Panel Says Asthma Should Be Treated

One thought an unmanageable disease, asthma, say two Harvard professors, can now be effectively treated and controlled.

As part of a 12-member federal panel, Harvard Medical School Professors Albert L. Sheffer and Christopher H. Fanta '70 released a report early last month showing that anti-inflammatory drugs will effectively combat the effects of the chronic respiratory disorder.

Given that the genetically inherited disease cannot be cured, Sheffer and Fanta say these findings should help hundreds of thousands of asthmatics lead normal lives.

Asthma caused 4600 deaths in the U.S. in 1987, according to Sheffer. The doctor and researcher attributes this high death rate to the fact that "physicians and patients often don't know how serious the disease is."

"[The report is] a reflection of new understandings of asthma over the last 10 years," says Fanta, who is also the director of the pulmonary division at Harvard's Brigham and Women's Hospital.

The report was the work of an expert panel brought together by the National Asthma Education Program at the National Heart, Lung and Blood Institute. This institute is a subsidiary of the National Institutes of Health, says Sheffer, who chaired the panel and directs the allergy sections at Brigham and Women's and at Deaconess Hospitals.

The panel confirmed that asthma is an air-way inflammatory disease rather than a result of air-way muscle constriction, Sheffer says. This finding is particularly important because it allows doctors to isolate treatment drugs for their patients.

"Our purpose was to come up with a broad guideline for the management of asthma," says Fanta. This mandate presented "a difficult task," Fanta adds, because asthma has so many forms.

"We included current best approaches to treatment of asthma," Fanta says. "There are different algorithms for different levels of asthma severity."

To combat asthma, Sheffer says, the report suggested anti-inflammatory agents, two of which are cromolyn and corticosteroids. "Both drugs are administered by a metered dose inhaled," Sheffer says.

"Now this is important, because most people know that corticosteroids when administered through the mouth have side effects," adds Sheffer. "But when inhaled it will have no side effects."

Both doctors say the key technique of preventing and fighting asthma is early testing. "The breathing capacity of the asthma should be measured on a regular basis," says Sheffer.

The aim of early testing is to prevent wheezing, says Sheffer. "If you can pick up asthma before they wheeze, they will suffer less," he says.

The panel chair says early detection and medical care of asthma will enable asthmatics to participate in sports like anyone else. "There is no reason why they can't," he says.

"Asthma treatment is a collaborative process between physicians and patients," says Sheffer.

Fanta agrees. "A major theme of the report was to get the patient involved in his or her own care," he says. "It's very important to have collaborative efforts."

"This involves patient education," continues Fanta. "We ought to teach patients about asthma and medication. Patients need to be prepared to care for themselves [in emergency situations]," he says. "This is called 'asthma co-management.'"

The report, which runs several hundred pages, also identified asthma as an allergic disease, says Sheffer. "Patients shouldn't have anunals in their homes," he says, since pets like cats and dogs can start an attack.

"They shouldn't live in a home where people smoke," he adds. "Passive smoking aggravates asthma," Sheffer says.

And while physicians and scholars nationwide digest these multiple findings, Sheffer says he's on to the next step. The Medical School professor is planning a conference to discuss ways to prevent asthma death worldwide.