Asthma Remains Largely Uncontrolled in the United States

Lara C. Pullen, PhD

February 28, 2012

February 28, 2012 — Asthma control falls far short of US national asthma management targets, according to a new survey. This study is noteworthy because it takes into account both asthma control and asthma severity, using methods from the Expert Panel Report III (EPR 3).

The results from the Comprehensive Survey of Healthcare Professionals and Asthma Patients Offering Insight on Current Treatment Gaps and Emerging Device Options (CHOICE) survey were published by Gene L. Colice, MD, from Washington Hospital Center and the George Washington University School of Medicine in Washington, DC, and colleagues in the March issue of the Annals of Allergy, Asthma and Immunology. The CHOICE survey incorporated the EPR 3 recommendations to assess asthma severity before the use of long-term controllers.

The survey also revealed that although a respondent may indicate a high burden of disease via the answers to survey questions, that same respondent often described their disease as either completely or well-controlled. Perhaps because of this, many of the asthma patients surveyed (49%) were not using controller medication, despite the presence of persistent disease.

"According to survey results, 79 percent of these patients had persistent asthma and should have been on controllers," said Dr. Colice in a news release. "Of the 51 percent on controllers, 86 percent were inadequately treated as their asthma was not well or very poorly controlled."

The CHOICE survey was a telephone survey of 1000 patients who were diagnosed with asthma. As such, it was vulnerable to the limitations of responder bias and inaccurate recall.

Asthma is a common illness, affecting 7 million children (10% of children in the United States) and 17.5 million adults (8% of adults in the United States). Direct and indirect asthma costs are substantial.

Visits to Allergists Can Reduce Asthma Failures

Michael Foggs, MD, an American College of Allergy, Asthma, and Immunology board member, spoke with Medscape Medical News about the survey results. He acknowledged that he was not surprised by the findings, but he commended the authors for publishing a "very important paper." He went on to explain that "all of this is solvable...if the right thing is done."

Dr. Foggs pointed to Asthma Management and the Allergist: Better Outcomes at Lower Cost , which he coedited, and explained that the data in the document indicate that the number of asthma failures can be dramatically decreased if patients with asthma are referred to allergists. He advised primary care physicians to read the EPR 3 asthma guidelines, and to refer patients to an allergist if there are any issues. He also pointed out the importance of patient education, explaining that many patients, especially those in the vulnerable inner city, consider asthma to be an event. They think that asthma medicine can cure them, and that an exacerbation is actually asthma returning. Because of this, patients may not be compliant with controller medication.

The study was supported by Teva Respiratory LLC. Dr. Colice is on the speakers' bureaus of Merck, Teva, and GSK, and is a consultant for Teva and Vatera. Disclosures for the other authors are listed in the article. Dr. Foggs has disclosed no relevant financial relationships.

Ann Allergy Asthma Immunol. 2012;108:157-162.e1. Abstract


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