Journal of Allergy and Clinical Immunology
Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma–Summary Report 2007
Introduction
More than 22 million Americans have asthma, and it is one of the most common chronic diseases of childhood, affecting an estimated 6 million children. The burden of asthma affects the patients, their families, and society in terms of lost work and school, lessened quality of life, and avoidable emergency department (ED) visits, hospitalizations, and deaths. Improved scientific understanding of asthma has led to significant improvements in asthma care, and the National Asthma Education and Prevention Program (NAEPP) has been dedicated to translating these research findings into clinical practice through publication and dissemination of clinical practice guidelines. The first NAEPP guidelines were published in 1991, and updates were made in 1997, 2002, and now with the current report. Important gains have been made in reducing morbidity and mortality rates caused by asthma; however, challenges remain. The NAEPP hopes that the Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma–Full Report 2007 will support the efforts of those who already incorporate best practices and will help enlist even greater numbers of primary care clinicians, asthma specialists, health care systems and providers, and communities to join together in making quality asthma care available to all people who have asthma. The goal, simply stated, is to help people with asthma control their asthma so that they can be active all day and sleep well at night.
EPR-3 Summary Report 2007 is a summary of the key recommendations in EPR-3 Full Report 2007. EPR-3 Summary Report 2007 does not include selected references for these recommendations. Rather, EPR-3 Full Report 2007 is considered the resource document, and it contains references and full discussion of the rationale for the recommendations. Accompanying EPR-3 Full Report 2007 are Evidence Tables on topics selected by the expert panel. Both EPR-3 Full Report 2007 and Evidence Tables are available at http://www.nhlbi.nih.gov/guidelines/asthma/index.htm. Detailed recommendations, the levels of scientific evidence on which they are based, citations from the published scientific literature, discussion of the Expert Panel's rationale for the recommendations, and description of methods used to develop the report are included in that resource document. Because EPR-3 Full Report 2007 is an update of previous NAEPP guidelines, highlights of major changes in the update are presented here, and Fig 1 presents a summary of recommended key clinical activities.
Section snippets
Definition and pathophysiology
Asthma is a complex disorder characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation. The interaction of these features determines the clinical manifestations and severity of asthma (Fig 2) and the response to treatment. The working definition of asthma is as follows:
Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role: in particular, mast cells, eosinophils,
Diagnosis of asthma
To establish a diagnosis of asthma, the clinician should determine that:
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Episodic symptoms of airflow obstruction or airway hyperresponsiveness are present.
The presence of multiple key indicators increases the probability of asthma, but spirometry is needed to establish a diagnosis. • Wheezing—high-pitched whistling sounds when breathing out—especially in children. A lack of wheezing and a normal chest examination do not exclude asthma. •
Managing asthma long-term
Reduce impairment • Prevent chronic and troublesome symptoms (eg, coughing or breathlessness in the daytime, in the night, or after exertion). • Require infrequent use (≤2 days a week) of inhaled SABA for quick relief of symptoms (not including prevention of exercise-induced bronchospasm [EIB]). • Maintain (near) normal pulmonary function. • Maintain normal activity levels (including exercise and other physical activity and attendance at school or work). • Meet patients'
Managing exacerbations
Asthma exacerbations are acute or subacute episodes of progressively worsening shortness of breath, cough, wheezing, and chest tightness, or some combination of these symptoms. Exacerbations are characterized by decreases in expiratory airflow; objective measures of lung function (spirometry or PEF) are more reliable indicators of severity than symptoms are. Individuals whose asthma is well controlled with ICSs have decreased risk of exacerbations. However, these patients can still be
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