Worsening Asthma Symptoms and Preventing Asthma Exacerbations with Dr. Jeff Drazen


Winter is upon us and asthma exacerbations are on the rise. But how well can clinicians and patients predict and prevent these asthma exacerbations before they start? NEJM Editor-in-Chief and Pulmonologist Dr. Jeff Drazen discusses the challenge clinicians and patients face in the setting of worsening asthma symptoms, also known as the “Yellow Zone”, the research behind treatments for exacerbation prevention and its clinical applications.


Introduction: 0:00
Clinical scenario: 1:57
Uncertainty of predicting asthma exacerbations: 3:17
The challenge of defining the “Yellow Zone” in asthma: 5:07
Patient perception and pathophysiology of the “Yellow Zone”: 7:50
Treatment options in the “Yellow Zone”: 9:24
Challenge of research for “Yellow Zone” treatment: 10:24
Evidence for increased inhaled glucocorticoid dosing for “Yellow Zone”: 10:58
Adult trials investigating increased inhaled glucocorticoid dosing for “Yellow Zone”: 14:14
Clinical interpretation and application of evidence: 15:00
Future research questions: 19:54
Take-aways: 23:20 

Additional Resources: 

1. Quintupling Inhaled Glucocorticoids to Prevent Childhood Asthma Exacerbations, NEJM, 2018
2. Effectiveness of inhaled corticosteroids in controlling acute asthma exacerbations in children at home, Clinical Pediatrics, 2001
3. Doubling the dose of inhaled corticosteroid to prevent asthma exacerbations: randomised controlled trial, Lancet, 2004
4. Quadrupling the dose of inhaled corticosteroid to prevent asthma exacerbations: a randomized, double-blind, placebo-controlled, parallel-group clinical trial, AJRCCM, 2009

This podcast is part of the series, Curbside Consults, which complements the foundational information in Rotation Prep by taking a deep dive into key topics with expert clinicians and educators. As we explore the details of pathophysiology and critique the evidence behind clinical practice, these conversations are intended to give you a better understanding of the topic and greater confidence when treating your patients.

 Jeffrey Drazen, MD, is a pulmonologist and critical care physician, and Editor-in-Chief of the New England Journal of Medicine. He is a Senior Physician at Brigham and Women’s Hospital, Distinguished Parker B. Francis Professor of Medicine at Harvard Medical School, Professor of Physiology at the Harvard School of Public Health and Adjunct Professor of Medicine at the Boston University School of Medicine.

 Angela Castellanos is a general pediatrician and editorial fellow at the NEJM.