BETHESDA -- A national panel of experts assembled to examine traditional treatment of asthma recommended significant changes yesterday, based on growing scientific evidence that inflammation is as much a part of the chronic disease as bronchial spasms.
Asthma, which affects 10 million Americans, has long been considered a disease primarily involving constriction of lung passages, and dilating treatments have been used to relieve the wheezing, difficult breathing and coughing that occur during an asthma attack. Research has only recently shown that an environmental trigger, such as dust mites, causes inflamed bronchial cells and that the inflammation produces the symptoms.
"We now know that inflammation is the predominant feature in asthma," said Dr. Albert L. Sheffer, chairman of the National Heart, Lung and Blood Institute's Expert Panel on the Management of Asthma. "Reducing and hopefully preventing inflammation, not just reversing bronchial constriction, is central to asthma management," said Dr. Sheffer, a clinical professor of medicine at Harvard Medical School.
Generally, the panel recommended decreased use of a standard asthma drug, theophylline, for both children and adults, and increased use of the anti-inflammatory drugs.
People who have moderate to severe asthma should use not only a dilator such as theophylline for immediate relief but also an anti-inflammatory drug, such as inhaled steroids or cromolyn sodium, a non-steroid, to reduce long-term inflammation, he said at a news conference called to release the panel's findings.
For children with moderate asthma, theophylline, which can cause awakening at night or excitability during the day, need not be used, the experts advised. Children also are more susceptible to overdose on theophylline, causing seizures and sometimes death, said Dr. Shirley A. Murphy, a panelist from the University of New Mexico School of Medicine.
The panel of experts was convened by the National Heart, Lung and Blood Institute's National Asthma Education Program and approved by a coordinating committee representing 29 major U.S. scientific, professional governmental and voluntary agencies concerned with asthma. Included were the American Lung Association, American Medical Association, American -Z Academy of Pediatrics and the U.S. Public Health Service.
Prepared over two years, the report was prompted in part by the increasing death rates from asthma.
According to the National Center for Health Statistics, the number of asthma deaths in the United States rose from 2,598 in 1979 to 4,597 in 1988. The rate per 100,000 population grew from 1.2 to 1.9 in that period.
The national panel said they hoped their recommendations would educate general practitioners and patients. Lung specialists are more likely to be aware of the most recent findings on the nature of asthma and best treatments, they said. They emphasized that asthma was treatable and that almost no one should die of it.
In Baltimore, Dr. Philip Norman, head of allergy and clinica immunology at the Johns Hopkins Asthma and Allergy Center, agreed that the new guidelines would be useful "to both $H physicians and people looking for care.
"Physicians graduate [from medical school] with a very low education on the subject," he said.
Management of asthma
1. Patients and general physicians should learn more about what is triggering asthma, the nature of the disease, the most effective treatments and realize that it is a chronic condition that can be life-threatening.
2. People who have asthma should try to eliminate allergic triggers in their environment at home and at children's schools: No smoking, no furry pets, control of dust mites and cockroaches.
3. People with moderate and severe asthma should use an inhaled steroid or non-steroid anti-inflammatory drug in addition to an inhaled bronchodilator. The standard asthma drug, theophylline, may also be used, and in severe cases, steroids also may be taken orally.
4. People with moderate and severe asthma should keep an instrument called a peak flow meter that measures how fast air is blown out of the lungs. The device is an asthma "thermometer" that can show by a number whether asthma is under control, in need of more medication or about to cause a medical emergency. It costs about $20.
Source: Report of the Expert Panel on the Management of Asthma, National Heart, Lung and Blood Institute
Asthma deaths in Maryland
.. .. .. .. .. .. .. Children age .. .. .. .. .. .. .. Rate per
... ... Adults... ... 12 and under... ... Total... ... 100,000
1980... ... 39... ... ... ... ...2... ...... 41... ... ... 1.0
1988... ... 80... ... .. ... ... 6... ... .. 86... ... ... 1.9
Source: Maryland Department of Health and Mental Hygiene