Evaluating New Evidence to Improve Asthma Care and Quality of Life
Twenty-five million Americans, including seven million children, suffer from the symptoms of asthma—shortness of breath, chest tightness, coughing, and wheezing. Exercise, allergies, or other factors may trigger such symptoms at any time.
Unfortunately, there is no cure. But with the tests and treatments available today, people can work with their clinicians to manage their disease. And AHRQ is pleased that new Agency research efforts can help.
In 2015, in anticipation of an update to the 2007 Expert Panel Report (EPR)-3 asthma diagnosis and management guidelines, the National Heart, Lung, and Blood Institute (NHLBI) asked AHRQ to review and analyze the evidence on select asthma treatments, interventions, and diagnostic tests.
AHRQ’s Evidence-based Practice Center (EPC) Program has 20 years of experience in developing, synthesizing, and disseminating evidence to improve care. In response to NHLBI, our EPC program developed five systematic reviews, which offer important new insights into today’s capabilities to control asthma. These include:
- The Role of Immunotherapy in the Treatment of Asthma found subcutaneous immunotherapy for allergic asthma reduces the need for use of long-term control medications as well as quick-relief medications, and may improve quality of life. It also found that sublingual treatments may improve asthma symptoms and quality of life while reducing the need for long-term control medications. Local and systemic reactions are common, but infrequently require changes in treatment. Life-threatening events are reported rarely.
- Intermittent Inhaled Corticosteroids and Long-Acting Muscarinic Antagonists for Asthma found different medications may be helpful to decrease asthma attacks in children of different ages and severity of disease. In children under 5 years old with recurrent wheezing, intermittent use of inhaled corticosteroids during an upper respiratory tract infection decreases asthma attacks. For children between 12 and 18 years old with persistent asthma, using the same corticosteroid and long-acting bronchodilator for both daily asthma control and for short-term relief may be more effective than using different medications to reduce asthma attacks. For this same population, using inhaled corticosteroids intermittently may be as effective as using them as a controller medication. In patients 12 years and older with uncontrolled, persistent asthma, adding a long-acting muscarinic antagonist to inhaled corticosteroids reduces asthma attacks and improves lung function.
- Effectiveness of Indoor Allergen Reduction in Management of Asthma did not find sufficient evidence for any single intervention to reduce indoor allergen exposure to asthma patients. Bundling interventions, however, may improve some asthma outcomes. Multicomponent interventions that include high-efficiency particulate air-filtration vacuums or pest control reduce asthma exacerbations and improve quality of life.
- Effectiveness and Safety of Bronchial Thermoplasty in Management of Asthma found this procedure, which uses heat to remove muscle tissue from the airways of adults with moderate to severe asthma, may improve asthma control and quality of life compared to medications. However, there are potential harms associated with bronchial thermoplasty, such as worsening of asthma symptoms, respiratory infections, and coughing up blood. The balance of benefits and harms remains uncertain.
- The Clinical Utility of Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management found this diagnostic test can help predict which patients will respond to inhaled corticosteroids, and can reduce asthma attacks when used to adjust and manage long-term medication treatment.
Not only do these reports synthesize available evidence on the effectiveness and harms of asthma treatments, interventions, and diagnostic tests, they also evaluate the strength of that evidence. And, importantly, they identify areas where more research is needed.
Ultimately, these reviews will inform those working to update the national asthma guidelines. We are hopeful this evidence will help the asthma health care community to improve asthma care and the quality of life of their patients.
Dr. Chang is Director of AHRQ's Evidence-Based Practice Center Program.
Page originally created April 2018