Too Few Asthma Patients Use Maintenance Drugs
July 12, 2004 -- People with asthma are still relying too much on rescue medications, which treat asthma attacks, while maintenance medications used to control the condition are being underprescribed, a nationwide study suggests.
Researchers found that about only about 25% of people treated in an emergency room for an asthma attack had been prescribed an inhaled corticosteroid -- a type of maintenance drug --over the previous year. By contrast, more than 80% had received rescue medications.
The study was sponsored by GlaxoSmithKline, which markets the inhaled corticosteroid Flovent and the combination asthma control drug Advair. Asthma expert Paul Kvale, MD, who reviewed the findings for WebMD, says the study highlights a major problem in asthma treatment. Kvale is president-elect of the American College of Chest Physicians.
"Even those of us who claim to be experts may not always recognize the severity of a patient's asthma and may underprescribe these [maintenance] medications," he says. "That means more people end up in emergency departments."
Asthma attacks account for roughly 2 million hospital emergency visits each year in the U.S., but experts say that figure could be cut significantly with the wider use of drugs designed to prevent or reduce the severity of asthma attacks. The National Asthma Education and Prevention Program promotes the use of inhaled corticosteroids as the asthma control drug of choice for preventing or reducing the severity of attacks.
In this study, researchers reviewed insurance claims from more than 20 managed care plans across the U.S. Treatment recommendations were assessed for almost 13,000 patients in the year prior to an asthma-related emergency hospital visit and in the two months following the attack. The findings were reported in the July issue of the journal Chest.
In the year before the hospital visit, 25% of the patients received an inhaled corticosteroid. A total of 30% received steroids as a rescue medication and 53% received a short-acting beta-antagonist as a rescue medication.
Even though 94% of the patients had seen a doctor during the year before the hospital visit, only 13% underwent testing to determine the severity of their asthma. The researchers suggest that this diagnostic failure, combined with a tendency among patients to underreport asthma symptoms, helps explain the underuse of asthma-control drugs.
"The majority of these patients had three contacts with health-care providers (before, during, and after the treated attack), but, unfortunately, for many these interactions did not result in an increased use of controller medications," researcher David A Stempel, MD, and colleagues wrote.
Kvale says patients with moderate to severe persistent asthma should discuss the use of control or maintenance medications with a physician, even if they think their condition is under control.
"Reducing the reliance on rescue medications will keep more patients out of the emergency departments," he says. "And that is a major goal of treatment."
Stempel is a consultant for GlaxoSmithKline. GlaxoSmithKline is a WebMD sponsor.
Researchers found that about only about 25% of people treated in an emergency room for an asthma attack had been prescribed an inhaled corticosteroid -- a type of maintenance drug --over the previous year. By contrast, more than 80% had received rescue medications.
The study was sponsored by GlaxoSmithKline, which markets the inhaled corticosteroid Flovent and the combination asthma control drug Advair. Asthma expert Paul Kvale, MD, who reviewed the findings for WebMD, says the study highlights a major problem in asthma treatment. Kvale is president-elect of the American College of Chest Physicians.
"Even those of us who claim to be experts may not always recognize the severity of a patient's asthma and may underprescribe these [maintenance] medications," he says. "That means more people end up in emergency departments."
2 Million ER Visits a Year
Asthma attacks account for roughly 2 million hospital emergency visits each year in the U.S., but experts say that figure could be cut significantly with the wider use of drugs designed to prevent or reduce the severity of asthma attacks. The National Asthma Education and Prevention Program promotes the use of inhaled corticosteroids as the asthma control drug of choice for preventing or reducing the severity of attacks.
In this study, researchers reviewed insurance claims from more than 20 managed care plans across the U.S. Treatment recommendations were assessed for almost 13,000 patients in the year prior to an asthma-related emergency hospital visit and in the two months following the attack. The findings were reported in the July issue of the journal Chest.
In the year before the hospital visit, 25% of the patients received an inhaled corticosteroid. A total of 30% received steroids as a rescue medication and 53% received a short-acting beta-antagonist as a rescue medication.
Diagnostic Failure
Even though 94% of the patients had seen a doctor during the year before the hospital visit, only 13% underwent testing to determine the severity of their asthma. The researchers suggest that this diagnostic failure, combined with a tendency among patients to underreport asthma symptoms, helps explain the underuse of asthma-control drugs.
"The majority of these patients had three contacts with health-care providers (before, during, and after the treated attack), but, unfortunately, for many these interactions did not result in an increased use of controller medications," researcher David A Stempel, MD, and colleagues wrote.
Kvale says patients with moderate to severe persistent asthma should discuss the use of control or maintenance medications with a physician, even if they think their condition is under control.
"Reducing the reliance on rescue medications will keep more patients out of the emergency departments," he says. "And that is a major goal of treatment."
Stempel is a consultant for GlaxoSmithKline. GlaxoSmithKline is a WebMD sponsor.
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