The Status of Asthma Control and Asthma Prescribing Practices in the United States: Results of a Large Prospective Asthma Control Survey of Primary Care Practices
ABSTRACT Control of asthma symptoms is, unfortunately, not a reality for many people with asthma. Asthma control is an ongoing challenge, requiring a multidisciplinary treatment approach. The National Asthma Education and Prevention Program (NAEPP) of the National Heart, Lung, and Blood Institute published its Guidelines for the Diagnosis and Management of Asthma in 1997, but the extent of implementation of recommendations in physician's practices remains to be determined. We sought to determine if a systematic implementation of the NAEPP practice guidelines would impact physician's treatment decisions for patients with asthma. The Asthma Care Network is a large, national, point-of-care program developed to assist health care providers in the assessment and management of their patients with asthma. Outcome measurements for the program included level of asthma control, activity limitation, sleep disruption, use of rescue medications, use of controller medications, and urgent care services. A total of 4,901 primary care physicians at 2,876 practice sites enrolled more than 60,000 patients. Nearly three fourths of patients reported symptoms consistent with a lack of asthma control (mean 74%, range 69-81%). Approximately 68% of pediatric patients and 78% of adult patients reported limited activities due to asthma in the past week. Sixty-two percent of pediatric patients and 68% of adult patients reported more than two symptomatic days in the past week. Approximately 40% of the patients surveyed were not using controller therapy. The overall percentage of patients reporting uncontrolled asthma who were prescribed a controller medication increased from 60% to 81%, and the use of inhaled corticosteroids containing medications among these patients increased by 52%. As a result of the assessment of the patients' level of asthma control during the office visit, physicians changed their patterns of prescribing controller therapy in patients with uncontrolled asthma.
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ABSTRACT: Ringsberg KC, Wetterqvist H, Löwhagen O, Sivik T. Physical capacity and dyspnea in patients with asthma-like symptoms but negative asthma tests. Ten female patients with asthma-like symptoms but negative asthma tests ‘study group’ were compared with 10 female asthmatics in an exercise test with and without pretreatment with β2-stimulants. The aim was to determine whether the asthma-like symptoms in the patients of the study group could be explained by bronchoconstriction, circulatory abnormalities, or physical unfitness when provoked physically, and whether the exercise test could be used to distinguish these patients from asthmatics. Without pretreatment, the asthma group reacted with bronchoconstriction, as indicated by postexercise systematic changes in PEFR, FEV1, FVC, and Sao2, which were not seen in the study group. The groups differed in the ratings of “difficulty in getting air”, as only the asthma group had significantly lower ratings when pretreated. The study group's mean test performance was 94 W; the asthma group's was 106 W. The low performance was not explained by disturbances in heart rate, electrocardiogram, or blood pressure or physical unfitness. The exercise test was found to distinguish between the groups, especially for bronchoconstriction, oxygen saturation, and ratings of dyspnea. It could be used complementary to lung function tests to eliminate bronchoconstriction, circulatory abnormalities, and physical unfitness as a cause of the asthma-like symptoms.Allergy 06/1997; 52(5):532-40. DOI:10.1111/j.1398-9995.1997.tb02596.x · 6.00 Impact Factor
Article: Asthma control in adultsBMJ (online) 05/2006; 332(7544):767-71. DOI:10.1136/bmj.332.7544.767 · 16.38 Impact Factor
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ABSTRACT: The focus in managing asthma has undergone a paradigm shift from the concept of assessing severity to assessing control. The recent Practice Parameter on attaining optimal asthma control highlights the need to titrate the step-care management of asthma to the level of control assessed at each clinic encounter. Recent advances in the monitoring of asthma control in children include the use of questionnaires such as the Childhood Asthma Control Test, use of biomarkers such as fractional concentration of exhaled nitric oxide, sophisticated hand-held electronic monitoring of lung function such as peak flow and forced expiratory volume, indicators of lung growth and bronchial hyper-responsiveness such as post-bronchodilator forced expiratory volume, outcomes-utilization data, markers of atopy, and electronic measures of adherence. Three recent proof-of-concept studies in adults have demonstrated the relevance of criteria other than guidelines-recommended asthma symptoms and pulmonary function tests. These studies used airway hyper-responsiveness, sputum eosinophilia, and fraction of exhaled nitric oxide as indices to facilitate fine-tuning of asthma control and use of controller-inhaled steroids. The next logical step would be to determine the applicability of these and other measures to children in both research and clinical settings.Current Opinion in Allergy and Clinical Immunology 05/2006; 6(2):113-8. DOI:10.1097/01.all.0000216854.95323.91 · 3.66 Impact Factor