Feb. 18, 2010 -- Asthma patients know more than they did a decade ago about controlling their disease and have better medications to do it with. But a new nationwide survey finds little decline in hospitalizations or ER visits over the last 10 years.
Based on a survey of 2,500 patients who reported having at least one asthma attack during the past year, researchers concluded that there has been little meaningful improvement in some key markers of asthma control, including hospitalizations, ER visits, and time missed from work or school due to asthma.
The private research group SRBI Inc. conducted the 2009 survey. It was paid for by drugmaker Schering-Plough, which funded a similar survey in 1998. Schering merged with Merck & Co. late last year.
Among the major findings:
- 7% of patients surveyed reported having been hospitalized for their asthma over the previous year. That’s the same percentage as in 1998.
- 16% of patients reported having their asthma treated in hospital emergency departments over the previous year, compared to 19% in 1998.
- In both 1998 and 2009, roughly 1 in 4 patients reported seeking emergency treatment for symptomatic asthma over the previous year, either in hospital ERs or in a doctor's office.
The sampling error of the survey is +/- 2%.
"It is very disturbing to me that there appears to have been no real change in the control of this disease since the last major, nationwide survey was conducted," says asthma specialist Michael S. Blaiss, MD, who co-wrote the survey.
Blaiss is a professor of pediatrics and medicine at the University of Tennessee Health Science Center in Memphis.
"We have better treatments and we understand this disease much better," Blaiss tells WebMD. "But it is clear that a substantial number of patients are undertreated or do not understand the seriousness of their condition."
Asthma on the Rise
According to the CDC, roughly 16 million adults and 7 million children in the U.S. have asthma -- three times the number reported just 25 years ago.
Blaiss says the 2009 survey provides new information about how well asthma is being managed and the burden of the disease in the U.S.
In addition to asthma patients, roughly 1,000 adults without asthma and 300 asthma specialists and general care physicians participated in the survey.
In all, about one in three asthma patients over the age of 12 reported requiring some type of emergency treatment for their condition over the previous year.
Adults with asthma reported taking an average of 12 days off from work due to sickness, compared to just under four days reported by adults without asthma.
The adults with asthma also reported more than twice as many days in which their activities were limited due to illness -- 38 days compared to 16 days reported by people without asthma.
Surprisingly, more than two out of three asthma patients surveyed believed their disease was well controlled, but nearly half met the criteria for poorly controlled asthma.
Sixteen percent said they used rescue inhalers daily and 7% said they used the inhalers three to six times a week.
Using rescue inhalers more than twice a week is considered an indication of poorly controlled asthma by the National Institutes of Health (NIH). More frequent use may indicate a need for longer-acting, maintenance medications such as inhaled steroids or leukotriene modifiers.
Denver asthma specialist Stanley J. Szefler, MD, of National Jewish Health, says these medications are underprescribed by doctors and underused by patients.
Szefler, who is a spokesman for the American Academy of Allergy, Asthma and Immunology, was not involved in the survey.
"We have accomplished a lot in the last decade," he tells WebMD. "We have put a dent in asthma mortality and there are fewer asthmatics who require [high doses] of steroids. But on the sobering side, we are not controlling asthma nearly as well as we should be."
He says many doctors either do not take the time or do not have the time to identify patients with poorly controlled asthma.
NIH guidelines recommend evaluating patients at least every six months, testing lung function regularly, and asking about frequency of rescue inhaler use, use of inhalers during the night, and how their disease is impacting their life.
"Asthmatics are notorious about accommodating their illness," he says. "When you ask them how they are doing the usual answer is, ‘OK.' But if you ask specific questions about what they aren’t doing because of their asthma, you get a better idea of how asthma is impacting their life."
Blaiss says even when long-acting, preventive medications are prescribed, patients may resist taking them, especially when they are not symptomatic.
"Asthma is a chronic disease, just like hypertension and diabetes," Blaiss says. "But we don’t have a simple number like blood pressure or A1c to tell patients how they are doing, so it’s often hard to get them to take the drugs they need to properly control their asthma."