National Asthma Education and Prevention Program: Evidence Based Clinical Practice Guidelines

1. National Asthma Education and Prevention Program: Evidence Based Clinical Practice Guidelines James P. Kiley, M.S., Ph.D. Director Division of Lung Diseases, NHLBI, NIH Congressional Allergy and Asthma Caucus October 13, 2011

2. Burden of Asthma • 24.6 million Americans have asthma • Lost productivity • 14 million work days lost per year • 10.5 million school days lost per year (200,000 children w. asthma miss >2 weeks) • Reduced quality of life • 48% parents in national survey have children avoid exertion • 30 % percent don’t sleep through the night • High morbidity • 456,000 hospitalizations, all ages • 1.75 million emergency department visits • High cost • $56 billion annual direct and indirect costs • Death • 3,447 deaths in 2007

3. NIH Research Drives Changes in Asthma Care • New understanding of asthma as an inflammatory condition • New evidence on treatments • Inhaled corticosteroids: Attacks, ED visits, hospitalizations ~ 50% Symptom free days ~20% Lung function • Reducing exposure to allergens/irritants at home Urgent health care visits ~15% Symptom free days ~20% Medication requirements • Patient education and Physician-Patient Communication ED visits, hospitalizations ~10-40% Symptom free days ~10-50% School absences Activity levels and quality of life

4. National Asthma Education and Prevention Program: Clinical Practice Guidelines • Translate research findings into recommendations for clinical practice • Assist, but do not replace, individual clinician decision making • Provide common language for clinical and community activities to improve asthma control

5. NAEPP Guidelines: Key Components of Quality Asthma Care • Assessment and monitoring • “Asthma Checkups” at least every 6 months to assess level of asthma control and adjust treatment • Medications • Inhaled corticosteroids are most effective • Patient/family education for self – management • Provide written Asthma Action Plan • Control environmental exposures that make asthma worse

6. Asthma Can be Controlled: Expect Nothing Less • New goals to control asthma, which can be achieved for most patients: • Prevent chronic symptoms • Maintain (near normal lung function) • Sleep through the night and be active during the day • Reduce the risk of exacerbations

7. Impact of Guidelines-Based Asthma Care Asthma hospitalization per 10,000 population, United States, 1980-2008 Asthma mortality per 100,000 population, United States, 1981-2007

8. Widespread Adoption of Guidelines Remains a Challenge • Deaths, hospitalizations, and ED visits are down—but they need to go down further because most are avoidable • Racial and ethnic disparities persist • In some areas, < 50% of asthma patients get recommended treatments • Day to day quality of life measures important to patients–going to school or work, physical activities, family and social events without asthma interfering—need improvement

9. Comprehensive National Programs Can Make a Difference • A national program in Europe accomplished: • 6% reduction in hospital days • 61% reduction in childhood ED visits • 35% reduction in costs • With continued education and increasing adoption of guidelines-based care, the United States could accomplish even greater benefits Haahtela et. al. Thorax 2006; 61: 665-670

10. National Asthma Control Initiative (NACI) • National Asthma Education and Prevention Program launched NACI to put guidelines' messages in motion nationwide through partnership activities • Partnership activities w/professional societies • Demonstration projects to develop “user friendly” tools • Champions program to engage community based asthma leaders in accelerating change among their clinician peers • Information exchange NACI Plan of Action NACI Action Guide

11. Research, Guidelines & Clinical PracticeA Dynamic Interaction • This is a dynamic interaction. The cycle of research and clinical experience helps us continuously improve asthma care. • Recent NIH research addressed numerous clinical questions; an update to the guidelines is planned.