The National Heart, Lung, and Blood Institute (NHLBI) had originally
established guidelines about the diagnosis and management of asthma,
and these recent recommendations build upon those original guidelines.
It is important for doctors to constantly monitor their patients’ control
over his or her asthma because symptoms associated with asthma
can change over time. The original NHLBI guidelines already included
measuring asthma so that physicians can correctly classify a patient’s
asthma severity before treatment begins, but the new practice parameter
recommends making asthma management decisions on an ongoing basis,
measuring asthma each visit to more accurately determine the patient’s
level of control over asthma.
"Asthma is a chronic disease and needs to be continually
reassessed," said James T. Li, MD, FAAAAI, and lead author
of the new practice parameter. "Every doctor or clinic visit
should consist of a detailed assessment to determine if the patient's
asthma is or is not under control. People with asthma should not
be satisfied with less than well controlled or completely controlled
"Asthma is not a static disease, and each patient reacts
differently to medication, their environment, triggers and changing
allergens that affect their asthma symptoms. Assessing these changes
requires strong communication between the doctor and patient on
an ongoing basis to determine whether changes are needed in medication
- either an increase or a decrease."
According to Attaining Optimal Asthma Control:
A Practice Parameter,
a patient’s asthma control should be assessed at every clinic
or physician visit and assessment needs to be individualized because
each patient reacts differently to medication. Based on the level
of asthma control, asthma management decisions can be more appropriately
determined, according to the parameter. If asthma is completely
or well-controlled, patients may be able to reduce the amount of
medicine they take and decrease their level of therapy while uncontrolled
asthma requires a boost in therapy, which may include increased
medication use and more frequent visits to the doctor.
The new practice parameter asserts that well or complete controlled
asthma control is not only possible, but that asthma sufferers
should expect it. The parameter defines complete asthma control
as full activity of exercise, no asthma symptoms during the day
or at night, no need for “as needed” Albuterol, no
missed school or work, and normal lung function.