The National Asthma Education Program Report



The National Heart, Lung, and Blood Institute (NHLB) and its National Asthma Education Program (NAEP) convened a panel of experts on the management of asthma who released a comprehensive report ("Guide-lines for the Diagnosis and Management of Asthma") in 1991. This excellent resource included a suggestion for a "traffic light system" that would allow patients to easily remember how to manage their asthma. This green-yellow-red zone system has been adopted by many physicians and has been included in at least one peak flow meter design.

The Green Zone

As defined by the NAEP the green zone is a safe area in which the asthma patient experiences few or no symptoms. Peak flow measurements are 80 to 100 percent of a patient's predicted normal value or personal best with no more than a 20 percent swing in values. Medications are individualized for each patient, whether they are mild, moderate, or severe asthmatics.

The Yellow Zone

The yellow zone outlined by the NAEP signals "caution." The patient has peak flows that are 50 to 80 percent of his or her predicted normal or personal best and/or asthma symptoms that may include nocturnal attacks, coughing, wheezing, decreased activity, and chest tightness. This "zone" indicates that medications should be adjusted according to the management plan suggested by the physician. Patients who make frequent visits to the yellow zone should have their maintenance medications reviewed and adjusted.

The Red Zone

The red zone signals a "medical alert."Peak flows are below 50 percent of the predicted value or personal best and asthma symptoms are frequent, including at rest. The patient's management plan should immediately be put into place for this degree of attack, as previously outlined. Typically, this calls for immediate use of a B-agonist and introduction of oral corticosteroids. Patients who do not respond require immediate medical attention, usually an emergency room visit. Patients who fall into the red zone should certainly have their maintenance asthma program reviewed and adjusted.

Should This Terminology Be Used?

The simple terminology suggested by the NAEP may be helpful to patients in managing their asthma. For anyone familiar with traffic signals, it is certainly easy to remember. Peak flow meters with green-yellow-red colored scales or stickers are available. Remember, however, that treatment decisions should be based on prior consultation with the physician and the patient's record of personal best flows and not by color zones alone. Each patient should have green, yellow, and red zones defined with written guidelines for treatment decisions.

Putting Your Strategy to Work

Asthma has been defined as mild, moderate, and severe and specific treatment strategies proposed for each category. A system based on traffic signal colors has been introduced. Whatever strategy is used for the treatment of asthma, its success depends on a working partnership between patient and physician. Up to this point the physician has directed treatment and provided guidelines.