Guidelines for the Diagnosis and Treatment of Asthma

Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (2007)

The Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (EPR-3) are a set of recommendations for ideal asthma management. EPR-3 provides guidance for selecting treatment based on a patient’s individual needs and level of asthma control.

The guidelines emphasize that while asthma can be controlled, the condition can change over time and differs among individuals and by age groups. Thus, it is important to monitor the patient’s level of asthma control regularly so that treatment can be adjusted as needed.

The full set of guidelines can be viewed at the NHLBI website.

Here are the 6 key messages from the EPR-3 Asthma Guidelines

Most Important:
1) Inhaled corticosteroids are the most effective anti-inflammatory medication for long term management of persistent asthma.

All patients should receive:
2) Written asthma action plan
3) Initial assessment of asthma severity
4) Review of the level of asthma control (impairment and risk) at all follow up visits
5) Periodic, follow up visits (at least every 6 months)
6) Assessment of exposure and sensitivity to allergens and irritants and recommendation to reduce relevant exposures.

Here are the 4 more key messages from the EPR-3 Asthma Guidelines as identified by the Quality Improvement and Asthma Care Subcommittee of AIM.

All patients should also receive:
7) Asthma education by a qualified health professional
8) Referral to an asthma specialist, when appropriate
9) Education regarding the danger of over-use of short-acting beta-agonists
10) Information regarding risk factors for death from asthma.

The Asthma Initiative of Michigan has also put together an “Essential Information” brochure that is free for download and use. This brochure contains the tables “Components of severity,” “Components of Control,” and the “Stepwise Approach for Managing Asthma.” In addition, the Guideline Implementation Steps & Tools materials can help primary care providers integrate the guidelines into their asthma visits.

For more information, please refer to the actual guidelines.

Essential Information Trifold (8.5 x 11 size)

The 2020 Focused Updates to the Asthma Management Guidelines: A Report from The National Asthma Education and Prevention Program Expert Panel Working Group

The report includes 19 recommendations in six key areas of asthma diagnosis, management, and treatment.

2020 Focused Updates to the Asthma Management Guidelines: Clinician’s Guide

This Clinician’s Guide summarizes the 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group to help clinicians integrate the new recommendations into clinical care.

Summary of the Updates to be Used with the 2007 EPR-3 Guidelines

1. Using daily controller medicines as-needed instead of daily
There are two types of asthma medicines: quick-relief and long-term controller medicines.

The updated guidelines include three options for taking inhaled steroid controller medicines.

  • The first option is to take inhaled steroids every day to control asthma, and to use quick-relief medicine at the first sign of asthma symptoms. This recommendation is also in the 2007 guidelines.
  • A second and new option recommends that people with asthma take inhaled steroid controller medicines as needed. Inhaled steroids and quick-relief medicines can be used at the same time for asthma symptoms. This can be as effective as using a controller medicine every day.
  • A third and also new option is a treatment option known as SMART (Single Maintenance And Reliever Therapy). SMART uses one inhaler that combines a controller and long-acting reliever medicine together. The inhaler contains an inhaled steroid and a medicine called formoterol. Together, they act as both a daily control medicine and a relief medicine.
  • Use this Practical Guide to Implementing SMART in Asthma Management
  • Use this SMART Step Guide to help you implement SMART with your patients

2. Using long-acting muscarinic antagonists (LAMAs)
Two types of asthma controller medicines keep the muscles around airways from tightening and causing asthma symptoms: long-acting muscarinic antagonists (LAMAs) and long-acting bronchodilators (LABA). If asthma is not well-controlled with inhaled steroids, the new guidelines recommend adding a LABA. If the patient cannot use a LABA, a LAMA may be a good option. If a patient is currently taking a LABA or LAMA medicine, they should not stop taking them without consulting their doctor.

3. Reducing indoor allergens
The updated guidelines now offer steps that can be taken to reduce indoor asthma triggers. The report recommends that people with asthma take many steps to reduce or remove allergens. For example, using a mattress cover alone to reduce dust mites may not be enough- vacuuming often using a vacuum cleaner with a HEPA filter and washing bedding in hot water weekly may also be needed.

4. Allergy shots – immunotherapy as a treatment for allergic asthma
Previous guidelines recommended allergy shots (immunotherapy) for people with allergic asthma. The updated guidelines also recommend allergy shots. The guidelines do not recommend sublingual immunotherapy (SLIT) – the tablet or drop placed under the tongue.

5. FeNO testing (fractional exhaled nitric oxide testing)
Nitric oxide (NO) is produced throughout the body, including in the lungs, to fight inflammation and relax tight muscles. FeNO is a quick pulmonary function test that measures the amount of nitric oxide gas that is exhaled. The updated guidelines recommend FeNO testing to help diagnose asthma.

6. Bronchial thermoplasty (BT)
Bronchial thermoplasty (BT) is a series of three medical procedures for adults with moderate-to-severe asthma that use heat to remove smooth muscle tissue from the airways. The updated guidelines do not recommend BT to treat asthma. Their findings show the benefits of the treatment are small. The risks are moderate, and long-term outcomes are uncertain.

Control Assessments

Validated instruments for assessment and monitoring asthma include:

The CDC and National Asthma Education and Prevention Program (NAEPP) have put together a resource for health care professionals called Key Clinical Activities for Quality Asthma Care. This booklet was developed to improve the implementation of the NHLBI guidelines, and contains key clinical activities in the areas of diagnosis, classification, follow-up care, specialty care, education, comorbidities, medications, asthma action plans, and self-management of asthma.

Global Initiative on Asthma (GINA)

GINA guidelines are updated annually. They provide many formats, including reports, pocket guides and slide sets.