Year in review: asthma

Abstract

The Yellow Zone Practice Parameter reviewed the evidence for home interventions for patients when they lose asthma control and enter the yellow zone in the “traffic light” model of asthma action plans.1 As pointed out in the parameter, patients often adjust their medications (with or without the advice of their physician) when faced with loss of control but, unfortunately, often do so inappropriately. The hope of the parameter is to offer evidence-based recommendations for patient-directed treatment changes. It is meant to create a partnership between the provider and the patient, empower patients to manage their asthma symptoms, and prevent patients from entering the red zone. Strong recommendations in the parameter include instructing patients to activate the yellow zone intervention plan early on when there is acute loss of asthma control and/or at the onset of an upper respiratory infection if this is a known trigger. Beyond the recommendationsmade in the Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma of a short-acting b-agonist use in the yellow zone, the practice parameter poses other treatments as options, including symptom-driven use of an inhaled corticosteroid (ICS) with a concomitant b-agonist. The approach relies on “dynamic dosing,” which is the use of ICS with a reliever or “adjustable