What’s new in the updated asthma guide? -Harvard Health Blog


In 2007, soprano It is a popular TV show, and patterned decoration is a popular trend. The National Asthma Education and Prevention Program (NAEPP) sponsored by the National Institutes of Health released the second edition of the “Asthma Management Guide.”

Many changes have taken place since 2007, including asthma. NAEPP recently released Asthma Management Guide Third Edition Address these changes. This update reflects our latest developments in the disease mechanisms that cause asthma and current best practices for controlling asthma symptoms. Therefore, the updated guidelines are an important tool to enhance the ability of physicians and patients to control asthma and minimize the impact of this disease on their lives.

Asthma hazards in the U.S.

Asthma is a chronic lung disease that accounts for about 5% to 10% of the American population. It is characterized by symptoms of wheezing, chest tightness and dyspnea alternately with periods of basically normal breathing. Symptomatic attacks can be extremely debilitating and even life-threatening-about 3,500 people die of asthma each year, many of them children. Like many diseases, asthma has a greater impact on ethnic minorities and economically disadvantaged patients. There is currently no cure for asthma, so the focus of treatment is to prevent and treat the onset of symptoms, which is called exacerbation.

New asthma guidelines update treatment recommendations

The main focus of the updated guidelines is the treatment of asthma. Most asthma therapies address the two causes of asthma symptoms: airway inflammation and airway constriction. Airway inflammation in asthma is caused by an excessive and/or inappropriate immune response. Steroids are usually used for treatment. These steroids can help control inflammation or swelling of the airways over time.

Airway contraction is controlled by nerves in the airway. There are two main types of airway nerves, sympathetic nerves and cholinergic nerves. The sympathetic neural network, especially the β-2 neural receptor, is the most common neural target in the treatment of asthma. Drugs that activate beta-2 neuroreceptors are called beta agonists. They are usually given in the form of inhaled medicines. Beta agonists are bronchodilators. They relax the muscles in the airway and reopen the narrow airway. There are two basic types of beta agonists: fast-acting and short-duration (SABA) drugs that can relieve symptoms immediately. As well as long-lasting and (usually) delayed onset drugs (LABAs), these drugs can be used for maintenance therapy.

Previously, asthma patients who needed daily maintenance or control therapy used separate steroid and beta agonist inhalers to treat airway inflammation and contraction. LABA is recommended for maintenance therapy due to its longer duration of action. But for patients who have been on steroids and LABA for maintenance therapy, the use of SABA to treat breakthrough symptoms means that the second type (if the maintenance treatment uses a combination of steroids/LABA inhalers) or the third type (if a single steroid is used) And LABA inhaler for treatment and maintenance). This method is cumbersome and destroys the patient.

This update provides guidance for the use of a new inhaler that combines steroids with LABA as a control medicine and emergency medicine.The use of an inhaler for maintenance and rescue treatment is A more effective way Instead of an inhaler that uses multiple inhalers. First, it is easier to use one inhaler correctly than to take several doses from multiple inhalers. Secondly, the use of combined inhalers for rescue treatment can not only relieve symptoms immediately, but also increase the dose of steroids. Therefore, this method increases the dosage of anti-contraction drugs and anti-inflammatory drugs.

However, not all combined inhalers are suitable for this method. In order to be used for maintenance and rescue, LAB must be effective quickly. A type of LABA (formoterol) works quickly. The guide outlines which combination therapy can be used both as a controller and as a rescue therapy, and how to incorporate it into asthma treatment.

Recent evidence It has been shown that cholinergic nerves are also important in regulating airway size in asthma. The updated guidelines incorporate these findings, including recommendations for the use of long-acting anticholinergic therapies (LAMAs), such as tiotropium (Spiriva HandiHaler) or umeclidinium (Incruse Ellipta) to treat asthma.

New treatments target specific inflammatory cells

most A recent study The focus of asthma research is to identify subtypes of asthma patients based on different inflammation patterns. These studies have led to the development of new therapies that specifically target specific types of inflammatory cells and their products. These therapies are very specific and are not suitable for all asthma patients. They can sometimes cause severe and even life-threatening allergic reactions. The updated guidelines provide general guidance on when this new approach can be incorporated into a patient’s asthma management strategy. However, since this field is still new, this guideline does not provide specific recommendations on these drugs.

The new guidelines also cover the safe use of leukotriene inhibitors, zileuton (Zyflo) and montelukast (Singulair). These are effective asthma treatments, but they can sometimes cause serious side effects. In particular, montelukast is associated with depression. The FDA recently added a warning about this issue to this drug. This guideline outlines how to use it safely.

The determination of nitric oxide can be used for the diagnosis of asthma

The update also provides guidelines for the use of new technologies to diagnose asthma. The cellular activity that causes airway inflammation in asthmatics produces a by-product called nitric oxide, which is exhaled with the person’s breathing. Reliable measurements of exhaled nitric oxide are widely available, and the new asthma guidelines explain how to incorporate these measurements into the diagnosis of asthma.


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