1. Introduction to Asthma
Brief definition
“Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. In susceptible individuals, this inflammation causes recurrent episodes of coughing (particularly at night or early in the morning), wheezing, breathlessness, and chest tightness. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment.”- EPR3/4
“Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation.”- GINA
Guidelines for asthma care
There are national and global guidelines available for asthma. The two most widely accepted are reviewed and summarized in this reference guide.
National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC) Expert Panel Report (EPR). These reports are produced by expert panels on an as needed basis and update recommendations on asthma care and management. The EPR1 published in 1991, EPR2 was published in 1997, and EPR3 produced in 2007. The EPR4 are working group most recently published their report in 2020 updating 6 priority topics. It is a published report from a committee functioning under the United State’s National Heart Lung and Blood Institute. In this reference guide, we will mainly focus on the differences between the EPR3 and EPR4.
Global Initiative for Asthma (GINA) Report: The GINA report is published annually and is used globally with many different countries using it as their national reference.
A table is provided to compare major similarities and differences between the EPR3, EPR4, and GINA 2020.
EPR3 (2007) | EPR4 (2020) | GINA (2020) | |
---|---|---|---|
Goals of guideline |
To provide quality care to those with asthma
|
Appropriate diagnosis, management of asthma, improving outcomes for individuals with asthma, reducing morbidity, mortality and improving quality of life. Goal: Updating EPR3 with data on 6 priority topics |
Does not consider themselves a guideline but rather an “integrated evidence-based strategy focusing on translation into clinical practice” Goal: to prevent deaths, exacerbations, symptom control. Information is targeted towards PCPs |
Step therapy |
Refer to Steps Diagram for differences and comparisons between different guidelines/reports for recommendations on pharmacotherapy for asthma based on severity and on follow up visits. We have elected to keep all 6 steps as per EPR and embedded recommendations from GINA within 6 steps. |
||
Age groups: 0-4 years of age 5-11 years of age >12 years of age
6 total steps for all age groups |
Same as EPR 3 |
Age groups: 0-5 years of age 6-11 years of age >12 years of age
4 steps for 0-5 years old 5 steps for 6-11 years old 5 steps for >12 years old |
|
Inhaled Corticosteroid (ICS) Highlights of recommendation changes, for full comparison refer to steps diagram. |
0-4 years of age:
>12 years of age:
|
0-4 years of age:
> 4 + years of age:
>12+ years of age:
|
ICS is preferred daily controller should be considered at any age from Step 2 onward At age 6 onward, addition of ICS whenever SABA is taken as an alternative therapy in Step 1 and step 2 Emphasis on low, medium, and high dose ICS varying with age. (Please see ICS dosing charts)
|
- Asthma Reference Guide Home
- 1. Introduction to Asthma
- 2. Asthma Diagnosis
- 3. Asthma Presentation
- 4. Goals of Asthma Therapy and Management
- 5. Asthma Severity and Asthma Control
- 6. Asthma Outpatient Management
- 7. Treating Modifiable Risk Factors
- 8. Treating Co-Morbid Conditions
- 9. Asthma Medications
- 10. Yellow Zone Therapy Options
- 11. Allergy Immunotherapy and Biologic Therapy
- 12. Asthma Exacerbations in the Emergency Department or Urgent Care
- 13. Special Asthma Considerations for Inpatient
- 14. Asthma Management in the PICU
- 15. Respiratory Support for Asthma Exacerbation
- 16. Asthma Education Resources