Overview of changes to asthma guidelines: diagnosis and screening

The Expert Panel Report 3 of the National Asthma Education and Prevention Program represents a major advance in the approach to asthma care by emphasizing the monitoring of clinically relevant aspects of care and the importance of planned primary care, and by providing patients practical tools for self-management. Treatment of asthma should be guided by a new system of classification that assesses severity at initial evaluation and control at all subsequent visits. Asthma severity is determined by current impairment (as evidenced by impact on day-to-day activities) and risk of future exacerbations (as evidenced by frequency of oral systemic corticosteroid use), and allows categorization of disease as intermittent, persistent-mild, persistent-moderate, and persistent-severe. Initial treatment is guided by the disease-severity category. The degree of control is also determined by the analysis of current impairment and future risk. Validated questionnaires can be used for following the impairment domain of control with patients whose asthma is categorized as "well controlled," "not well controlled," and "very poorly controlled." Decisions about medication adjustment and planned follow-up are based on the category of disease control. Whereas a stepwise approach for asthma management continues to be recommended, the number of possible steps has increased.