What Is The National Asthma Education And Prevention Program (NAEPP)?

The National Asthma Education and Prevention Pro-gram, or NAEPP, was founded in March 1989 to address the growing problem of asthma in the United States. Although much was understood about asthma itself, treatment and outcomes were clearly suboptimal, especially when viewed from a national perspective. The NAEPP’s primary goal is to improve asthma care in the United States.

Its focus is education—to teach health professionals, asthma patients, and the general public about asthma. The program strives to improve the quality of life for those with asthma and hopes to decrease asthma-related morbidity and mortality. The NAEPP is administered and coordinated by the U.S. Department of Health and Human Services’ National Institute of Health’s National Heart Lung and Blood Institute (NHLBI). The NAEPP’s coordinating committee commissioned a panel of medical experts to review the scientific asthma literature in order to improve the clinical management of asthma in the United States and to stimulate additional research on asthma.

Its landmark report, the Expert Panel Report (EPR): Guidelines for the Diagnosis and Management of Asthma  first appeared in 1991. Since then, updated guidelines for diagnosis and treatment of asthma have been published, reflecting the tremendous amount of new information about asthma. A follow-up Expert Panel Report (EPR-2) came out in April of 1997. In June 2002, the NAEPP committee added refinements to the 1997 document leading to the Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma–Update on Selected Topics 2002.

The third and current Expert Panel Report (EPR-3) was finalized and then posted online in August 2007. All 440 pages of the  EPR-3 report are available for free reading and downloading via the Internet (http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm). Print copies may be ordered from the NHLBI educational Materials Catalogue for a small fee from NHLBI Information Center, P.O. Box 30105, Bethesda, MD 20824-0105.

A key component of all the NAEPP’s asthma treatment guidelines is the classification of asthma into four separate categories based on asthma symptoms, pulmonary function test (FEV1) values, and disease severity. An individual with asthma will fall into one of the four groups at the time of the initial assessment of his or her asthma severity. Interestingly, that person’s classification may change over time depending on how effectively the disease and its symptoms become controlled. Patients at any level of severity can also experience exacerbations, which also can be mild, moderate, or severe in intensity. The accurate classification of a person’s asthma severity at the time of diagnosis and ongoing follow-up evaluations of disease control as treatment proceeds is part of the NAEPP’s effort to ensure better care for persons with asthma of all ages.

The NAEPP recommends specific medications and interventions for each level of asthma severity. The  EPR-3 update emphasizes assessment of asthma severity (as in the prior reports) at the time of asthma diagnosis and adds a complementary formal assessment of the degree of asthma control obtained through treatment over time. The emphasis on asthma control and on monitoring the response to therapy are new features of the 2007 guidelines. The latest NAEPP report presents updated treatment recommendations based on both the initial asthma severity rating and the response to ongoing treatment. The report  emphasizes that lung  function measurements (FEV1), the frequency  and intensity of symptoms, and any functional limitations should be included in the assessment of the degree of asthma control.

The report advocates a six-step approach to the pharmacologic management of asthma and provides detailed treatment suggestions based on severity, control, and age. The EPR-3 further separates persons with asthma into three groups for purposes of assessment and asthma treatment: children younger than 5 years of age, children between the ages of 5 and 11 years old, and people who are 12 or older. Within each of those age-related categories, it  makes specific treatment recommendations  for each level of asthma severity/control and outlines specific medicines for each of the six steps of asthma treatment. Patient education and the development of a partnership between the treating team of healthcare professionals and the patient and his or her family remains an essential component of asthma care as envisaged by the EPR-3.