Dr Michelle Cloutier on Asthma Advancements Reflected in NAEPP Guideline Updates

Michelle M Cloutier, MD, is professor emerita at UCONN Health in Farmington, Connecticut, and chair of the National Asthma Education and Prevention Program (NAEPP) Coordinating Committee Expert Panel Working Group.

Among other things, new guidelines clarify the recommendations regarding indoor allergen mitigation strategies, said Michelle M. Cloutier, MD. At this year's American Thoracic Society (ATS) annual conference, Cloutier explained updates to the National Asthma Education and Prevention Program (NAEPP) asthma guidelines.

Transcript

These were the first updates to federal comprehensive asthma management and treatment guidelines in more than a decade. What has changed in this field in the past 10 years?

I think there's been an explosion of new information. In this update, there are new preferred treatments for asthma, for individuals with mild persistent and moderate persistent asthma. This represents a paradigm shift for us in the management of asthma. In addition, we now know more about, and we can further clarify, the recommendations regarding allergen mitigation strategies. There are new recommendations, ones that have not been previously in any other NAEPP guideline, regarding the use of fractional exhaled nitric oxide and bronchial thermoplasty, as well as long-acting muscarinic antagonists. So 3 of the 6 topics are new to the guidelines themselves.

Can you discuss why indoor allergen mitigation is important for people with asthma?

The new guidelines clarify the recommendations regarding indoor allergen mitigation strategies. First of all, they confirm the importance of assessing the environment—the home environment, work environment, and school environment—in individuals with asthma. In individuals who are exposed to specific allergens, the new guidelines recommend mitigation strategies only if the individual is either sensitized to the specific allergen to which they're exposed or develop symptoms upon exposure.

Thus, the new guidelines clearly state that allergen mitigation strategies are not a part of routine asthma care. That is, they're not for everyone who has asthma. They are, however, for individuals who are exposed to specific allergens, and either sensitized or develop symptoms upon exposure. This is important because we want to make sure that clinicians focus their attention on effective strategies for their patients, and we don't want them to spend time that's not needed on mitigation strategies. But if they are indicated, if they are a part of asthma care, then we want them to go full out and implement multicomponent strategies, not just a single strategy, which clearly has not been shown to be effective. We want good use of our time, and we want effective use of our time.