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THE FOUR COMPONENTS OF ASTHMA
MANAGEMENT
Introduction
The Expert Panel
Reports presenting clinical practice guidelines for the
diagnosis and management of asthma have organized
recommendations for asthma care around four components
considered essential to effective asthma management:
Measures of assessment and
monitoring, obtained by objective tests, physical examination,
patient history and patient report, to diagnose and assess the
characteristics and severity of asthma and to monitor whether
asthma control is achieved and maintained
Patient Education for a partnership
in asthma care
Control of environmental
factors and comorbid conditions that affect asthma
Pharmacologic therapy
Asthma therapy has several components: patient education, control of factors contributing to severity, and pharmacological therapy, as well as the use of objective measures to assess the severity of disease and monitor the course of therapy.
Patient Education
Patient education is an essential component of successful asthma management.
It should begin at the time of diagnosis and be integrated into every step of medical care.
Asthma education programs have led to improved patient outcomes, including reduced
hospitalizations and emergency room visits, fewer asthma symptoms and physician visits,
and improvement in asthma management skills. However, the performance and adequacy of
education is not easily assessed through medical record review. Therefore, the review and
the indicators that follow will not focus on the patient-education component of care.
Pharmacological Therapy
Corticosteroids
Corticosteroids are the most potent and the most effective anti-inflammatory medication
currently available. Inhaled forms are used for long-term control, while systemic
corticosteroids are often used to obtain prompt control of the disease when beginning
long-term therapy. Inhaled corticosteroids, at currently approved doses, are safe and
effective for the treatment of asthma and are being utilized more frequently as primary therapy.
In any patient requiring chronic treatment with oral corticosteroids (i.e., exceeding one month in duration), a trial of inhaled corticosteroids should
be attempted in an effort to reduce or eliminate oral steroids.
High doses of inhaled steroids are used if conventional doses fail to permit oral steroid
tapering. Pulmonary functions (PEF or FEV1) are monitored during tapering.
Inhaled glucocorticosteroids are now the mainstay of
therapy. Anti-inflammatory medications are proven to improve
lung function (ie. FEV1, AHR) and to decrease symptoms,
exacerbation frequency, and the need for rescue inhalers.
Prolonged daily
use of oral corticosteroids is reserved for patients with severe asthma despite use of
high-dose inhaled corticosteroids. In patients on long-term oral corticosteroids,
pulmonary function tests should be used to objectively assess efficacy.
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