Treatment for any disease should be aimed at whatever outcomes are judged achievable for that particular illness. Some diseases, such as infections, can be cured. However, asthma has no cure. But the good news is that no one has to suffer asthma symptoms on a daily basis. Complete asthma control is a realistic goal for almost everyone who has asthma. People with asthma can live a life without limits.
National Institutes of Health & Asthma Goals
The National Institutes of Health (NIH for short) is a U.S. based governmental agency dedicated to the study and treatment of various diseases. The NIH has many different subunits devoted to specific subcategories of disease. The National Heart, Lung, and Blood Institute, or NHLBI for short, provides research, education and support for a number of heart and respiratory diseases, including asthma.
NHLBI, along with the National Asthma Education Program, another arm of the NIH, have developed a comprehensive guideline document that helps doctors and other health care workers know how to approach the treatment of asthma in all age groups.
The Asthma Treatment Guidelines look at how common asthma is across different populations, as well as various risk factors for asthma. They also cover various methods for diagnosing asthma in both adults and children. And then finally they lay out a step by step approach to treating asthma that is based on the severity of the disease and the symptoms you are having.
But, most importantly, the NHLBI guidelines help your doctor know whether treatment is working effectively. The guidelines talk about assessing and monitoring asthma in terms of 3 factors:
- Severity
- Control
- Responsiveness
Severity refers to the intensity of the disease and its symptoms. Responsiveness is how well control can be achieved through therapy. Control is defined as "the degree to which the manifestations of asthma (symptoms, functional impairments, and risks of untoward events) are minimized and the goals of therapy are met."
Both severity and control are dependent on the current degree of impairment the person with asthma is experiencing. They also will affect the person's future risk for asthma symptoms, asthma attacks, and damage to the airways. In short, the level of asthma control guides all future decisions on maintaining asthma treatment or if it needs to be adjusted.
Ultimately, the NHLBI guidelines emphasize that the goals of asthma treatment are to achieve maximum asthma control with the least amount of asthma medicine.
GINA & Asthma Control
Asthma is a global disease now, which means it can be found in many nations throughout the world. In fact, the numbers of asthma sufferers has increased so quickly in recent decades that representatives of health organizations around the world banded together to form the Global Initiative for Asthma. Like the NHLBI, GINA is focused on asthma education, asthma research and developing asthma treatment standards.
In 2006, GINA revamped its asthma treatment guidelines. One of the most central changes was a new emphasis on classifying asthma in terms of control, rather than severity. They also stressed that asthma management should be based not only on severity, but also on your response to treatment. When NHLBI revamped their guidelines at the end of 2007, they followed the same path GINA had a year earlier, as noted above.
Other key points in the GINA guidelines having to do with control include:
- Treatment should be adjusted in a continuous cycle depending on the patient’s level of control:
- Assessing asthma control
- Treating to achieve control
- Monitoring to maintain control
- Treatment should be stepped up when control is lost then brought back down when control is achieved. (Step-wise approach to treatment)
- Measurement of airway variability is key to both asthma diagnosis and the assessment of asthma control.
- Although most people with asthma should be able to reach and maintain asthma control, some patients with difficult-to-treat asthma may be unable to achieve the same level of control.
What Is Asthma Control?
Most experts would agree that you can measure asthma control by the severity and frequency of your asthma symptoms. When asthma is completely controlled, you never have symptoms such as coughing, wheezing, chest tightness, or shortness of breath. In addition, peak flow readings will be in your personal best – or healthy – range.
How to Tell If You Have Asthma Control
When asthma control begins to slip, asthma symptoms begin to crop up when you are exposed to asthma triggers, even if you are taking your asthma medication. You may need to use your quick-relief inhaler. As long as this is happening less than twice a week, then asthma can still be considered to be under adequate (though maybe not top notch) control.
But when you start to have more severe symptoms, or they occur more often, requiring you to use your quick-relief inhaler and / or progressing into full-blown asthma attacks, then asthma is no longer in control. As a general rule, if you need to use your rescue inhaler more than twice a week, asthma is not in control.
When asthma is under control, the following will all be true:
- You are able to take part fully in work and school, as well as being active and exercising.
- You seldom have asthma symptoms such as coughing, wheezing, chest tightness, or shortness of breath. If you do have them, they are mild or short-lived.
- You can sleep through each night without having asthma symptoms wake you up.
- You do not need to seek emergency care at your local emergency room or make unscheduled doctor's office visits because of asthma attacks.
- Peak flow readings reveal normal or near-normal airway function.
- You are having few to no side effects from asthma medicines.
