Control of asthma symptoms is, unfortunately, not a reality for many people with asthma. Asthma control is an ongoing challenge, requiring a multidisciplinary treatment approach. The National Asthma Education and Prevention Program (NAEPP) of the National Heart, Lung, and Blood Institute published its Guidelines for the Diagnosis and Management of Asthma in 1997, but the extent of implementation of recommendations in physician's practices remains to be determined. We sought to determine if a systematic implementation of the NAEPP practice guidelines would impact physician's treatment decisions for patients with asthma. The Asthma Care Network is a large, national, point-of-care program developed to assist health care providers in the assessment and management of their patients with asthma. Outcome measurements for the program included level of asthma control, activity limitation, sleep disruption, use of rescue medications, use of controller medications, and urgent care services. A total of 4,901 primary care physicians at 2,876 practice sites enrolled more than 60,000 patients. Nearly three fourths of patients reported symptoms consistent with a lack of asthma control (mean 74%, range 69-81%). Approximately 68% of pediatric patients and 78% of adult patients reported limited activities due to asthma in the past week. Sixty-two percent of pediatric patients and 68% of adult patients reported more than two symptomatic days in the past week. Approximately 40% of the patients surveyed were not using controller therapy. The overall percentage of patients reporting uncontrolled asthma who were prescribed a controller medication increased from 60% to 81%, and the use of inhaled corticosteroids containing medications among these patients increased by 52%. As a result of the assessment of the patients' level of asthma control during the office visit, physicians changed their patterns of prescribing controller therapy in patients with uncontrolled asthma.

Participants in a variety of health plans, clinics and employer groups were invited to participate in the Asthma Self-Management Program (ASMP), an education program designed to improve self-management skills and daily functioning in individuals with asthma. The ASMP is an 8-week classroom program that provides information on the respiratory system, trigger avoidance, use of monitoring techniques and asthma medications. After program completion, graduates were contacted at scheduled intervals to reinforce performance of behaviors that are important to asthma self-management and to collect outcomes data. This paper reports the results of 2 years of follow-up with these individuals.

The Society and Avalere Health are working to develop and test interventions in clinical settings that will improve early identification and management of T2D patients at high risk for hypoglycemia.

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Globally, the number, variety, and prevalence of respiratory disorders and diseases pose a major health concern. Many of the causes of these disorders can be linked to two human-generated factors: air pollution and cigarette smoking. Air pollutants, for example, adversely affect the health of 4 to 5 billion people throughout the world. Polluted air is harmful to patients with respiratory disorders, particularly asthma, because it can trigger attacks or exacerbate them. The problem of air pollution will only continue to increase because of the expanding world population, the burning of fossil fuels, and the increased amount and array of industrial chemicals being released into the air (Pimental et al., 1998). Cigarette smoking is discussed by Fisher (in press). However, the association between smoking and respiratory disorders merits a brief comment. Cigarette smoking is a significant risk factor for chronic obstructive pulmonary disease (COPD). For example, China has the largest number of tobacco-related deaths in the world. Liu et al. (1998) pointed out that 45% of the deaths in China are caused by respiratory illness, specifically COPD.If current smoking rates in China persist, Liu and his colleagues estimated that tobacco will kill about 100 million of the 0.3 billion male population 239