Allergy & Asthma Network Mothers of Asthmatics (AANMA)
Guidelines for the Diagnosis and Management of AsthmaThe National Asthma Education and Prevention Program (NAEPP), under the National Institutes of Health (NIH) National Heart, Lung and Blood Institute (NHLBI), issued the first Guidelines for the Diagnosis and Management of Asthma in 1991. As research advanced through the years, the Guidelines were updated, most recently as Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (EPR3). This research-based report offers step-by-step instructions for treating asthma.
The Guidelines Implementation Panel (GIP) isolated 6 measures that have the biggest impact on asthma care and patient health. Click here for a summary of those 6 steps – and AANMA’s take on why they’re so important.

The Guidelines prioritize steps to diagnose and individually treat asthma symptoms so that patients require the least amount of medication to achieve maximum results. Federally funded research and programs have demonstrated repeatedly that the Guidelines work and save money: Once symptoms are stabilized and causative factors have been resolved, maintaining symptom-free days and nights becomes routine and cost effective.
Ironically, many patients from all walks of life and with all types of insurance – including federally funded programs such as Medicare and Medicaid — are denied Guidelines-level care, such as access to specialists and appropriate medications. Short-sighted health policies based on short-term savings are too expensive for America’s economy.
The sooner we adopt Guidelines-level care for all patients, the sooner we’ll start reducing asthma’s $20 billion annual price tag; children and families will experience fewer symptoms and get back to school and work; and asthma deaths will be eradicated. Anything less is a waste of federally funded research and proven programs.

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AANMA’s take on why the 6 GIP measures are so important:
When the National Institutes of Health released the new national asthma guidelines, Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (EPR-3), AANMA was excited to read that many of the Expert Panel’s recommendations echo asthma treatment concepts we’ve been supporting since 1985.
The Guidelines Implementation Panel (GIP) isolated 6 measures they say could have the biggest impact on asthma care and patient health.

1. Inhaled corticosteroids are the most effective anti-inflammatory medications for long-term management of persistent asthma.
Why? Inhaled corticosteroids treat the quietly smoldering part of asthma – inflammation. (Inflamed airways are raw, swollen and filled with mucus.) Inhaled corticosteroids are particularly well suited for people whose stubborn symptoms hang on, even after they faithfully use other medications, eliminate known allergens and irritants and rule out interrelated medical conditions such as sinus infections or gastroesophageal reflux disease (GERD). Inhaled corticosteroids are usually used daily until you and your physician feel you can decrease the dose or stop using the medication
altogether.
2. All people with asthma should receive a written asthma action plan.
Why? Asthma is a complex, potentially life-threatening condition. Treatment instructions, which include using multiple medications, responding to various stages of symptoms and making environmental changes, must be written in the patient’s record and the patient should get a copy. This asthma action plan will cover routine or daily treatment as well as recognizing and handling worsening symptoms. Every person with asthma deserves an individualized, written asthma action plan. If you don’t have one, make an appointment today to meet with your medical care team to develop your own asthma action plan.
3. All patients should have an initial assessment that covers impairment and risk to determine the level of therapy needed.
Why? To decide on a treatment plan, your asthma care team must look at the big picture as well as deal with your current breathing problems. It’s important to take into account how asthma affects your daily activities and to assess the risk of future symptoms or life-threatening events.
4. At planned follow-up visits, asthma patients should review their level of control with their healthcare provider based on multiple measures of current impairment and future risk in order to guide clinician decisions to either maintain or adjust therapy.
Why? Traditionally, asthma was only treated in the emergency department or when symptoms were flaring beyond your ability to stop them at home. With planned, scheduled visits, you can focus on good health and work with your medical care team to learn to intervene early and hold on to the best possible breathing levels.
These visits are all about you getting answers to the questions you have. Review your daily symptom diary. Talk about how the results of your home peak flow monitoring compare with the office lung function tests. Together, you and your physician can check the progress you’re making toward your agreed-upon goals and reassess your future risk of symptoms and/or life-threatening events.
AANMA’s AsthmaTracker® daily symptom diary can help you track asthma symptoms, peak flow meter readings and medication use. Order the AsthmaTracker® from AANMA’s online store or call 800.878.4403 to order your copy today.
5. Patients who have asthma should be scheduled for planned follow-up visits at periodic intervals in order to assess their asthma control and modify treatment, if needed.
Why? Planned follow-up visits are important or they wouldn’t be mentioned in two of these recommendations. After education and conversation, the office visit turns to assessing how or if the asthma action plan should be revised – specifically, whether or not to adjust the dose and frequency of medications. The goal: Use the least amount of medication necessary to achieve the maximum result, meaning asthma doesn’t interfere with your daily life.
6. Clinicians should review each patient’s exposure to allergens and irritants and provide a multi-pronged strategy to reduce exposure to those allergens and irritants that make a patient’s asthma worse.
Why? Controlling asthma symptoms involves much more than prescribing medications. That’s why the guidelines direct clinicians to ask about your exposures to common inhalants known to cause airway inflammation, such as airborne particles of pet dander, tobacco smoke, mold, dust mites, cockroaches, pollen and other pollutants at home, work, school and play.
This is no time to hide the truth about smoking or pets – two of the most troubling subjects for adults, children and parents of children with asthma. Open discussions should lead to creative solutions, not lectures!
It may take a set of allergy-proofing measures to make a difference – no single, quick solution will do it all – but many people find they decrease their symptoms and the need for daily medications after eliminating the environmental culprits.
First published: Allergy & Asthma Today, February 2007
Reviewed:  March 2009, Laurie Ross

A Guide to the Guidelines – for Real (Busy) People
1. Order the full 326-page report or the 74-page summary. You can also download pdf copies online. They’re free — click here to order or download your copy.
2. Read it cover-to-cover if you’re so moved, or choose to supplement information from your healthcare provider. (Tip: Print it out using a color printer – some of the charts are color-coded.) The Summary Report contains vital information written for doctors, so if you don’t understand it all – that’s OK. Your healthcare provider should be able to decode anything that’s unclear to you.
3. Dog-ear these pages for easy reference:
Pages 6-7 – An easy-to-read chart of age-by-age management steps
Page 17 – Patient Self-Assessment Sheet 
Pages 20-21 – Sample Asthma Action Plans – for adults and children
Page 26-27 – How to control things that make your asthma worse
Page 60 – Illustrated Steps for Using Your Inhaler