According to the Asthma and Allergy Foundation of America (AAFA), asthma affects more than 22 million Americans. Data from 2004 have shown that it accounts for 1.8 million emergency room visits, 500,000 hospitalizations, and 4,000 deaths each year. For children, asthma is associated with nearly 13 million missed days of school, ranking as the leading cause of school absenteeism. In adults, the disease leads to more than 10 million missed days of work annually. The AAFA recently conducted a nationwide telephone survey of asthma sufferers and physicians to determine the existing gaps between awareness and perceptions of the disease. The survey was the second phase of the Asthma G.A.P. in America: General Awareness and Perceptions survey (www.AsthmaGap.com), which was initially launched in 2007 and revealed widespread misperceptions about asthma control.
Patient Misconceptions Persist
The AAFA survey demonstrated that most asthma patients know the risks of “uncontrolled asthma,” but they misinterpret asthma control. “Patients are not realizing that asthma is a chronic disease that requires long-term therapy, even when asthma symptoms aren’t present,” says Reynold A. Panettieri, Jr., MD (Table 1). “Most patients—about 97%—understand that uncontrolled asthma poses serious health risks, but 70% of those who had taken asthma controller medicines stopped their prescribed long-term treatment because they incorrectly believed their asthma was under control. Nearly a third didn’t believe that it’s harmful to stop taking controller medications if they’re not having symptoms.”
When left untreated, the chronic inflammation that occurs in asthma can lead to progressive loss of lung function and other severe consequences. “For patients with persistent asthma, controller medications or maintenance therapies can help manage chronic lung inflammation,” Dr. Panettieri explains. “When taken over the long term, asthma controller medications have been shown to control disease-related symptoms and improve lung function. This survey shows that there’s a striking divide between what patients know about their asthma and the actions they take to optimize control of their symptoms.”
Among all patients surveyed, many who had stopped taking their controller medications in the past 12 months reported experiencing a sudden asthma episode that led to some consequence. “The troubling part of this finding,” says Dr. Panettieri, “is that these problems are occurring even though 93% of patients indicated that controller medications work best when taken every day.”
Concern for Physicians
The AAFA also assessed physician beliefs and attitudes on asthma (Table 2). About 80% of physicians revealed that they were concerned that if their patients stopped their asthma controller medications, they may face serious consequences, including frequent, unexpected hospitalizations and trips to the emergency room. About 55% of physicians believed that only between 40% and 60% of patients were taking their controllers as instructed. Of the 300 physicians surveyed, only two believed that 90% or 100% of their patients took their controllers as instructed. “Most physicians believe that it can be difficult to explain the role of inflammation to patients because airway inflammation is not transparent until acute symptoms are present,” Dr. Panettieri says. “This underscores the need for more physician-to-patient education about asthma control and appropriate therapies.”
Each time an exacerbation occurs, Dr. Panettieri says that physicians can often enable patients to get better with therapy. “However, we need to recognize that some patients will never have their lung function return back to their pre-exacerbation levels. This loss-of-function effect is important to recognize. As such, physicians need to take steps toward focusing on the prevention of exacerbations.”
Action Plans Required
Clinicians and patients also need to work collaboratively to enhance outcomes. “The first step to asthma control is for patients and physicians to create an asthma action plan, which may include a controller therapy,” Dr. Panettieri says. “Physicians should refer to current asthma management guidelines, such as those from the National Heart, Lung, and Blood Institute. Asthma is properly controlled when patients are able to carry out all their normal daily activities. When oral corticosteroid therapy is required, patients should experience a decrease in weekly symptoms—no more than two times per week—and in yearly asthma attacks—no more than one attack per year. Action plans should be developed for patients who may experience minor exacerbations as well as for situations in which major attacks occur. Proper care and treatment is paramount to helping patients gain better control of their asthma symptoms. Physicians should help their patients take action to better manage symptoms through appropriate treatment, tools, and resources, many of which are available at www.AsthmaGap.com.”
Reynold A. Panettieri, Jr., MD, has indicated to Physician’s Weekly that he has worked as a consultant and paid speaker for Merck and AstraZeneca, and has received grants/research aid from AstraZeneca and Immune Control.
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