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| |  Study Finds Asthma Treatment in US Often Differs From National Guideline Recommendations NEW YORK -- March 20, 2008 -- According to a new study published in the current issue of the Annals of Allergy, Asthma and Immunology, some patients with asthma are not receiving prescriptions for inhalers that offer long-term control of the disease, despite the recommendations of the Expert Panel 2 Guidelines for the Diagnosis and Management of Asthma (EPR-2) issued by the National Heart, Lung and Blood Institute more than a decade ago. The study, conducted by Rajesh Balkrishnan, PhD, Merrell Dow Professor of Pharmacy, Pharmacoeconomics and Outcomes Research, Pharmacy Practice and Administration, College of Pharmacy, Ohio State University, Columbia, Ohio, and colleagues, examined data from more than 800 million asthma-related visits to doctors' offices between 1998 and 2004 taken from the National Ambulatory Medical Care Survey, which tracks US annual outpatient medical visits. The study looked at trends and comparisons among different types of patients and physicians. Due to the survey nature of the data, researchers could not accurately estimate the number of patients receiving specific types of medications because data existed for just 1 visit per patient, rather than entire prescribing histories. The trend analysis showed that patients with asthma overall had 3.3 times higher odds of being prescribed controller medications in 2002 than did those visiting doctors in 1998. However, treatment disparities based on age and race were also evident. During the course of the time period analysed, patients aged older than 65 years had 54% lower odds of receiving controller medication compared with patients between the ages of 35 and 64 years. In addition, patients listed in the "other" race category in the survey -- potentially patients of Asian or Hispanic background -- were only 40% as likely to receive controller medications as were white patients. Such disparities were not evident when prescriptions for African American and white patients with asthma were compared. The 1997 EPR-2 guidelines specified that anti-inflammatory medications, such as inhaled corticosteroids, leukotriene modifiers, and mast cell stabilizers, should be the prescribing physician's first choices in treating the underlying chronic inflammatory processes in asthma. In addition, the guidelines recommended using long-term controller medications for patients with persistent asthma and short-term reliever medications for acute symptoms only. EPR-3 guidelines were issued in 2007 with similar, but updated, recommendations. Inhaled corticosteroids are considered the most effective long-term asthma control for all age groups. Reliever medications that should be used for only acute symptoms include short-acting beta-agonists that relax muscles in the airways, anticholinergic agents that inhibit nerve impulses, and systemic corticosteroids. Researchers noted that changes in the treatment landscape could be a complicating factor in the ability of physicians to stay up to date on preferred treatments. During the time period analysed, a new kind of controller medication -- a long-acting beta-agonist -- was approved by the FDA for asthma treatment. Within just a few years, however, this agent came under scrutiny because of its apparent cardiovascular risks to some patients after long-term use. Only a third of the patients in the survey were treated by lung or allergy specialists. That suggests most asthma patients are treated by generalists who might need to be further educated about asthma and other specialty medical conditions to prescribe the most effective treatments. Balkrishnan noted that costs should not have a significant influence on which medication is prescribed, because even the most expensive of the commonly prescribed controller medications are covered by private and public insurance, such as Medicare and Medicaid. Of the patients in the study, 89% were covered by some type of insurance.
SOURCE: Ohio State University, Columbus, Ohio
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