Medical innovation often comes fast, but mainstreaming those discoveries into the clinic can come slowly. When the last federal asthma treatment guidelines were released in 2007, George W. Bush was president and the first iPhone was two months old. For a condition that affects over 24 and a half million Americans — almost 8% of the population– and considering the inroads made with understanding what asthma is and the biologics developed for treating certain types of asthma, that’s arguably a stretch.
This week, new guidelines were released to offer better treatment options for those millions of Americans. Ironically, this report does not include any recommendations on those five biologics that have FDA approval. “Any attempt to include biologic agents in this report at the start of this effort would have delayed the release of these recommendations for another 1 to 2 years,” the report author wrote. This delay “was felt to be unacceptable.”
What is asthma?
According to The National Institutes of Health, asthma is a long-term condition that causes inflammation and narrowing of the airway. This causes difficulty breathing and can occur in any age group. For some people with asthma, symptoms may happen every day. For others, attacks can be rare. Triggers for asthma symptoms can vary from specific air pollutants like dust and dander to something as simple as cold air.
New information has drastically changed the field for asthma specialists. Michelle M. Cloutier, M.D., chair of the National Asthma Education Prevention Program Expert Panel Working Group, noted in a news release that “The last national guidance on asthma care was published 13 years ago, and since then we’ve made substantial progress in understanding how to treat asthma in children and adults.” Chief among these changes is, as the foreward of the report acknowledges, that “asthma is not one disease, but it is a syndrome composed of multiple” subgroups. These subgroups include asthma stemming from an allergy, or no allergy; a sensitivity to aspirin; exercise; an occupational cause; and neutrophilia. Neutrophils are types of immune cells which respond to inflammation. They appear in severe asthma. Generally speaking, neutrophils that do not leave the site of the inflammation can cause damage to nearby tissue.
The process to the new guidelines began with a 2014 report by the Asthma Expert Working Group at the National Heart, Lung, and Blood Advisory Council, with research continuing through 2018. The final guidelines have been designed to provide caregivers and their patients with the tools to address the reality of asthma as a complex, multifaceted range of conditions with no one-size-fits-all solutions.
The Asthma Management Guidelines focus on six core treatments to handle different severities and causes of asthma.
- Inhaled corticosteroids, which are aimed at patients who have persistent issues
- Long-acting antimuscarinic antagonists (LAMAs), which can be used alongside corticosteroids to keep airway muscles relaxed
- Allergy shots, which use a small amount of an allergen to help suppress reactions in patients with allergic asthma
- Reducing the presence if indoor asthma triggers using air purifiers, bedding covers, and pest control
- Enhancing diagnostic measures using techniques such as fractional exhaled nitric oxide tests, which can detect airway inflammation
- Bronchial thermoplasty, which uses heat to shrink the airway muscle that tightens during asthma attacks
The report provides in-depth descriptions and guidance to help caregivers determine the best course of action, as well as advice and information to ease communication with patients.
The take home
The new Asthma Management Guidelines offer caregivers and patients a pathway toward better care, with the tools to provide an improved experience starting at initial diagnosis and continuing throughout the treatment process. If you want to learn more about asthma and other breathing conditions, visit the NIH resource page at “Breathe Better.”
Sean Marsala is a health writer based out of Philadelphia, PA. Passionate about technology, you can usually find him reading, browsing the internet, and exploring virtual worlds.