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Adult Asthma Patients Often Misuse Medications

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Dec. 10, 1999 (Atlanta) -- Almost two-thirds of adult asthma patients either overuse or underuse their inhalers, according to a report in the December issue of the journal Archives of Internal Medicine. Doctors say the findings have serious long-term implications for individual patient outcomes and managed care costs.

Researchers surveyed more than 6,000 adult asthma patients and used national guidelines to define overuse and underuse. Overuse of one type of inhalers, called beta-agonist inhalers, was defined as more than eight puffs per day. Underuse of inhaled corticosteroids was defined as four or fewer days per week and/or four or fewer puffs per day.

Asthma is a reactive airway disease in which the airways of the lung constrict when they become irritated or inflamed, making it difficult for the patient to breathe. Inhaled steroids are anti-inflammatory agents and work well in treating the underlying problem as the mainstay of therapy for most patients. Beta-agonists allow the airway to open temporarily to help the patient breathe when the patient has additional symptoms of asthma.

The data showed that among participants with moderate to severe asthma, 16% were overusing beta-agonist inhalers and 64% were underusing steroid inhalers. Also, patients overusing beta-agonist inhalers had more symptoms, used health care resources more frequently, and were more likely to be treated by pulmonologists. Patients underusing steroid inhalers were more likely to be treated by internists or family practitioners. The chief investigator says the results point to a need for improved asthma care.

"Underuse of steroid inhalers is a missed opportunity for better health," says Gregory Diette, MD, MSH, a pulmonologist and instructor of medicine and epidemiology at Johns Hopkins University in Baltimore. "And overuse of beta-agonist inhalers results in more hospitalization and death. Diette says asthma is also an economic burden. "The number of emergency room visits for asthma are increasing even though we have good medications to control it." Other asthma specialists agree.

"Steroid inhalers are the most important treatment for long-term asthma control," says Donald Dvorin, MD, an allergist and immunologist and assistant professor of clinical medicine and pediatrics at Hahnemann University in Philadelphia. "We counsel our patients to make it a routine twice a day by using the [steroid] inhaler after toothbrushing," says Dvorin. "We also stress that the beta-agonist inhaler is for rescue only. And patients who need it more than twice a week are probably not getting enough steroid treatment."

Dvorin says undertreatment may actually lead to physiologic changes. "There's a lot of new data that indicates undertreating asthma may lead to an airway remodeling problem. This remodeling refers to lung damage that's permanent and irreversible. So patients who use beta-agonist inhalers and are still short of breath should be evaluated by an asthma specialist." Dvorin adds more research is needed.

"We're now looking at differences in asthma care between pulmonologists, allergists, internists, and family practitioners," says Diette. "At present, it's not clear whether there are differences between the specialties or differences in the patients referred to them. But if there are physician differences that result in symptom control, it's important to know about them."

The study was supported by the Managed Health Care Association Outcome's Management System Project Consortium and Merck & Co.

Vital Information:

  • According to new research, almost two-thirds of asthma patients either underuse or overuse their medications.
  • Underuse of steroid inhalers is a missed opportunity for better health and could lead to physiologic changes, while overuse of beta-agonists leads to more hospitalizations and death.
  • Asthma is also an economic burden, even though there are enough effective medications available to control it.

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