #3-3, Palatine, IL 60067.