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| |  Physicians Under-Prescribing Important Asthma Therapy PHILADELPHIA, June 9, 1997 -- A study by researchers at Allegheny University of the Health Sciences (AUHS), appearing in today’s issue of the Archives of Internal Medicine, suggests that physicians are not following national guidelines for prescribing therapy for patients with asthma. The finding could represent a set-back in nationwide efforts to reduce the significant morbidity and mortality associated with asthma --essentially a controllable disease. "Our work suggests a strong tendency by physicians to direct asthma management toward symptomatic relief, rather that toward the longer-term reduction of inflammation," said David Lang, M.D., associate professor of Medicine and director of Allergy and Immunology at AUHS. Guidelines from the National Heart, Lung and Blood Institute (NHLBI) have encouraged more frequent use of inhaled steroids for asthma management, with concomitantly decreased reliance on bronchodilators. Inhaled steroids are the most potent and effective anti-inflammatory therapy currently available for moderate or severe asthma, and are well-tolerated and safe at recommended dosages. Bronchodilators have a short-term "quick-relief" effect on asthma symptoms and do not address the inflammation that characterizes chronic asthma. In August 1991, under the auspices of the National Asthma Education Program, an expert panel published "Guidelines for the Diagnosis and Management of Asthma" that encouraged more frequent use of inhaled steroids. Yet, in looking at the period from July 1991 to June 1993, the researchers found a widening gap between optimal and actual prescribing patterns for asthma drugs in Philadelphia; in fact, while prescriptions for bronchodilators were relatively constant, prescription rates for inhaled steroids declined substantially. "We have shown a tendency for underuse of inhaled steroids in Philadelphia that has only grown since release of the NHLBI guidelines," noted Dr. Lang. "Unfortunately, the higher rates of bronchodilator use and lower rates of inhaled-steroid prescriptions occur in Philadelphia zip codes with lower educational levels -- suggesting that interventions that include addressing the special asthma care needs of a low literacy population will be required to achieve the goals of the National Asthma Education Program." Asthma, a chronic inflammatory disease of the airways, affects an estimated 14 to 15 million Americans and is the most common chronic pediatric disease, affecting approximately 4.8 million children. People with asthma have more than 100 million days of restricted activity and 470,000 hospitalizations annually. More than 5,000 Americans die from asthma each year. This study follows on the heels of Dr. Lang's December 1994 report in the New England Journal of Medicine that found a tripling of asthma-related deaths in Philadelphia over the last two decades. The Archives study was co-authored by AUHS faculty Michael Sherman, M.D., associate professor of Medicine, and Marcia Polansky, Sc.D., associate professor, AUHS School of Public Health. Advance copies of "Guidelines and Realities of Asthma Management" from the June 9 Archives of Internal Medicine are available from Natalie Olinger at the AMA Science News Bureau, 312-464-4465.
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