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 Immunology & Allergy Research Study Project Ministry of Health, Labour and Welfare, Japan Guest Editors Sohei Makino Ken Ohta Sankei Nishima Akihiro Morikawa 12 figures and 20 tables, 2005 Basel Freiburg Paris London New York Bangalore Bangkok Singapore Tokyo Sydney
S. Karger Medical and Scientific Publishers Basel Freiburg Paris London New York Bangalore 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 regulations, 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 ). Copyright 2005 by S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) Printed in Switzerland on acid-free paper by Reinhardt Druck, Basel ISBN 3 8055 7943 8 Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com
Vol. 136, Suppl. 1, 2005 Contents 1 Foreword Chapter 1 Definition, Diagnosis, Disease Types, and Classification of Asthma 3 Definitions 3 Definition of Adult Asthma 3 Definition of Childhood Asthma 3 Asthma Classification Based on Severity and Frequency of Asthma Attacks Chapter 2 Epidemiology of Asthma 5 Epidemiology of Asthma 5 Survey Methods 5 Survey Results 5 Current Prevalence of Asthma Symptoms 5 Changes over Time in Asthma Symptom Prevalence 6 Regional Differences in Asthma Prevalence 7 Male-Female Ratio 7 Age at Onset 8 Family History of Asthma 8 Number and Percentage of Patients Diagnosed with Asthma 8 Asthma Deaths 10 Asthma Deaths in Adults 12 Asthma Deaths in Children 13 Countermeasures to and Prevention of Asthma Deaths 13 References 13 Further Reading 2005 S. Karger AG, Basel Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Access to full text and tables of contents, including tentative ones for forthcoming issues: www.karger.com/iaa_issues
Chapter 3 Pharmacologic Control of Asthma 14 Pharmacologic Treatment for Long-Term Management of Asthma 14 Drugs 14 Controller Medications 15 Corticosteroids 17 Sustained-Release Theophylline 17 2 -Agonists 17 Anti-Allergic Agents 19 Reliever Medications 19 Corticosteroids 19 2 -Agonists 20 Subcutaneous Epinephrine Injection 20 Aminophylline/Theophylline 20 Inhaled Anti-Cholinergic Drugs 20 Other Drugs and Therapy 20 Traditional Chinese Herbal Medicines (Kampo) 21 Hyposensitization Therapy 21 Nonspecific Therapy 22 A Stepwise Plan of Pharmacologic Therapy in Adults 22 Goal of Asthma Control 22 Implementation of Asthma Therapy 22 Four Steps in Long-Term Management of Asthma 22 Step 1: Mild Intermittent Asthma 22 Step 2: Mild Persistent Asthma 23 Step 3: Moderate Persistent Asthma 23 Step 4: Severe Persistent Asthma 25 Supplement: Intractable Asthma 25 Follow-Up Evaluation and Testing 25 Management of Acute Exacerbation (Attacks) in Adults 25 Management of Patients at Home 26 Standard Drugs Used for the Treatment of Asthma Attacks (Reliever Medications) 26 Inhaled 2 -Agonists 26 Subcutaneous Epinephrine 26 Theophylline 27 Factors Which Affect Serum Theophylline Level 27 Corticosteroids 29 Oxygen 29 Other Therapy 29 Procedures for Emergency Outpatient Treatment IV Int Arch Allergy Immunol Vol. 136, Suppl. 1, 2005 Contents
29 Management and Treatment of Childhood Asthma 29 Management of Acute Attacks in Childhood Asthma 29 Home Management of Patients 31 Treatment in a Medical Facility 31 Treatment of Mild Attacks 31 Treatment of Moderate Attacks 34 Treatment of Severe Attacks 35 Treatment for Acute Respiratory Failure 36 Indications for Hospitalization 36 Medication Plans for Long-Term Management of Childhood Asthma 37 Controller Medications 37 Anti-Allergic Drugs 37 Inhaled Corticosteroids 40 Sustained-Release Theophylline 40 2 -Agonists 41 Stages in Long-Term Asthma Management (Treatment Steps) 41 Important Considerations when Treatment Is Stepped up or Stepped down 41 Assessing Treatment Step-Down 41 Sustaining Asthma Control 42 Assessing Treatment Step-Up 42 Discontinuing Long-Term Asthma Medication 42 Steps in Asthma Treatment 42 Mild Intermittent Asthma (Step 1) 42 Mild Persistent Asthma (Step 2) 43 Moderate Persistent Asthma (Step 3) 43 Severe Persistent Asthma (Step 4) 43 Early Intervention 44 Primary Prevention 44 Secondary Prevention 45 References 49 Further Reading Contents Int Arch Allergy Immunol Vol. 136, Suppl. 1, 2005 V
The following groups participated in the preparation of the Asthma Prevention and Management Guidelines 2003, Japan (Update from: JGL1998). 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, Labour and Welfare, Japan. 1998 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, Labour and Welfare, Japan. 2005 S. Karger AG, Basel Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Accessible online at: www.karger.com/iaa
Members of the research groups are as follows: Director: Dr. Sohei Makino Prof. Emeritus, Dokkyo University School of Medicine; Tokyo Allergic Disease Research Institute/Jobu Hospital of Pulmonary Medicine Members (alphabetical order): Dr. Mitsuru Adachi Dr. Yukihiro Ago 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 Dr. Norio Kihara Dr. Satoshi Kitamura Dr. Koichiro Kudo Dr. Kenji Mano Dr. Takehiko Matsui First Department of Internal Medicine, Showa University School of Medicine National Center of Neurology and Psychiatry (Present Bunkyo Gakuin University) Research Center for Allergy and Rheumatology, National Sagamihara Hospital (Present Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital) Doai Memorial Hospital Tamana Central Hospital (Present Kyushu University of Nursing and Social Welfare) 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 (Present Kokura Allergy Clinics) Department of Pediatrics, Showa University School of Medicine Third Department of Internal Medicine, Iwate Medical University Department of Allergy and Respiratory Disease, Doai Memorial Hospital (Present Yugawara Kosei-Nenkin Hospital) Clinical Cell Biology, Graduate School of Medicine, Chiba University Yugawara Kosei-Nenkin Hospital (Present Taiheiyo Cement Corp. Clinics) Department of Pharmacology, Dokkyo University School of Medicine First Department of Medicine, Hokkaido University School of Medicine (Present Kohnan Hospital) Kihara Hospital Department of Pulmonary Medicine, Jichi Medical School (Present Minami-Tochigi Hospital) International Medical Center of Japan Department of Internal Medicine, Teikyo University School of Medicine (Present Taikyo College of Medical Technology) Department of Pediatrics, Tokyo Metropolitan Ebara General Hospital Int Arch Allergy Immunol Vol. 136, Suppl. 1, 2005 VII
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. Ken Ohta Dr. Takao Okubo 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 Prof. Emeritus, University of Kyoto, Kansaidenryoku Hospital Okinawa Chubu Hospital (Present Muribushi-Okinawa, Muribushi Project for Okinawa Residency Program) Prof. Emeritus, University of Tokyo; Japan Clinical Allergy Research Institute Department of Respiratory Medicine, Graduate School of Medicine, University of Tokyo (Present Ochanomizu University) Fourth Department of Internal Medical, Kinki University School of Medicine (Present Department of Medicine and Pulmonology, Kinki University Sakai Hospital) Department of Internal Medicine, St. Marianna University School of Medicine Life Science Research Institute, Kinki University School of Medicine (Present Kinki University Nara Hospital) Gunma University School of Health Sciences National Hospital Organization, Fukuoka National Hospital Department of Medicine, Teikyo University School of Medicine Prof. Emeritus, Yokohama City University; International University of Health and Welfare Division of Pulmonology and Allergology, Fujita Health University School of Medicine Department of Allergy and Respiratory Medicine, Doai Memorial Hospital Former Department of Pediatrics, National Himeji Hospital Nagoya University School of Health Sciences National Hospital Organization, Minami-Okayama Medical Center Department of Respiratory and Infectious Diseases, Tohoku University School of Medicine Prof. Emeritus, Toho University Osaka Prefectural Habikino Hospital (Present Toyoshima Pediatric Clinics) Niigata Allergic Disease Research Institute Ehime Prefectural Central Hospital Second Department of Internal Medicine, Hiroshima University Faculty of Medicine (Present Kure Kyosai Hospital) Collaborators: Dr. Susumu Hosoi Dr. Hironori Sagara Department of Pediatrics, Graduate School of Medicine, Kyoto University (Present Ako City Hospital) Department of Pulmonary Medicine and Clinical Immunology, Dokkyo University School of Medicine VIII Int Arch Allergy Immunol Vol. 136, Suppl. 1, 2005