The yellow zone in asthma treatment: is it a gray zone?

Objective: To review the available literature on methods of preventing and minimizing exacerbations and to target problems for improvement.

Data Sources: PubMed and Cochrane Review searches of the English-language literature using the following key yellow zone terms: asthma exacerbation, self-management plans, inhaled corticosteroids, and acute management of asthma exacerbations.

Study Selection: Articles relevant to our yellow zone intervention inquiry.

Results: The National Institutes of Health (NIH) guidelines advocate that physicians give patients written action plans with instructions on managing home (yellow zone) exacerbations. However, the criteria used to identify the yellow zone are ambiguous and often confusing to patients and physicians. In addition, apart from a passing mention that doubling doses of inhaled corticosteroids may be an option in asthma step-up care, the guidelines contain no recommendations for yellow zone treatment strategies. This deficiency is directly related to the paucity of organized evidence on the efficacy of the various pharmacological interventions that can be used during an exacerbation.

Conclusions: Translating the NIH guidelines into realistic clinical practice requires a clearer and more patient-friendly definition of the yellow zone, and this improved definition will facilitate the prescription of effective interventions in the management of yellow zone exacerbations.