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


Challenges in Asthma Management: Severity-Based Classification of Patients


GOAL
To provide physicians and managed care professionals with practical information for diagnosing and managing asthma with respect to the National Asthma Education and Prevention Program (NAEPP) guidelines.

TARGET AUDIENCE
This activity is designed for physicians in primary care and respiratory medicine, pharmacy and therapeutic committee members, managed care decision makers, and healthcare policy planners. No prerequisites required.

LEARNING OBJECTIVES
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. At the conclusion of this activity, participants should be able to:

  • Identify the strengths and pitfalls of asthma severity classification.
  • Recognize the variability of asthma severity, especially as it relates to patients with predominantly mild asthma.
  • Describe the various effects of environmental factors on exacerbations in patients with mild asthma.
  • Evaluate existing data on optimizing asthma control.

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

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

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

Release date: May 1, 2003. Expiration date: May 1, 2005.

This program is approved for 2 hours (0.2 CEUs) and is cosponsored by the University of Tennessee College of Pharmacy, which is approved by the American Council on Pharmaceutical Education as a provider of continuing pharmaceutical education. A statement of CE credit will be mailed within 4 weeks of successful completion and evaluation of the program. ACPE Program# 064-999-03-206-H01.

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 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 unrestricted educational grant from GlaxoSmithKline.

Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, a division of Advanced Studies in Medicine, an HMG Company. PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2003 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. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC.

Full Disclosure Policy Affecting CME Activities:
As a sponsor accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of 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 sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Director and Participating Faculty reported the following:

PROGRAM DIRECTOR

    Peter S. Creticos, MD
    Associate Professor of Medicine
    Clinical Director, Division of Allergy and Clinical Immunology
    Johns Hopkins University School of Medicine
    Medical Director, Asthma and Allergy Diseases
    Johns Hopkins Asthma and Allergy Center
    Baltimore, Maryland
    • Dr Creticos reports reports receiving grant and/or research support from, serving as a consultant to, and being a member of the speakers' bureau for ALK; Allergenics; Aradigm; Aventis; AstraZeneca LP; Dynavax; GlaxoSmithKline; Janssen; McNeil; Merck & Co, Inc; Pfizer, Inc; Pharmacia & Upjohn; Schering-Plough; and Stallergenes.

PARTICIPATING FACULTY

    William J. Calhoun, MD
    Associate Professor of Medicine
    Director, Asthma, Allergy, and Airway Research Center
    Division of Pulmonary, Allergy, and Critical Care Medicine
    University of Pittsburgh
    Pittsburgh, Pennsylvania
    • Dr Calhoun reports receiving grants and/or research support from GlaxoSmithKline; Merck & Co, Inc; and Sepracor, Inc.

    Joseph Spahn, MD
    Associate Professor of Pediatrics
    National Jewish Medical and Research Center
    Denver, Colorado
    • Dr Spahn reports receiving grants and/or research support from GlaxoSmithKline and Merck & Co, Inc; serving as a consultant to AstraZeneca LP and GlaxoSmithKline; and receiving honoraria from AstraZeneca LP, GlaxoSmithKline, and Merck & Co, Inc.

Notice:
In accordance with the ACCME Standards for Commercial Support, the audience is advised that one or more articles in this continuing medical education activity may contain reference(s) to unlabeled or unapproved uses of drugs or devices. Faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or products.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. 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.

Challenges in Asthma Management: Severity-Based Classification of Patients
Peter S. Creticos, MD*

In 1991 and 1997, the National Heart, Lung, and Blood Institute's National Asthma Education and Prevention Program (NAEPP) issued guidelines for the diagnosis and management of asthma. An update on selected issues covered in the guidelines was published in 2002. The NAEPP guidelines have improved the standard and consistency of asthma care and have encouraged research into approaches and treatments leading to continuous advancements in the ability to help patients with asthma.

Although the guidelines have stimulated these advances, their application in clinical practice can be challenging. In particular, the recommendation of severity-based stratification of patients as a means of guiding treatment decisions can be problematic when followed without an appreciation of the challenges inherent in this approach. This issue of Advanced Studies in Medicine, which includes a review article, a case study, and a clinician interview, examines the challenges and practical implications of severity-based classification of patients with asthma.

In the NAEPP guidelines, intervention is tailored to patients' asthma severity, which is classified on the basis of lung function tests, symptoms, and functional ability as being mild intermittent, mild persistent, moderate persistent, or severe persistent. In their review, "Challenges in Assessing Asthma Severity in Clinical Practice," Drs Joseph Spahn and William J. Calhoun emphasize that these severity categories, with their corresponding treatment recommendations, are intended to be general guiding principles for therapeutic decision-making and that they need to be interpreted and applied with flexibility. This flexibility is necessary because of the difficulty in accurate determination of asthma severity in clinical practice. Drs Spahn and Calhoun discuss several factors that may impede accurate determination of asthma severity:

  • Severity classification varies according to how it is assessed
  • Asthma is a variable disease
  • Patients underreport asthma symptoms
  • Asthma control and asthma severity are not synonymous
  • Mild asthma and/or normal spirometry do not necessarily translate into the absence of a need for careful monitoring or therapeutic intervention. Patients with mild asthma and/or normal spirometry can be sicker than pulmonary function tests reflect and can benefit from interventions typically reserved for patients in higher severity strata.

In the case study accompanying the review, Dr Spahn describes a case that illustrates how the above factors can complicate asthma assessment in clinical practice. The case illustrates that, while assessing asthma severity in the clinic can be difficult, careful attention to the patient and consideration of a range of measures can help in formulating an accurate assessment of asthma severity. To gain an additional perspective on the practical implications of severity-based stratification of patients with asthma, the Senior Contributing Editor for Advanced Studies in Medicine interviewed Dr Calhoun; excerpts of the interview are published in this issue. Aside from offering insight on assessing asthma severity in clinical practice, Dr Calhoun discusses his views on treatment approaches and recent developments in asthma.

Accurate assessment of asthma severity is critical in optimizing patient care. As Drs Spahn and Calhoun point out, misappraisal of patients' clinical status leads to inappropriate intervention, in which medication is either overprescribed or is underprescribed with a resulting deterioration of asthma control. Healthcare providers can improve their ability to gauge asthma severity in clinical practice by judiciously interpreting and applying the NAEPP guidelines while remaining vigilant about their limitations.

*Associate Professor of Medicine and Clinical Director, Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, and Medical Director, Asthma and Allergy Diseases, Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland.





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.