Development of NAEPP Evidence-based Reports

24-7. Increase the proprotion of persons with asthma who receive appropriate asthma care according to the NAEPP Guidelines.

24-1. Reduce asthma deaths.

24-2. Reduce hospitalizations for asthma.

24-3. Reduce emergency department visits for asthma.

Diagnose and Manage Asthma

Increase the percentage of patients with asthma who receive appropriate diagnosis and treatment.

Prevent Recurrent Exacerbations of Asthma

Reduce the percentage of patients with asthma who require repeated emergency and/or urgent care visits or hospitalizations due to uncontrolled asthma.

1. To put in place and maintain an ongoing monitoring and review system to update the national recommendations for the diagnosis and management of asthma.
2. To test the process of prioritizing and periodically submitting a limited set of questions for an evidence based review as a means of updating the guidelines in an ongoing, timely and scholarly fashion.
3. To develop a process for disseminating new and/or modified recommendations forthcoming from the monitoring and review process.

The "Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma" (EPR-2) is a consensus document of researchers and practitioners that offers recommendations on best practices to ensure optimal care of persons with asthma. Two such reports have been developed already by the NAEPP. It is essential that these guidelines stay on the cutting edge of scientific advances in asthma research for rapid application of new knowledge in the field. Systems for updating clinical practice recommendations must be improved by engaging experts to conduct literature reviews, data analysis, and develop consensus recommendations supported by solid scientific evidence.

In this regard, the NAEPP worked with the Agency for Healthcare Research and Quality and the Blue Cross/Blue Shield of Chicago's Evidence Practice Center (EPC) from 1999-2001 to conduct an evidence based review of the literature on priority topics, and to develop an evidence report and tables from which updated scienced-based recommendations were developed by the NAEPP Science Base Committee.

The NAEPP Science Base Committee meets at least once a year to exchange information and determine if new research findings warrant more intensive review for potential updating of selected areas of the EPR-2. The Asthma Management Model System (AMMS), Research Mode, is a tool available to facilitate this process. Priority topics are selected and submitted to a panel of experts to develop systematic evidence reports. Each evidence report takes approximately 9 months, and in the case an EPC review is needed, must be budgeted separately. Therefore, the Science Base Committee must establish priorities.

In addition, Coordinating Committee members, through their respective subcommittees, may forward a request to the Science Base Committee for consideration as a priority topic for systematic review, or to generate a topic-specific position statement, if a full evidence review through an EPC is not warranted. One such request was submitted by the Professional Education Subcommittee to the Science Base Committee in June 2000 which stated: "Recognizing that physicians need current medical information in order to prescribe newly released asthma drugs and to use current drugs in new delivery systems, the subcommittee recommends that the Science Base Committee look into the feasibility of providing a quick response summary of such new asthma drugs and devices." The SBC concluded that creating such a system was not feasible.

A more recent topic, Management of Asthma During Pregnancy, was submitted to the SBC in the fall 2002. A recommendation to the chair for a more in-depth review of this topic led to the appointment of a working group to conduct the review.

As the clinical recommendations for asthma are updated the NAEPP-CC will formulate strategies for their dissemination and implementation.