The Status of Asthma Control and Asthma Prescribing Practices in the United States: Results of a Large Prospective Asthma Control Survey of Primary Care Practices

Abstract

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.

Interaction effect of psychological distress and asthma control on productivity loss?

“…Poorly controlled asthma places an excess burden in terms of direct healthcare costs as it is associated with increased rates of asthma-related hospitalisations [4,5] we well as emergency department visits [4,5], and use of medications [6,7]. However, the increased consumption of medical resources is not the only factor associated with uncontrolled asthma [8][9][10][11].…”

Is Clinical Judgment of Asthma Control Adequate ? : A Prospective Survey in a Tertiary Hospital Pulmonary Clinic = هل يكفي الحكم السريري لتقدير مدى السيطرة على مرض الربو ؟

“…Although complete asthma control is possible in the majority of patients using the available therapies, worldwide studies have repeatedly shown that complete control is only achieved in a small number of patients. [1][2][3][4][5] This has been attributed to many factors related to both health care providers and patients. 4,[6][7][8] Factors linked to health care providers include poor follow-up and instructions, incomplete and often subjective assessment, poor knowledge of inhaler technique, and underestimation of disease severity leading to inadequate treatment.…”

“…A prospective survey in a tertiary hospital pulmonary clinic Sawsan Baddar, 1 *Jayakrishnan B., 1 Omar Al-Rawas, 2 Jojy George, 1 Khalfan Al-Zeedy 1 A sthma management is based on regular follow-up for assessment and treatment to achieve maximal control. Although complete asthma control is possible in the majority of patients using the available therapies, worldwide studies have repeatedly shown that complete control is only achieved in a small number of patients.…”

Clinical Tools to Assess Asthma Control in Children

“…1,2 Numerous studies have confirmed the inadequacy of asthma control in the United States. 3,4 The domains of severity and control can be assessed in terms of impairment (frequency and intensity of symptoms, variations in lung function, and limitations of daily activities) and future risk (likelihood of exacerbations, progressive loss of lung function, or adverse effects from medications). Asthma can be considered to be well controlled if symptoms are present twice a week or less; rescue bronchodilator medication is used twice a week or less; there is no nocturnal or early awakening; there are no limitations of work, school, or exercise; and the peak flow (PEF)/ forced expiratory volume in 1 second (FEV 1 ) is normal or at the personal best.…”