sthma is a chronic, potentiallyfatal disease caused by inflamedairways that restrict airflow.Disease characteristics are shortness of breath, wheezing, chest tightness andcoughing.
In 1996, asthma affected anestimated 14.5 million people in theUnited States, an estimated 10.5 millionof whom were under the age of 45.
During the past two decades, thenumber of asthma cases and asthma-related deaths has increased,particularly among economicallydisadvantaged, urban, and minoritygroups.
Asthma is also increasing inprevalence among children. The deathrate due to asthma for children 19years of age and younger increased by78 percent between 1980 and 1993.
There are about 470,000hospitalizations and more than 5,000deaths each year from asthma, and it isthe third leading cause of preventablehospitalizations in the United States.
Asthma is recognized as an importantpublic health issue in the U.S. althoughit remains under diagnosed and undertreated, possibly because signs andsymptoms vary widely from patient to patient as well aswithin each patient over time.
Managing asthma requires a long-term, multi-facetedapproach, including patient education, frequent medicalfollow-up, behavior changes, drug therapy, and avoidanceof asthma triggers such as irritants, viruses, and inhaledallergens to which the patient is sensitive. About one of every five adults and children suffer from allergies,including allergic asthma.
Effective therapies are available to treat and manageasthma. Asthma therapies improve respiratory function,thus reducing coughing, wheezing, and tightness in thechest, and improve the patient
s functional activity andquality of life. However, data shows an increase inprevalence and complications of asthma despite availableeffective therapies. In 1991, in response to this data, theNational Asthma Education and Prevention Program(NAEPP) of the National Institutes of Health releasedguidelines as the first step toward attempting to reduceincidences of death and disability due to asthma.
Theguidelines were distributed to more than 300,000practitioners to enhance physician understanding of effective asthma management.In 1997, the guidelines were updated.
They recommendlong-term control with daily use of inhalers for those withmoderate to severe asthma.
Although not new, inhalerscontaining anti-inflammatory medicines have emerged asthe primary treatment for asthma.
New drugs haverecently been introduced that offer longer lasting effectsfor patients who require regular, frequent treatments, andoffer oral dosage forms that are particularly useful tochildren who may not be able to properly use inhalers.Although appropriate care and management does reducethe use of asthma-related health care services, overallcompliance with national guidelines is low.
The NAEPP guidelines also emphasize the importance of educating patients about the proper use of inhalers tomanage asthma and recommend a written action plan forpatients with moderate to severe persistent asthma or ahistory of severe asthma. However, studies from two majormetropolitan areas of adults hospitalized with asthmafound that only 28 percent of the adult patientshospitalized had written action plans that explained howto manage their asthma.
Multiple efforts to prevent and appropriately treat asthmaare being undertaken. The Center for Disease Control(CDC) is working with state and local partners toimplement and evaluate comprehensive asthmaprevention programs and is funding selected state and cityhealth agencies in their efforts to assess their asthmaprograms. As these efforts become increasingly successful,it is likely that pharmaceutical spending will continue toincrease. However, this increased use of asthmamedications not only improves the quality of care forasthma patients, but also reduces the use of other costlymedical resources.