New asthma guidelines urge daily control

Breathing easier without limiting activities is the goal of new government guidelines that urge more attention to asthma sufferers' day-to-day symptoms, not just their severe attacks.

Some 22 million Americans have asthma, and guidelines updated Wednesday by the National Institutes of Health stress the importance of adjusting therapy until their asthma is under good control.

"Asthma control is achievable for nearly every patient," said Dr. Elizabeth Nabel, director of NIH's National Heart, Lung and Blood Institute. "Patients really should accept nothing less."

The guidelines reflect a shift already under way, as specialists seek to teach patients that a flare-up isn't the only sign of trouble. Someone who only avoids an attack by giving up exercise, or who thinks it's normal to wake up at night coughing or wheeze while running, doesn't have asthma well-controlled.

And the recommendations come at a key time: Asthma hospitalizations peak in September and October, said Dr. Homer Boushey of the University of California, San Francisco, a guideline co-author. Patients aren't as good at taking asthma-prevention medication during the summer and can be caught by surprise when schoolchildren start bringing home fall viruses.

Asthma is a chronic lung disease caused by inflammation inside airways that in turn makes them super-sensitive, narrowing in response to irritants that wouldn't bother a healthy lung. Symptoms include wheezing, coughing, chest tightness and difficulty breathing.

There is no cure, but daily medications are very effective at reducing inflammation and preventing flareups. Yet asthma kills about 4,000 people a year and causes almost half a million hospitalizations.

The guidelines are aimed at doctors, but include some patient-friendly advice:

_Give your doctor details about day-to-day symptoms and whether you've adjusted activities to avoid wheezing, to help him or her monitor both current impairment and future risk of a severe attack.

_Every patient needs a written "action plan" with instructions for daily treatment and what to do is asthma worsens. Share that action plan with teachers and coaches.

_Inhaled corticosteroids are the foundation of preventive treatment for all ages. Patients also need inhaled rescue medication. To ensure patients know how to use each, practice with "dummy" inhalers in the doctor's office.

_Children ages 5 to 11 usually do very well on low doses of a single drug, the inhaled corticosteroid, instead of the combination treatments required by many adults. There are a variety of additional medications for more severe asthma, all with side effects to consider in picking the right cocktail.