Implications of the asthma guidelines for the clinician

Abstract

JB is a 19-year-old sophomore at the local university. He is a member of the men’s tennis team and has been experiencing increasing shortness of breath requiring frequent use of his rescue inhaler since the beginning of the tennis season. Additionally, he uses his inhaler daily when walking up a steep hill to his classes and 2 or more times a week when he is awakened from sleep because of coughing. Further questioning reveals that he has received 3 bursts of oral corticosteroids in the past year for exacerbations. His previous physician, though, told him that he has only mild asthma and recommended that he be treated with albuterol on an as-needed basis only. At the time of the initial visit with JB, his spirometry revealed a prebronchodilator FEV1/forced vital capacity ratio of 75% of predicted value and an FEV1 of 76% of predicted value. His Asthma Control Test questionnaire score is 16. JB tells us that his goal is to be a competitive tennis player and not have symptoms that inhibit his performance. Additionally, he does not want his asthma to interfere with his regular activities, he wants to be able to sleep through the night without coughing, and he wants to not be dependent on his albuterol inhaler. What guidance does the new National Heart, Lung, and Blood Institute’s Expert Panel Report ‘‘Guidelines for the diagnosis and management of asthma’’ (Expert Panel Report 3) provide us about how to properly evaluate and treat him? The document states that the ultimate goal of treatment is to enable patients to live with few, if any, symptoms; no functional limitations; and no impairment in quality of life associated with asthma. Furthermore, there should be few, if any, adverse events from either the