Vidyya Medical News Service
Volume 6 Issue 321 Published - 14:00 UTC 08:00 EST 16-Nov-2004 Next Update - 14:00 UTC 08:00 EST 17-Nov-2004
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New study shows patients experience asthma variability, despite strict adherence to guidelines

A study presented today at the 62nd Annual Meeting of the American College of Allergy, Asthma and Immunology shows that many patients with asthma continue to experience variability of disease control, despite strict adherence to treatment guidelines published by the National Heart, Lung and Blood Institute.(1) Variability in asthma control leads to continued disease symptoms and increased resource utilization, even when the disease is closely managed.

Although patients enrolled in the study experienced reductions in hospitalizations, emergency visits and clinic visits, researchers found important differences between those classified as having "high variability" and those with "low variability" of disease symptoms. Specifically:

  • Patients in the high variability group experienced greater overall direct and indirect costs, measured by number of emergency department visits, hospitalizations and days lost from work, school or daily activities of living. These patients also experienced more "sick visits," measured by unscheduled routine follow-up visits to primary care physicians, asthma clinics or urgent care facilities than those in the low variability group.(1)

  • Hospitalization, emergency room visits and clinic visit costs for treating asthma of high variability patients were estimated at $163 per patient per month, twice the cost for treating low variability patients ($81 per patient per month).

  • 74 percent of patients in the high variability group used rescue bronchodilators daily for more than half of the weeks of the observation period, compared to less than half (47 percent) of the patients in the low variability group.(1)

  • Asthma interrupted daily activity more often for patients in the high variability group. On average, high variability patients reported that asthma caused them to miss work, school, exercise or social activities 1.84 days per patient per month. Low variability patients reported missing activities 1.25 days per patient per month.(1)

    "Asthma is a highly variable disease, and patients may continue to suffer from symptoms as a result, despite adherence to practice guidelines," said Ileen Gilbert, MD, Professor of Medicine, Medical College of Wisconsin, lead investigator of the study. "We still need to know more about the underlying pathophysiology of the disease as well as more about environmental factors that trigger events and how to modify them in order to fully treat and reduce costs of this complicated disorder."

    Study Design and Methodology

    The analysis of the study, supported by AstraZeneca, assessed asthma variability in 125 inner-city patients (72 percent female; 68 percent minority [African- and Hispanic-American]; 80 percent treated by primary care physicians) in a period beginning six months prior to enrollment into an NHLBI guidelines-directed clinical and education intervention to minimize barriers to adherence, and ending six months following enrollment. Patients were stratified into two groups: those with high variability in asthma, and those with low variability. For purposes of the study, variability was defined as the number of fluctuations in NAEPP symptom class in the six-month post- intervention period. The 62 patients in the high variability group changed their NAEPP symptom class about once every other month, or more frequently. All other patients were classified as having symptoms in the low variability group.

    About Asthma Asthma is one of the most serious chronic medical conditions in the United States. In 2002, it was estimated that 20 million Americans have asthma. Of these, nearly 12 million Americans had an asthma attack or episode in the past year. Additionally, it is estimated that more than 30 million Americans, or about 10 percent of the U.S. population, have been diagnosed with asthma at some point in their lives.(2)

    Asthma is a reversible obstructive lung disease, caused by increased reaction of the airways to various stimuli, such as cigarette smoke, airborne molds, pollens, dust, animal dander, exercise, cold air, many household and industrial products, air pollutants, scents or simple stress. It is a chronic inflammatory condition that usually leads to breathing problems known as "episodes" - a series of events that result in narrowed airways - which is responsible for the difficulty in breathing with the familiar wheeze.(3)

    Although each person reacts differently to the factors that may trigger asthma, it can be a life-threatening disease if it is not properly managed. According to the American Lung Association, more than 4,200 Americans died from asthma in 2001.(2)

    (1) Gilbert IA, Perry SM, Olivares A, et al. Resource utilization associated with asthma variability in patients with mild, moderate, or severe persistent asthma adhering to national asthma education prevention program therapy guidelines. Abstract presented at 62nd Annual Meeting of the American College of Allergy, Asthma and Immunology, November 12, 2004

    (2) Trends in Asthma Morbidity and Mortality, American Lung Association, April 2004

    (3) Asthma in Adults Fact Sheet, American Lung Association, July 2003

    Additional Vidyya Resources:

    Resources, Patient Education, and Information:

         Asthma: Cockroaches, asthma, and allergies
         Asthma: How Asthma-Friendly Is Your Child-Care Setting?
         Asthma: Information for schools and parents - The asthma action card
       Asthma: Living with asthma - special concerns for older adults
       Asthma-related Publications and Resources
       Interactive Health Asthma Tutorial (view on-line or print), MEDLINEplus, the National Library of Medicine's consumer-health site
       Focus on Asthma, National Institute of Allergy and Infectious Disease (Last updated August 29, 2001)
       School Asthma Education Slide Set, National Heart, Lung, and Blood Institute
       Global Initiative for Chronic Obstructive Lung Disease (GOLD): Teaching Slide Set
       A Presentation on Asthma Management and Prevention, Centers for Disease Control: Asthma Presentation (last reviewed June 23, 2003)

    News Articles:

       Asthma and Allergy Foundation of America says allergy sufferers need to study -23-March-2004
       Asthma could be several diseases masquerading as one -09-January-2004
           Asthmatic patients with sinusitis more likely to have nasal polyps -19-September-2004
       Cell associated with asthma linked to tobacco smoke -26-April-2004
       Customized program reduces asthma-related illness in inner-city children -10-September-2004
       Domestic solvents, cleaning products may increase childhood asthma risk -27-August-2004
       Early childhood ear infections linked to asthma -11-May-2004
       Environment and diet may explain different rates of asthma -31-August-2004
       Ethnicity may affect allergies in children with asthma -14-January-2004
       Genetics play role in response to most common asthma drug -23-October-2004
       Greater acetaminophen use can lead to newly diagnosed asthma in women -26-March-2004
       Ingredient in asthma inhaler drug may counteract inhaler benefits -24-March-2004
         Low activity levels found among children with asthma due to parental health beliefs -5-April-2004
         Mayo Clinic researchers define link between eosinophils and asthma -17-September-2004
         New diagnostic test for asthma -18-February-2004
       No asthma exacerbation help from children's flu vaccination -18-February-2004
       Parents' anti-asthma efforts may miss the mark -17-August-2004
       Planned-care method" of asthma care reduces kids' symptoms -6-September-2004
         RSV can increase the risk of asthma -29-June-2004
       Regular use of asthma drugs poses respiratory, cardiac dangers -18-June-2004
       Respiratory therapists twice as likely to have asthma than other therapists -12-October-2004
       Three-fourths of children with asthma unprepared for an exercise-induced bronchospasm -9-July-2004
       Vital amino acid levels lower in asthmatics -15-July-2004
       Yale researchers discover new potential asthma therapeutic targets related to parasites and insects -13-June-2004

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