Asthma Prevention and Management Guidelines
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1 Asthma Prevention and Management Guidelines 1998, Japan (JGL 1998): English version Report of the Research Group for Asthma Prevention and Management Guidelines, supported by the Immunology & Allergy Research Study Project Ministry of Health and Welfare, Japan Guest Editors Sohei Makino Kenshi Furusho Terumasa Miyamoto Ken Ohta 10 figures, and 35 tables, 2000
2 Editorial development by BIOMEDIS INTERNATIONAL LTD. S. Karger Medical and Scientific Publishers Basel Freiburg Paris London New York New Delhi Bangkok Singapore Tokyo Sydney Drug Dosage The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulation, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center (see General Information ). Ó Copyright 2000 by S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) Printed in Switzerland on acid-free paper by Reinhardt Druck, Basel ISBN Fax karger@karger.ch
3 Vol. 121, Suppl. 1, 2000 Contents 1 Foreword 2 Preface Chapter 1 Goals for the Management and Treatment of Asthma, Definition, Diagnosis, Disease Types, and Classification of Severity 4 Objectives for the Management and Treatment of Asthma 4 Asthma: Definition, Diagnosis, Disease Types, and Classification of Severity 5 Adult Asthma 5 Definition 5 Asthma Classification Based on Etiology 6 Diagnosis 10 Asthma Classification Based on Severity 10 Childhood Asthma (Points of Difference from Adult Asthma) 10 Definition 10 Asthma Classification Based on Etiology 12 Diagnosis 12 Asthma Classification Based on Severity 14 References Chapter 2 Epidemiology of Asthma 15 Epidemiology of Asthma 15 Survey Methods 15 Survey Results 19 References 20 Bibliography Chapter 3 Risk Factors for Asthma 21 Risk Factors for the Development of Asthma 21 Predisposing Factors 21 Causal Factors 22 Contributing Factors 22 Risk Factors for Acute Asthma Exacerbations in Asthma Patients 22 Factors in Acute Exacerbation of Asthma 23 References Chapter 4 Pathophysiology of Asthma 25 Pathophysiology In Adults 25 Airway Pathophysiology in Asthma Ó 2000 S. Karger AG, Basel Fax karger@karger.ch Access to full text and tables of contents, including tentative ones for forthcoming issues:
4 27 Mechanism of Airway Inflammation in Asthma 28 Correlation between Airway Inflammation and Airflow Limitation 29 Correlation between Airway Inflammation and Airway Hyperresponsiveness 29 Effects of Allergen Exposure on Airway Narrowing, Airway Inflammation, and Airway Hyperresponsiveness (Immediate Asthmatic Response, Late Asthmatic Response, Post-Late Asthmatic Response) 29 Specific Considerations in Children 30 Airway Inflammation 30 Airway Hyperresponsiveness 30 Correlation between Airway Inflammation and Airway Hyperresponsiveness 30 Evaluation of Allergic Status 30 Evaluation of Respiratory Physiology and Pulmonary Function 30 Conclusion 31 References Chapter 5 Prevention of Asthma 32 Primary and Secondary Prevention Strategies 32 Primary Prevention Strategies Related to Asthma Development 32 Factors and Secondary Prevention Strategies Related to Asthma Exacerbation 33 References Chapter 6 Patient Education and the Doctor/Patient Partnership 34 The Importance of Patient Education and the Doctor/Patient Partnership 34 The Importance of Self-Management by the Patient 34 Keeping an Asthma Diary 34 Monitoring PEF 35 Knowledge about Medications 35 Educating the People Who Are Close to the Patient 35 Patient Education and the Doctor/Patient Partnership (Specific Considerations in Children) 35 The Doctor/Patient Relationship 35 Monitoring PEF 36 Using Inhaled Drugs Correctly 36 References Chapter 7 Pharmacologic Control of Asthma 37 Pharmacologic Treatment for Long-Term Management of Asthma 37 Drugs 37 Controller Medications 38 Corticosteroids 39 Sustained Release Theophylline 39 β 2 Agonists 40 Antiallergy Agents 40 Mediator Release Inhibitors 40 Histamine H 1 Antagonists 40 Thromboxane A 2 Inhibitors and Antagonists 41 Leukotriene Antagonists 41 Th2 Cytokine Inhibitors 41 Reliever Medications 41 Corticosteroids IV Int Arch Allergy Immunol Vol. 121, Suppl 1, 2000 Contents
5 41 β 2 Agonists 42 Subcutaneous Epinephrine Injection 42 Aminophylline 42 Inhaled Anticholinergic Drugs 42 Other Drugs and Therapy 42 Traditional Chinese Herbal Medicines (Kampo) 43 Hyposensitization Therapy 44 Nonspecific Therapy 44 A Stepwise Plan of Pharmacologic Therapy in Adults 44 The Objectives of Asthma Control 44 Implementation of Asthma Therapy 44 Four Steps in Long-Term Management of Asthma 44 Step 1. Mild Intermittent Asthma 44 Step 2. Mild Persistent Asthma 46 Step 3. Moderate Persistent Asthma 46 Step 4. Severe Persistent Asthma 47 Supplement: Intractable Asthma 47 Follow-Up Evaluation and Testing 47 An Asthma Management Zone System for Patients 48 Home Management of Asthma Exacerbations (Attacks) 48 Management of Acute Exacerbation (Attacks) in Adults 49 Management of Patients at Home 49 Standard Drugs Used for the Treatment of Asthma Attacks (Reliever Medications) 49 β 2 Agonists 49 Subcutaneous Epinephrine 49 Theophylline 50 Corticosteroids 50 Oxygen 51 Other Therapy 51 Procedures for Emergency Outpatient Treatment 51 Patients with Mild Symptoms (Mild Attacks) 51 Moderate Symptoms or Unrelieved Mild Symptoms (Moderate Attacks) 53 Patients with Severe Symptoms (Severe Attacks) or with Unrelieved Moderate Symptoms 55 Very Severe Symptoms of Asthma: Emergencies (Very Severe Attacks) 55 Summary of Criteria for Hospital Admission 56 Summary of Criteria for Admission to ICU (Intensive Care Unit) 56 Criteria for Discharge from the Emergency Room 57 Criteria for Discharge from the Hospital 57 Management and Treatment of Childhood Asthma 57 Management of Acute Attacks in Childhood Asthma 57 Home Management of Patients 57 Treatment in a Medical Facility 57 Treatment of Mild Attacks 59 Treatment of Moderate Attacks 60 Treatment of Severe Attacks 62 Medication Plans for Long-Term Management of Childhood Asthma 62 Mild Intermittent Asthma 64 Mild Persistent Asthma 64 Moderate Persistent Asthma 65 Severe Persistent Asthma 67 Supplement: Institutionalized Therapy 67 References 70 Bibliography Contents Int Arch Allergy Immunol Vol. 121, Suppl 1, 2000 V
6 Chapter 8 QOL (Quality of Life) 71 References Chapter 9 Other Considerations 72 Introduction 72 Deaths from Asthma 72 Asthma Deaths in Adults 75 Asthma Deaths in Children 76 Prevention of Asthma Related Deaths 77 References VI Int Arch Allergy Immunol Vol. 121, Suppl 1, 2000 Contents
7 The following groups participated in the preparation of the Asthma Prevention and Management Guidelines 1998, Japan (JGL 1998). 1995/1996 Research Group of Bronchial Asthma (Research group director S. Makino and 40 members), Allergy Division, Long-Term Chronic Disease Research Projects, supported by Ministry of Health and Welfare, Japan Research Group for Asthma Prevention and Management Guidelines (Research group director S. Makino and 44 members), Division of Effective Approaches for Treatment of Immunological and Allergic Disorders, Immunology and Allergy Research Study Project, supported by Ministry of Health and Welfare, Japan. Members of the research groups are as follows: Director Dr. Sohei Makino Members (alphabetical order) Dr. Mitsuru Adachi Dr. Yukihiro Agō Dr. Kazuo Akiyama Dr. Minoru Baba Dr. Yosuke Egashira Dr. Masaki Fujimura Dr. Takeshi Fukuda Dr. Kenshi Furusho Dr. Yoji Iikura Dr. Hiroshi Inoue Dr. Koji Ito Dr. Itsuo Iwamoto Dr. Junzaburo Kabe Dr. Yuichiro Kamikawa Dr. Yoshikazu Kawakami Prof. Emeritus, Dokkyo University; Tokyo Allergic Disease Research Institute First Department of Internal Medicine, Showa University School of Medicine Kohnodai Hospital, National Center of Neurology and Psychiatry Research Center for Allergy and Rheumatology National Sagamihara Hospital Doai Memorial Hospital Kyushu University of Nursing and Social Welfare The Third Department of Internal Medicine, Kanazawa University School of Medicine Department of Pulmonary Medicine and Clinical Immunology, Dokkyo University School of Medicine Kishiwada City Hospital Department of Pediatrics, Showa University School of Medicine 3rd Department of Internal Medicine, Iwate Medical University Department of Allergy & Respiratory Disease, Doai Memorial Hospital Department of Internal Medicine II, Chiba University School of Medicine Yugawara Kosei-Nenkin Hospital Department of Pharmacology, Dokkyo University School of Medicine First Department of Medicine, Hokkaido University School of Medicine Ó 2000 S. Karger AG, Basel Fax Accessible online at:
8 Dr. Norio Kihara Dr. Satoshi Kitamura Dr. Koichiro Kudo Dr. Kenji Mano Dr. Takehiko Matsui Dr. Haruki Mikawa Dr. Seishiro Miyagi Dr. Terumasa Miyamoto Dr. Yutaka Morita Dr. Yukio Nagasaka Dr. Takemasa Nakagawa Dr. Shigenori Nakajima Dr. Tsugio Nakazawa Dr. Sankei Nishima Dr. Takao Ōkubo Dr. Ken Ohta Dr. Hiroki Sakakibara Dr. Yasuyuki Sano Dr. Keisuke Shinomiya Dr. Kenzo Takagi Dr. Kiyoshi Takahashi Dr. Gen Tamura Dr. Hisao Tomioka Dr. Kyoichiro Toyoshima Dr. Kazuharu Tsukioka Dr. Nobuo Ueda Dr. Michio Yamakido Collaborator Dr. Susumu Hosoi Department of Respirology, Kihara Hospital Department of Pulmonary Medicine, Jichi Medical School International Medical Center of Japan Department of Internal Medicine, Teikyo University School of Medicine Department of Pediatrics, Tokyo Metropolitan Ebara General Hospital Kansaidenryoku Hospital Okinawa Chubu Hospital Prof. Emeritus, University of Tokyo; Japan Clinical Allergy Research Institute Department of Respiratory Medicine, Graduate School of Medicine, University of Tokyo Department of Medicine and Pulmonology, Kinki University Sakai Hospital Department of Internal Medicine, St. Marianna University School of Medicine Division of Respiratory & Allergic Diseases, Nara Hospital Kinki University School of Medicine Gunma University School of Health Sciences National Minami Fukuoka Chest Hospital The 1st Department of Internal Medicine, Yokohama City University School of Medicine Department of Medicine, Teikyo University School of Medicine Division of Pulmonology and Allergology, Fujita Health University School of Medicine Department of Allergy and Respiratory Medicine, Doai Memorial Hospital Department of Pediatrics, National Himeji Hospital Nagoya University School of Health Sciences National Sanatorium Minami-Okayama Hospital The 1st Department of Internal Medicine, Tohoku University School of Medicine Toho University School of Medicine, Sakura Hospital Osaka Prefectural Habikino Hospital Niigata Allergic Disease Research Institute Ehime Prefectural Central Hospital 2nd Department of Internal Medicine, Hiroshima University Faculty of Medicine Department of Pediatrics, Graduate School of Medicine, Kyoto University VIII Int Arch Allergy Immunol Vol. 121, Suppl. 1, 2000
Asthma Prevention and Management Guidelines
DOI: 10.1159/000084008 Asthma Prevention and Management Guidelines 2003, Japan (JGL 2003): English summary Report of the Research Group for Asthma Prevention and Management Guidelines, supported by the
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