NAEPP Updates National Asthma Guidelines

Vol. 15 •Issue 25 • Page 20
NAEPP Updates National Asthma Guidelines

Corticosteroids Dubbed First-Line Therapy

New guidelines now recommend inhaled corticosteroids as safe, effective and preferred first-line therapy for children as well as adults with persistent asthma, according to the National Asthma Education and Prevention Program’s (NAEPP) “Guidelines for Diagnosis and Management of Asthma.”

The rule update continues to recommend a “step-wise” approach to asthma management in which therapy is adjusted according to disease severity. But the guidelines modify specific treatment recommendations at each step to reflect recent research.

Coordinated by the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health, NAEPP convened an expert panel as needed to ensure that the asthma guidelines correspond to current scientific findings. The guidelines were first published in 1991.

An Executive Summary of the update report was recently released at the NAEPP Coordinating Committee meeting.

“Asthma is one of the most common chronic health conditions in the United States, and the number of Americans who suffer from asthma continues to rise,” said NHLBI Director Dr. Claude Lenfant. “It is essential that they are treated according to the best available scientific evidence, and this update brings such evidence to clinical practice.”


The update stresses that inhaled corticosteroids are preferred for controlling asthma symptoms and improving lung function and quality of life. Inhaled steroids treat chronic inflammation of the airways, confirmed as a key characteristic of asthma.

“We have learned a lot about the effectiveness and safety of inhaled steroids in the past few years,” said Dr. William Busse, professor of medicine in allergy and immunology for the University of Wisconsin Medical School and chair of the NAEPP expert panel.

“We have also found that inhaled steroids alone may not be sufficient in all cases. Combination therapy–that is, adding long-acting inhaled beta2-agonists to inhaled steroids–is more effective than simply increasing the dose of inhaled steroids for patients over five [years] who have moderate or severe persistent asthma,” he continued. “But few studies on combination therapy include young children, and additional research is needed for this age group.”


In addition, the update reflects new data that provide reassuring evidence on the safety of inhaled steroid use at appropriate doses in children. The expert panel reviewed studies examining possible side effects of inhaled corticosteroids, including slowed growth in children.

The update reports that large clinical trials have shown the potential risk of a delay in growth linked to inhaled corticosteroids is temporary and possibly reversible. The expert panel also concluded that other potential concerns, such as reduced bone mineral density, suppressed adrenal function and increased incidence of cataracts, are not considered significant risks for children.

“Asthma is a complex disease. Research has led to numerous medications that help control asthma so that patients can live active lives,” said Dr. James Kiley, director of the NHLBI Division of Lung Diseases. “Little is known, however, about what makes the disease become more severe and whether treatment can prevent this progression.” The panel identified these and other areas, such as therapies for children five years and younger, as priorities for future studies.

Additional topics in the update include:

• new recommendations regarding the use of leukotriene modifiers as alternative therapy for mild persistent asthma or as combination therapy in moderate asthma; and

• reaffirmation that antibiotics should not be used to treat acute asthma attacks except when a separate bacterial infection is present.

In 1998, about 11 million Americans re.ported asthma attacks, according to the National Center on Health Statistics. Asthma is re.sponsible for 5,000 deaths each year in the U.S. with annual direct and indirect costs estimated at $12.7 billion in 2000, according to the NHLBI.

The NAEPP was established in March 1989 to reduce asthma-related illness and death and to enhance the quality of life of people with asthma. Today, 40 major medical associations, voluntary health organizations and numerous federal agencies comprise the NAEPP Coordinating Committee. The NAEPP also coordinates federal asthma-related activities, as designated by Congress through the Children’s Health Act of 2000.

• For more information on this report, visit the NHLBI’s Web site at

You can reach Shawn Proctor at [email protected].