Key Point

In a new practice parameter, the Joint Task Force on Practice Parameters emphasizes that the level of asthma control should guide asthma therapy.

ROCHESTER, MINN—To refine and improve asthma care, the Joint Task Force on Practice Parameters has released a practice parameter addressing that topic.¹ "We stressed the importance of individualized care based on the level of asthma control rather than on asthma severity," said James T. Li, MD, a member of the Joint Task Force and Chair of the Division of Allergic Diseases at the Mayo Clinic in Rochester, Minnesota.

The new parameter, an update of a 1998 document, contains 11 summary statements graded A through D, according to the strength of the evidence supporting them.

Statement 1. Asthma symptoms do not always correlate with asthma severity. There are limitations to classifying asthma severity in patients already being treated (grade: B).

Statement 2. Management based on asthma control encompasses the principles of chronic disease management (grade: B).

Statement 3. Asthma control should be assessed at every clinical encounter for asthma, and management decisions should be based on the level of asthma control (grade: B).

Statement 4. Asthma control is based on symptoms, sleep disturbance, use of rescue medication, activity limitations, overall assessment, and lung function (grade: A).

Statement 5. Asthma should be considered well controlled if symptoms occur and rescue bronchodilator is used no more than twice a week; there are no nocturnal or early-morning symptoms; no limitations on work, school, or exercise; and the patient and physician deem the disease well controlled (grade: B).

Statement 6. Total asthma control can be defined as the absence of symptoms; no rescue bronchodilator use; no nighttime or early morning symptoms or limitations on exercise, work, or school; and a normal or personal best peak expiratory flow or FEV¹ (grade: A).

Statement 7. In addition to asthma control, several other important variables should be assessed during visits for asthma, including psychosocial status, adherence/compliance, medication use and side effects, and asthma triggers. Also, the asthma diagnosis should be confirmed and the written action plan should be reviewed as appropriate (grade: B).

Statement 8. A patient’s asthma control for a specific clinical encounter should be classified as well controlled or not well controlled (grade: B).

Statement 9. A detailed assessment of asthma should be conducted for patients whose asthma is not controlled (grade: B).

Statement 10. The step care of asthma should be based on asthma control (grade: A). Drug therapy is divided into four steps, each corresponding to a specific level of asthma severity—mild intermittent, mild persistent, moderate persistent, and severe persistent.

Statement 11. Asthma management that is driven by level of asthma control demands a close partnership between physician and patient (grade: B).

"A team approach and a physician-patient partnership have always been important elements of asthma guidelines," Dr. Li said. "But now they are absolutely essential."

—Timothy Begany

Reference
1. Li JT, Oppenheimer J, Bernstein IL, et al. Attaining optimal asthma control: a practice parameter. J Allergy Clin Immunol. 2005;116:S3-S11.

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