NIH Asthma Guidelines and Prevention
- Wednesday, July 29, 2009, 22:27
- Asthma
- 554 views
Andrew:
We talked earlier about National Institutes of Health (NIH) guidelines that I guess came out last year, after a lot of work, by yourself and other leaders in the asthma field. Why were these guidelines necessary, and how well are they understood?
Dr. Shapiro:
The National Heart, Lung and Blood Institute is a major branch of the NIH. This branch has done work like cholesterol screening work and high blood pressure programs. It became apparent in the last couple of decades that the epidemic in asthma needed the same sort of attention as the problems of blood pressure and cholesterol. So groups of experts were brought together to have an evidence-based approach, something that the experts could really believe in, to pass on to physicians who do primary care and to patient advocate groups, so that the message would be spread through the community–the medical and the lay community–about the best treatment of asthma. The first guidelines for asthma were actually [written] in 1991, and then they were revised in 1997. And I think they really have raised the level of care. Whether or not you’ve actually read the guidelines, your doctor probably has gone to a talk about the guidelines, or talked to other doctors about how they’re treating asthma. And there’s a trickle-down effect, so if you haven’t read it, you’ve still heard about it one way or another. And the idea of inflammation and hitting inflammation has really spread somewhat, because of these guidelines.
Andrew:
So you’ve mentioned the use, particularly, of inhaled corticosteroids before an asthma attack.
Dr. Shapiro:
Protecting therapy is so important, and these very safe medications are available.
Andrew:
If someone goes to a doctor and feels that NIH guidelines for preventive care may not be addressed, would you suggest that it may be time to seek more specialized care?
Dr. Shapiro:
Or at least ask, “I’ve heard that I can take preventative medication. I think I’m at the stage where I really should do that, because I’m worried about this airway remodeling problem.” That may make the doctor aware that you are interested and it’s time for a conversation.
Andrew:
I’ve heard the term, “airway remodeling” in learning about asthma. And I understand that is a bad kind of remodeling, permanent damage that can happen to your respiratory system if asthma goes unchecked. Is that correct?
Dr. Shapiro:
Yes, it’s an interesting concept that’s receiving a lot of attention by the medical community now. It seems that the reason to try to get good control of asthma isn’t just for day-to-day quality of life, which of course is very important. It’s also because if you leave the lungs in a state of inflammation and just put up with it or just use the bronchodilator alone, there’s a reasonable chance that you may have scarring and thickening in the walls of the airway that may never get back to normal. So if you really want to promote your chances of growing out of the disease or halting the progression of the disease, then you need to have anti-inflammatory therapy early on to prevent this sort of negative remodeling into a scar tissue sort of situation.
Andrew:
So what you know now in your study of asthma is that getting it under control both improves quality of life and prevents a more severe condition later on.
Dr. Shapiro:
There is some good evidence to support that. And there’s a feeling that the progression of asthma can be stopped by early use of anti-inflammatory agents like the inhaled corticosteroids. This information is from several studies, in a couple of thousand people who have been looked at critically. The evidence is very interesting.
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