US guidelines on asthma treatment updated first time for 10 years

“Asthma is one of the most common health problems in the United States - and it can significantly affect patients' lives - at school, at work, at play, and at home,” said National Heart, Lung, and Blood Institute (NHLBI) Director Elizabeth G. Nabel, M.D. “It is essential that asthma patients benefit from the best available scientific evidence, and these guidelines bring such evidence to clinical practice.”

More than 22 million people in the United States have asthma, including 6.5 million children under age 18, according to the Centers for Disease Control and Prevention (CDC). Without appropriate treatment, asthma can significantly limit individuals' activities and result in asthma exacerbations, which can lead to hospitalization and even death. The CDC estimates that 4,000 Americans die from asthma exacerbations each year. (cf UK - 1,400)

In-hospital asthma mortality was reported in 2006 to be 0.5% (99% confidence interval [CI], 0.4–0.6), with mean hospital stay of 2.7 d (99% CI, 2.6–2.8 d) and $9,078 (99% CI, US$8,300–9,855) in hospital charges. Deaths in this population accounted for about one-third of all asthma deaths reported in the United States

The National Asthma Education and Prevention Program (NAEPP) was established in March 1989 to reduce asthma-related illness and death and to enhance the quality of life of people with asthma. The NAEPP also coordinates federal asthma-related activities, as designated by Congress through the Children’s Health Act of 2000.

The NAEPP , through the NIH issued the first revision in 10 years of their updated guidelines for the treatment of asthma.(Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma - Full Report, 2007)

The revised guidelines, reaffirm that "inhaled corticosteroids are the most effective long-term control medication across all age groups."

The NIH panel that updated the guidelines said there is "even stronger evidence" that inhaled corticosteroids, such as GlaxoSmithKline's Flovent and AstraZeneca's Pulmicort, "are generally safe and are the most effective medication at reducing inflammation" in all age groups.

It is noted that low doses of these treatments are particularly effective in paediatric patients aged 5-11s. This age group was previously classified under guidelines for the treatment of adults but is now grouped alone based on new evidence that children may "respond differently" than older patients to asthma therapies.

The experts added that therapies including AstraZeneca's Symbicort and GlaxoSmithKline's Advair, which combine corticosteroids and long-acting beta agonists, may not be needed for patients aged less than 12 years. ", based on their success in being treated with just inhaled corticosteroids.

For older patients they point out that long-acting beta agonists, such as GlaxoSmithKline's Serevent and Novartis' Foradil, should only be used in patients 12 years and older whose asthma is not controlled by corticosteroids.

Drugs other than the standard corticosteroids should only be used as needed and discontinued as soon as possible.

The report also highlighted new recommendations for treatment options such as Genentech's and Novartis' Xolair (omalizumab) for severe asthma; leukotriene receptor antagonists and cromolyn for long-term control; and albuterol, levalbuterol and corticosteroids for acute exacerbations.

Public information on asthma from NIH is available here , Washington Post article Scientific American

Asthma in the UK

In 2004 Asthma UK stated that 5.2 million people in the UK were receiving treatment for asthma of which 2.6 million exhibit severe symptoms. 1.1 million children are currently being treated which is approximatel 1 in 10 children.

There were just under 1,400 deaths (1,381) from asthma in the UK in 2004 (40 were children aged 14 years or under). Asthma costs the NHS an average of £889 million per year and te annual cost of hospital treatment for asthma per child under 5 years of age is almost six times greater (£198) than for a child aged 5–15 years (£34). Over 12.7 million working days are lost to asthma each year.

There is currently no cure for asthma.