MEDIA ALERT: Managing Asthma

Asthma affects approximately 20 million Americans and is responsible for nearly 5,000 deaths a year. There are 2 million asthma-related visits to emergency departments each year for asthma.

Even people who consider their asthma to be well controlled can end up in the hospital with an asthma exacerbation, or "asthma attack." Stress, exposure to high levels of allergens (molds, pollens) or triggers (smoke, exercise) or not taking medication as prescribed all can exacerbate asthma symptoms of coughing, wheezing, chest tightness or shortness of breathing, leading someone to seek emergency care.

The majority of hospitalizations for asthma may be the result of people not taking their inhaled steroid medication, a study in the December 2004 Journal of Allergy and Clinical Immunology (JACI) showed. According to the study of 405 adult asthma patients:

• Overall adherence to inhaled steroids was approximately 50%.
• Patients who missed one out of four doses of their prescribed inhaled steroid doubled their risk of being hospitalized.
• 60% of hospitalizations could have been prevented had patients taken their inhaled medication as directed.
• Poor medication adherence was also associated with emergency department visits and the need to use oral steroid medications, which are associated with more severe asthma.

Inhaled steroids have become the standard in the treatment of persistent asthma. They have been shown to significantly improve asthma symptoms and reduce asthma complications. However, adherence to the prescribed inhaled steroids is poor among adult asthma patients.

"Attaining Optimal Asthma Control: A Practice Parameter," published in the November 2005 JACI, recommends that asthma should be assessed each time a patient sees his or her physician, to determine whether asthma is well controlled or not well controlled. In addition:

• Asthma management needs to be individualized since each patient reacts differently to medication.
• Asthma management decisions should be driven by the level of asthma control. If asthma is completely or well-controlled, patients may be able to step-down therapy and take less medicine. Uncontrolled asthma requires a step-up in therapy, which may consist of increased medication use and more frequent visit to the doctor.

The practice parameter also states that well or complete controlled asthma control is not only possible, but that asthma sufferers should expect it. Complete asthma control is defined as:

• Full activity of exercise
• No asthma symptoms during the day or at night
• No need for "as needed" Albuterol
• No missed school or work
• Normal lung function

Patients with asthma should work with an allergist/immunologist to ensure that their asthma is well-managed. Having asthma should not stop patients from participating in normal activities. According to Attaining Optimal Asthma Control: A Practice Parameter published in the December 2005 Journal of Allergy & Clinical Immunology (JACI), the peer-reviewed, scientific journal of the AAAAI.

The parameter also provides evidence that patients with asthma who are under the care of an asthma specialist, such as an allergist/immunologist, experience:

• Fewer visits to the emergency department.
• Fewer asthma control problem.
• Less severe asthma symptoms.
• Significantly higher scores for asthma-specific quality of life and for overall general health.
• Significantly better understanding of how to manage their asthma and greater overall satisfactions with their care.

The AAAAI represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic disease. Established in 1943, the AAAAI has more than 6,500 members in the United States, Canada and 60 other countries. The AAAAI serves as an advocate to the public by providing educational information and a physician referral directory through its Web site at www.aaaai.org.

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To speak to an expert on asthma management, contact Katie Tetzlaff or Natalie Lemke at the AAAAI executive office at (414) 272-6071.