Adult Asthma Patients Often Misuse Medications
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
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
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
The study was supported by the Managed Health Care Association Outcome's
Management System Project Consortium and Merck & Co.
- 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.