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Effectively managing asthma in young and middle adulthood.

Revised national guidelines for managing asthma in nonpregnant young adults and adults stress education for self-management and include provisions for stepped care. These guidelines also include education on asthma pathophysiology; measures to control exacerbations; medications available to treat the disease; use of inhalers, spacers, holding chambers and self-monitoring; and peak expiratory flow meters. Treatment is based on frequency of exacerbations and readings from the peak flow meter. The stepped-care approach means aggressively treating patients at a higher step than current signs and symptoms may warrant, to gain rapid control over these signs and symptoms. The new guidelines suggest that patients with intermittent asthma use inhaled, short-acting bronchodilators, whereas those with persistent asthma should begin with daily inhaled, antiinflammatory medicines. Once control is maintained for weeks or months, dosages can gradually be reduced to the minimum effective level.