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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Asthma Management Strategies: An Evaluation of Current and Future Developments


GOAL
To provide primary care physicians, pediatricians, pulmonologists, and allergists with up-to-date information on the management of asthma.

TARGET AUDIENCE
This activity is designed for primary care physicians, pediatricians, pulmonologists, and allergists. No prerequisites required.

LEARNING OBJECTIVES
At the conclusion of this activity, the participant should be able to:

  • Understand the basics of asthma epidemiology and pathophysiology.
  • Appreciate the wide-ranging impacts of asthma on patient health and quality of life.
  • Describe the stepwise approach for diagnosing and managing adults and children with asthma as outlined in the most recent National Asthma Education and Prevention Program (NAEPP) Guidelines.
  • Acknowledge the gap between guideline-driven asthma care and actual asthma care.
  • Identify the main causes of the treatment gap, such as need for patient education, financial barriers and fragmented care coordination, lack of provider education/incentives for adhering to guidelines, difficulty in determining asthma severity, and concern about treatment side effects in children.
  • Gauge the practical impacts of new asthma programs, such as Asthma Action Plans, updated NAEPP guidelines, and HEDIS standards.
  • Evaluate the potential roles of new and emerging asthma policies, diagnostics, or therapies, including implementation of adherence standards, identification of new risk/prognostic factors, combination agents, new formulations of inhaled cortico-steroids, antibody approaches, novel vaccines, and cytokine antagonists.

The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The estimated time to complete this educational activity: 2 hours.

After reading this monograph, participants may receive credit by completing the CME test, evaluation, and receiving a score of 70% or higher.

Release date: March15, 2008. Expiration date: March15, 2010.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an educational grant from sanofi-aventis U.S.

Full Disclosure Policy Affecting CME Activities
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a provider has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following:

PROGRAM DIRECTOR

Peter S. Creticos, MD
Associate Professor of Medicine
Clinical Director, Division of Allergy and Clinical Immunology
The Johns Hopkins University School of Medicine
Medical Director, Asthma and Allergy Diseases
The Johns Hopkins Asthma and Allergy Center
Baltimore, Maryland
Dr Creticos reports receiving grants/research support from Genentech and Schering-Plough; serving as a consultant for AstraZeneca, Genentech, GlaxoSmithKline, Novartis, Schering-Plough, and Teva; and receiving honoraria from AstraZeneca, GlaxoSmithKline, Merck and Company, and Novartis.

PARTICIPATING FACULTY

Erwin W. Gelfand, MD
Chairman, Department of Pediatrics
National Jewish Medical and Research Center
Denver, Colorado
Dr Gelfand reports receiving grants/research support from Altana and Novartis; serving as a consultant for Merck and Company, Novartis, Schering-Plough, and Teva; and receiving honoraria from Merck and Company, Novartis, Schering-Plough, and Teva.

Harold S. Nelson, MD
Professor of Medicine
National Jewish Medical Center and Research
Denver, Colorado
Dr Nelson reports having no financial or advisory relationships with corporate organizations related to this activity.

Roopen R. Patel, MD
Chief Allergy Fellow
Northwestern Memorial Hospital
Chicago, Illinois
Dr Patel reports having no financial or advisory relationships with corporate organizations related to this activity.

Robert P. Schleimer, PhD
The Roy and Elaine Patterson Professor
Chief, Allergy-Immunology
Northwestern Feinberg School of Medicine
Chicago, Illinois
Dr Schleimer reports receiving grants/research support from Centocor and GlaxoSmithKline; serving as a consultant for AstraZeneca, Aventis, GlaxoSmithKline, Schering-Plough, and Wyeth; and receiving honoraria from Altana, Amgen, and Wyeth.

Notice: All faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

Johns Hopkins Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Johns Hopkins Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Asthma Management Strategies: An Evaluation of Current and Future Developments
Peter S. Creticos, MD*

More than 22 million people in the United States have asthma,1 a chronic disease that causes narrowing of the airways and impairs the ability to breathe. Untreated or inadequately treated, asthma can impede patients' normal daily activities and puts patients at risk of potentially life-threatening asthma exacerbations. Until a means of primary prevention of asthma is a reality, asthma control is achieved through adherence to medical regimens and reduction of exposure to causes of asthma exacerbations. Significant progress in the management of asthma has been realized in the United States and other countries in the past decade. For example, deaths due to asthma have decreased and hospitalization rates for asthma have stabilized during the past 10 years.1,2 These developments are attributed in part to increasing adoption of evidence-based guidelines for asthma care and to judicious use of asthma pharmacotherapy. Although some progress has been made, asthma remains uncontrolled for many patients as suggested by the approximately 497 000 hospitalizations per year for asthma in the United States.2 This issue of Johns Hopkins Advanced Studies in Medicine discusses asthma in the United States today and highlights exciting current and future developments that will assist healthcare providers in continuing to improve the quality of care for their patients with asthma.

Erwin W. Gelfand, MD, discusses the burden of asthma in his article. Dr Gelfand notes that the prevalence of asthma continues to increase such that it now affects approximately 8% of the US population. Asthma is associated with significant economic burden to both the employer and the healthcare system. Together, the annual direct and indirect costs of asthma are estimated at $14 billion in the United States. Dr Gelfand describes data showing that asthma disproportionately affects children, who may be particularly vulnerable to the adverse asthma effects on emotional, intellectual, and physical development. He concludes that increasing asthma-associated morbidity, quality-of-life impairment, and healthcare costs demonstrate that asthma care is not optimized for many patients. He suggests that improved adherence to national guidelines for asthma care can contribute significantly to reducing the humanistic and economic burdens of asthma.

The guidelines by the National Asthma Education and Prevention Program (NAEPP) for the diagnosis and management of asthma were developed in 1991 to help improve asthma care, decrease asthma-associated morbidity and mortality, and reduce the economic and societal burdens of asthma. In August 2007, the NAEPP issued the first comprehensive update of the clinical guidelines for the diagnosis and treatment of asthma in a decade. Harold S. Nelson, MD, reviews the NAEPP asthma guidelines and highlights elements of the guidelines that have changed from previous versions. The 2007 guidelines include new material on monitoring asthma, in addition to new information on aspects of asthma management (controlling environmental triggers, educating patients, and selecting pharmacotherapy) with special sections on treating childhood asthma.

Pharmacotherapy is a mainstay of asthma management, and inhaled corticosteroids remain the cornerstone of asthma therapy in the 2007 NAEPP guidelines. In their paper, Roopen R. Patel, MD, and Robert P. Schleimer, PhD, discuss the continuing role of inhaled corticosteroids as potent anti-inflammatory agents in the management of asthma. They also discuss novel anti-inflammatory targets for investigational asthma medications and review findings on new and emerging therapies, including immunomodulators, cytokine antagonists, and vaccines. They conclude that the future of asthma treatment may involve combination therapy targeting multiple mechanisms for maximum benefit and therapy individualized based on genotype.

Some of the information discussed in the 3 articles in this issue of Johns Hopkins Advanced Studies in Medicine is reinfored in a practical manner in 3 case studies that highlight challenges in asthma care. Issues discussed in the 3 articles are also expanded in a clinician interview that appears in this monograph. The authors hope that healthcare providers find the information in this monograph useful in improving the quality of care for patients with asthma.

REFERENCES
1. National Asthma Education and Prevention Program. Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health; 2007. NIH publication 07-4051.
2. National Health Interview Survey (NHIS 2005). Hyattsville, MD: National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention; 2005. Available at: http://www.cdc.gov/nchs/about/major/nhis/reports_2005.htm. Accessed January 9, 2008.

*Associate Professor of Medicine, Clinical Director, Division of Allergy and Clinical Immunology, The Johns Hopkins University School of Medicine, Medical Director, Asthma and Allergy Diseases, The Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland.
Address correspondence to: Peter S. Creticos, MD, Associate Professor of Medicine, Clinical Director, Division of Allergy and Clinical Immunology, The Johns Hopkins University School of Medicine, Medical Director, Asthma and Allergy Diseases, The Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, 2B 71, Baltimore, MD 21224. E-mail: pcretic@jhmi.edu.

 The content in this monograph was developed with the assistance of a medical writer. Each author had his/her final approval of his article and all its contents.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.