AAAAI, ACAAI recommend continual assessment of asthma control


Early Release article from the Journal of Allergy & Clinical Immunology

Asthma should be assessed each time a patient sees his or her physician, to determine whether the asthma is well controlled or not well controlled, according to a new practice parameter. Attaining Optimal Asthma Control: A Practice Parameter is featured in the November 2005 issue of the Journal of Allergy & Clinical Immunology (JACI) and is currently available on the JACI's Web site at The JACI is the peer-reviewed, scientific journal of the American Academy of Allergy, Asthma & Immunology (AAAAI).

The recommendations in the practice parameter build upon the guidelines for the diagnosis and management of asthma developed by the National Heart, Lung, and Blood Institute (NHLBI). Because asthma symptoms change over time, asthma needs to constantly be monitored by a physician or other health care professional to make sure the patient has control over his or her 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."

The NHLBI guidelines include measuring asthma to develop a baseline classification of asthma severity before treatment begins. The new practice parameter recommends making asthma management decisions on an ongoing basis to determine the patient's level of control over asthma.

"Asthma is not a static disease, and each patient reacts differently to medication, their environment, triggers and changing allergens that affect their asthma symptoms," Li said. "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."

Attaining Optimal Asthma Control: A Practice Parameter recommends:

  • Asthma control should be assessed at every clinic or physician visit.
  • Asthma management needs to be individualized since each patient reacts differently to medication.
  • Asthma control demands a close relationship between the doctor and patient.
  • Asthma management decisions should be driven by the level of asthma control. If asthma is completely or well-controlled, patients may be able to step-down therapy and take less medicine. Uncontrolled asthma requires a step-up in therapy, which may consist of increased medication use and more frequent visit 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. Complete asthma control is defined 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
  • Normal lung function

Asthma affects approximately 20 million Americans, and is responsible for nearly 5,000 deaths a year. In addition, there are nearly 2 million asthma-related visits to the emergency department each year due. To help gain well or complete asthma control, the American Academy of Allergy, Asthma & Immunology (AAAAI) recommends working with an asthma specialist, such as an allergist/immunologist, who is the best qualified medical professional trained to manage the prevention, diagnosis and treatment of allergies and asthma.

Studies have shown that patients with asthma under the care of an allergist/immunologist were significantly less likely to require treatment in an emergency room due to their asthma. Allergy specialty care also reduces hospitalizations, improves quality of life and reduces healthcare costs.

Attaining Optimal Asthma Control: A Practice Parameter, was developed by the Joint Task Force on Practice Parameters for Allergy & Immunology, a joint coalition of the American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma & Immunology's (ACAAI).

Source: Eurekalert & others

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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