Asthma care in the United States can be improved. This is a simple statement that most clinicians, asthma patients
and their families would agree with, but one that has not been so simple to
achieve. Numerous educational efforts, including the NAEPP Expert Panel
Reports of 1991 and 1997, have attempted to improve asthma care in the U.S.
but asthma still ranks as the third highest reason for preventable
hospitalizations in the U.S., with 470,000 hospitalizations and more than
5,000 deaths each year. These statistics are unacceptable to everyone
involved in asthma care. Most clinicians believe that hospitalizations due
to asthma are preventable when patients receive timely and appropriate care.
Asthma is a chronic inflammatory disease of the airways. The word
chronic in any definition should send up red flags to everyone involved that
the disease will, most likely, be difficult to treat, because it has occurred
over time and may require long-term care to manage and maintain stability. Inflammatory describes the component that is a central factor in
asthma pathophysiology and, therefore, in asthma management.
Both of the NAEPP reports strongly emphasize the importance of the use of
anti-inflammatory medications to treat persistent asthma and the role of
education for everyone involved in asthma care. Oral and inhaled bronchodilators accounted for 88.2% of the total number of
prescriptions for asthma in those years, while inhaled steroids accounted for
only 11.8%.
Clinicians need to diagnose asthma and initiate a partnership with
the patient; reduce airway inflammation, symptoms and asthma exacerbations;
monitor and manage asthma over time; and treat asthma episodes promptly.
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