Quality of Life for Asthmatics Improved Little Over a Decade

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.