Sunday, April 4, 2010
One of the changes between the Second Expert Panel Report (EPR2, July 1997) for the Diagnosis and Management of Asthma and the Third Report (EPR3, August 2007) is the concept of risk for future asthma. As shown in the figure, the brown-colored boxes are the understanding in 1997. In 2007, the red-colored boxes were added to the brown-colored boxes. I think this is a tremendous step forward. Based on the EPR3, my patients or their parents will remember me asking about the control of the current asthma and then urging them to CONTINUE their anti-inflammatory treatments (avoidance, inhaled coticosteroids, allergy immunotherapy) to reduce the FUTURE risk of active asthma, even when the control has been excellent. Stepping down, as I have written earlier, should be considered, yes, but much more slowly than people would like. The risk of another attack persists for years, unfortunately, I would agree.
I hope this diagram really helps people understand my thought process,
Your Allergy Dude.
P.S. This model of current control and future risk has been used with many other diseases. For example, if you've had a heart attack, which was caused by smoking, high cholesterol, and high blood pressure, and even resumed a completely active lifestyle, you should not stop treating the caustive factors. You remain at high risk for another heart attack. The same with asthma.