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


Advances in Asthma Management


GOAL
To provide physicians with current information on new advances in the management and treatment of asthma.

TARGET AUDIENCE
This activity is designed for pulmonologists, allergists, immunologists, and primary care physicians who treat patients with asthma.

LEARNING OBJECTIVES
After reading this issue, the participant should be able to:

  • Describe the state of asthma care in the United States with reference to the National Heart, Lung, and Blood Institute (NHLBI) goals for asthma therapy.
  • Identify the best means for monitoring and preventing asthma exacerbations and its importance in reducing asthma-associated morbidity and mortality.
  • Demonstrate understanding of the newest clinical data on dual-controller therapy, an NHLBI-recommended strategy for controlling moderate persistent and severe persistent asthma.

DESIGNATION STATEMENT
This activity has been planned and produced in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education. The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The Johns Hopkins School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this continuing medical education activity for a maximum of 1 hour in Category 1 credit toward the American Medical Association Physicians' Recognition Award. Each physician should claim only those hours of credit that are actually spent on the educational activity. Credits are available until the expiration date of January 31, 2004.

This continuing education activity was produced under the supervision of Peter S. Creticos, MD, Associate Professor of Medicine, Johns Hopkins University School of Medicine; Clinical Director, Division of Allergy and Clinical Immunology; and Medical Director, Asthma and Allergy Diseases, Johns Hopkins Asthma and Allergy Center.

This program is supported by an unrestricted educational grant from GlaxoSmithKline.

Publisher's Note and Disclaimer: The opinions expressed in this issue are those of the authors, presenters, and/or panelists and are not attributable to the publisher, editor, advisory board of Advanced Studies in Medicine, or The Johns Hopkins University School of Medicine or its Office of Continuing Medical Education. Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this issue are not necessarily the same as indicated in the package insert for the product and may reflect the clinical experience of the authors, presenters, and/or panelists or may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.

Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, LLC, an HMG Company. P.O. Box 340, Somerville, NJ 08876. (908) 253-9001. Web site: www.galenpublishing.com. Copyright ©2001 by Galen Publishing, LLC. 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. Bulk postage paid at Somerville, NJ Post Office and at additional mailing offices. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC. Printed on acid-free paper. BPA Membership applied for December 2000.

CHAIR

    Peter S. Creticos, MD
    Associate Professor of Medicine
    Johns Hopkins University School of Medicine
    Clinical Director, Division of Allergy and Clinical Immunology
    Medical Director, Asthma and Allergy Diseases
    Johns Hopkins Asthma and Allergy Center
    Baltimore, Maryland
    • Dr Creticos reports receiving grant/research support from, serving as a consultant to, and is a member of the speakers' bureau for ALK, Allergenics, Aradigon, Aventis, Astra Zeneca, Dynarax, GlaxoWellcome, Janssen, McNeil, Merck, Pfizer, Pharmacia and Upjohn, Schering-Plough, SmithKlineBeecham, and Stallergens.

PARTICIPATING FACULTY

    William J. Calhoun, MD
    Associate Professor of Medicine
    University of Pittsburgh
    Director, Asthma, Allergy, and Airway Research Center
    Pittsburgh, Pennsylvania
    • Dr Calhoun reports receiving grant/research support from Merck, GlaxoSmithKline, and Sepracor.

    Richard J. Martin, MD
    Professor of Medicine
    University of Colorado Health Sciences Center
    Head, Pulmonary Division
    Vice Chair, Department of Medicine
    National Jewish Medical and Research Center
    Denver, Colorado
    • Dr Martin reports receiving grant/research support from, serving as a consultant to, and receiving honorarium from GlaxoSmithKline, 3M, Aventis, Schering, Forest, Merck, AstraZeneca, Purdue, Novartis, and Immunex.

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

Advances in Asthma Management
Peter S. Creticos, MD*

Knowledge about the pathophysiology of asthma has advanced tremendously over the past decade, and health care providers are better able than ever before to tailor asthma therapy to patients' individual needs and to help patients maintain good lung function, functional ability, and quality of life. Good asthma control is an achievable goal for the vast majority of patients with asthma. This issue of Advanced Studies in Medicine features 3 medical review articles summarizing the most current information on asthma management. These papers were developed to assist health care providers with applying new information about asthma management to clinical practice in order to optimize asthma therapy.

In his article titled, "Management of Asthma in the United States: Where Do We Stand?," Dr William Calhoun considers recent data showing that, despite the advances in knowledge about asthma and the availability of effective therapy, many patients continue to suffer with poorly controlled asthma that impairs their functional ability and quality of life. Furthermore, asthma exacerbations continue to exact a large financial toll on society and the health care system. Using the National Heart, Lung, and Blood Institute (NHLBI) goals of asthma therapy as a yardstick, Dr Calhoun shows that there is significant need for improvement in the educational, practical, and pharmacotherapeutic aspects of asthma management. While these findings are unsettling, the good news is that the shortfalls in asthma care are addressable with changes in patients' and health care providers' behavior and awareness. By understanding the areas of deficiency in asthma care, health care providers may be better equipped to improve it.

One means of improving the state of asthma care is through judicious use of asthma pharmacotherapy. Dr Richard Martin considers this topic in his article, "Dual-Controller Asthma Therapy: Rationale and Clinical Benefits." Dr Martin specifically addresses the use of dual-controller therapy-ie, the concurrent administration of 2 medications with complementary mechanisms of action. Recommended in the 1997 NHLBI guidelines for patients with persistent asthma, dual-controller therapy is 1 of 2 broad treatment strategies for patients whose asthma is inadequately controlled with inhaled corticosteroids, which are long-term controller medications that improve asthma symptoms, normalize lung function, and help to mitigate damage to the airways by virtue of their anti-inflammatory mechanism of action. Among patients whose asthma is inadequately controlled with inhaled corticosteroids, the NHLBI guidelines suggest either increasing the dose of inhaled corticosteroids (ie, remaining on monotherapy) or adding another long-term controller therapy (ie, initiating dual-controller therapy).

Over the past decade, extensive research has accrued regarding the benefits of dual-controller therapy compared with monotherapy with an inhaled corticosteroid. In addition, data regarding the specific therapeutic combinations that provide optimum benefit in dual-controller regimens have become available. Dr Martin discusses both of these datasets to provide a comprehensive overview of the current state of knowledge regarding the dual-controller treatment strategy.

One application of dual-controller therapy is in the prevention and control of asthma exacerbations, a primary goal of asthma management. The appropriate management of mild or moderate exacerbations can prevent the development of uncontrolled asthma, which can be life threatening. Clinic-based health care providers, who see the majority of patients with mild or moderate exacerbations, can play a crucial role in reducing asthma-associated morbidity and mortality by monitoring the occurrence of exacerbations in their patients with asthma and tailoring pharmacotherapy to the severity of disease so that most exacerbations are prevented. In his article, "Best-Practice Strategies for Management of Asthma: Monitoring and Prevention of Asthma Exacerbations," Dr Peter Creticos considers the best means of monitoring and preventing asthma exacerbations in order to reduce asthma-associated morbidity and mortality.

The authors hope that health care providers will find the information in their articles useful in improving the quality of care for patients with asthma. For health care providers seeking to disseminate the information in this publication to others involved in the management of patients with respiratory diseases, a companion slide set with contents mirroring those of the publication articles is available by business-reply card.

*Johns Hopkins University School of Medicine, Division of Allergy and Clinical Immunology, Johns Hopkins Asthma and Allergy Center.





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.