NATIONAL ASTHMA EDUCATION AND PREVENTION PROGRAM

The National Asthma Education and Prevention Program (NAEPP) was established in March 1989 by the National Heart, Lung, and Blood Institute, a component of the U.S. National Institutes of Health. Its objectives are threefold: (1) to raise awareness among patients, health professionals, and the public that asthma is a serious chronic disease; (2) to ensure that symptoms of asthma are recognized by patients, families, and the public, and that appropriate diagnosis is made by health professionals; and (3) to ensure effective control of asthma by encouraging a partnership among patients, physicians, and other health professionals, using modern treatment and education programs.

Asthma ranks among the most common chronic conditions in the United States, affecting about 17 million persons of all ages, races, and ethnic groups. This chronic inflammatory disease of the airways is characterized by recurrent episodes of breathlessness, wheezing, coughing, and constriction in the chest. Asthma can range in severity from mild to life-threatening. It is one of the leading illness-related causes of school absenteeism, accounting for over 10 million missed school days annually, and it is the leading work-related lung disease.

Interest in asthma as an important cause of morbidity and mortality was not new in 1989 when the NAEPP was launched. The National Institutes of Health had, in fact, supported research on asthma for many years. What was new was scientific evidence that chronic airway inflammation is the underlying mechanism that leads to asthma—a finding that suggested an entirely different approach to treatment—and the demonstration by behavioral scientists that health education programs based on a sharing of responsibility by patients and their families with a physician can be very effective in promoting optimal management of asthma.

In establishing the NAEPP, the National Heart, Lung, and Blood Institute built upon its considerable experience with other health-education programs (e.g., the National High Blood Pressure Education Program, begun in 1972, and the National Cholesterol Education Program, begun in 1985). It was clear that addressing the problem of asthma would require coordinated, multidisciplinary efforts among research scientists, health care providers, public health personnel, and patient advocates. The NAEPP was developed under the auspices of a coordinating committee with representatives from thirty-six major medical associations, voluntary health organizations, and federal agencies with an interest in asthma. The committee continues to provide input on program strategies and materials development, and its participating organizations are directly involved in implementation of many activities.

In 1991, the NAEPP published its Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma. This landmark document set the stage for nationwide improvement in clinical management of asthma. It changed common perceptions about asthma and its treatment by emphasizing the role of inflammation in disease development, noting the importance of objective monitoring of lung function, and stressing the need to establish partnerships between patients and health care providers through patient education. More than 300,000 copies were distributed to physicians, health professionals, and medical schools. To promote broad use by health professionals involved in asthma care, strategically targeted companion documents were developed for nurses, emergency department personnel, pharmacists, and school personnel.

The Expert Panel Report also stimulated new research that so significantly increased knowledge about effective approaches to asthma care that a second expert panel was convened in 1995. Its report, Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma, published in 1997, remains the most accurate, up-to-date source of information for clinicians on asthma diagnosis and management.

The guidelines developed by the NAEPP translate research findings into recommendations for patient care. There is now substantial scientific evidence that the guidelines, when followed, lead to a significant reduction in the frequency and severity of asthma attacks, and the majority of patients can live fully active lives. Outreach and education programs, especially targeted to high-risk populations at the community level, are an essential part of the NAEPP effort to ensure full utilization of the guidelines. Interventions to facilitate access to medical care and appropriate financial support for medication, monitoring aids, and environmental control measures are critical for reducing the burden of asthma. These needs are being actively addressed through a partnership with community-based asthma coalitions.

Claude Lenfant

Suzanne Hurd

(see also: Asthma; National Institutes of Health )