For Immediate Release                                         Contact:  Jo Ann Faber
Nov. 4, 2005                                                                    (847) 427-1200 x240
                                                                                      joannfaber@acaai.org

Survey Reveals that Asthma Severity Is Underestimated
and Patients May Not Be Getting Optimal Treatment

ANAHEIM, Calif. – Asthma patients often underestimate the severity of their disease, and as result, they may not be getting the proper treatment, according to the results of a survey presented at the annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI) in Anaheim.

“We have between 4,000 to 5,000 asthma related deaths a year, and that number is not decreasing,” said Myron J. Zitt, M.D., ACAAI president and associate professor of clinical medicine at the State University of New York, Stony Brook, NY. “We have to ask ourselves why the mortality rate continues to be this high.”

There are many answers to that question, including the fact that some patients are not receiving the proper treatment.

And then we have to ask, who is not treating it properly, Dr. Zitt added. “Are physicians trained to treat it properly, or should we be looking more towards specialists to provide care? Patients have responsibility too. If they are underestimating their problem, it may be causing their symptoms to escalate. They may not be given the right medications, or not be using them properly.”

The survey on asthma, conducted by the ACAAI and funded with an unrestricted educational grant from Sepracor, evaluated the behavior and attitudes of 306 physicians towards asthma and its treatment. Included were 156 primary care physicians, 95 pulmonologists, and 55 allergists.

Of the three physician subgroups involved in the survey, patients who were seen by allergists had the fewest number of hospitalizations and emergency room visits. Outcomes were superior for allergists than for non-specialists, said Dr. Zitt.  “I firmly feel that we understand asthma and asthma severity and know how to treat it best.”

One of the problems is that people are not being diagnosed properly, and there are significant barriers to care. In Harlem, NY, there is a 25 percent prevalence of asthma among children, and rates are similar among other inner city youngsters. About 50 percent of people with asthma are also unable to recognize increasing severity of symptoms.

Medications are also not being properly prescribed and utilized, said Dr. Zitt. There are two types of medications commonly used to treat asthma--short acting bronchodilators and controller medications. The controller medications need to be used on a regular basis, but only 25 percent of patients are using these agents even though 75 percent of them experience persistent symptoms.

Another problem is the evaluation of symptoms. Right now our guidelines are only looking at asthma severity as a means of defining treatment, said Dr. Zitt, but asthma severity changes from time to time, and therapy needs to be stepped up and cut down depending on how the patient is doing.

Right now we are also primarily measuring airflow in patients, as a determinant to treatment, but the other major factor is inflammation, he said. “We need to be able to measure inflammation, and we need a better way of recognizing it. But we don’t have that right now.”

One of the most important results of this survey is that it has raised awareness of asthma, said Dr. Zitt. “Barriers exist to care, medications are not being used properly, quality of life is impaired, and we continue to have a high mortality rate. We have a long way to go with asthma.”

Patients could be doing more to manage their asthma if only they knew how to do it, and they could be more interactive with their care if they were given asthma treatment plans, said Nancy Sander, president and founder of Allergy & Asthma Network Mothers of Asthmatics (AANMA). “Treatment plans can help asthmatic patients achieve better control.”

The seriousness of asthma has often been downplayed, dismissed as a weakness, or the result of anxiety, said Sander, but we need to realize that asthma has to be taken seriously.

There are many obstacles to care, Sander pointed out. “Patients now need to get prior authorization to see a specialist, they have to go through a process to get a drug that isn’t on the approved therapy list, or they have to fail a treatment before they can get the drug that they need. These are artificial barriers to getting care and don’t need to be there.”

The language of asthma is also confusing for patients, and that needs to be rectified, said Sander. “Forty percent do not know what a controller medication is. The language needs to be more direct.”

Patients are often confused as to the purpose of the medications.  For example, calling a medicine “rescue” makes it seem that it’s a last resort rather than a first resort.

The language of asthma for patients is very different than it is for physicians, said Sander. “The diagnoses of having mild, moderate or serious disease underestimate the seriousness of asthma. The risk of asthma is real whether diagnosis is mild, moderate or severe.”

New guidelines may help to improve both diagnosis and treatment. The ACAAI, together  with the American Academy of Allergy, Asthma and Immunology, have revised the old classification of asthma patients by disease severity to determine treatment and are changing to a new system, excellent symptom control.

The national practice guidelines for treating asthmatics, which has been used for about 15 years, classified patients as having mild, moderate or severe asthma. Treatment was based on the severity of disease. The new guidelines recognize that asthma changes over time, and treatment needs to reflect that.

There is an important difference between asthma control and severity,” said Richard Nicklas, M.D., clinical professor of medicine at George Washington University. “Asthma is a chronic disease but not a static disease.”

Complete or total control may be a realistic goal for a subgroup of asthma patients, according to the new guidelines which are published in the November issue of the Journal of Allergy and Clinical Immunology.

The old guidelines don’t take into account the fluctuations of symptoms, said Dr. Nicklas. An example is a patient who is doing very well, and then is exposed to a trigger and suffers a fatal or near fatal episode.

“Now we are looking at how the patient functions, at home and at work,” he said. “How they’re doing and how the physician feels they are doing. Greater interaction is needed with patients, that involves sitting down with the patient and telling them that we need to develop a plan that we’re both comfortable with.”

The purpose of developing asthma control is that it will create better individualized treatment, said Dr. Nicklas. “No two patients are the same. Setting up a criteria of severity leaves people out, but basing it on asthma control is a better method.”

The ACAAI is a professional medical organization, headquartered in Arlington Heights, Ill., comprising nearly 5,000 qualified allergists-immunologists and related health care professionals. The College is dedicated to the clinical practice of allergy, asthma and immunology through education and research to promote the highest quality of patient care.

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