Newswise — The occurrence of asthma has doubled in the U.S. since the 1980s and African Americans shoulder a disproportionate risk of hospitalization and death from the disease. William E. Berger, M.D, MBA, Mission Viejo, Calif., president of the American College of Allergy, Asthma & Immunology (ACAAI), moderated a panel of experts to discuss the factors contributing to this increasing health threat and the measures that could be taken to curtail its growth at the 61st ACAAI Annual Meeting in New Orleans.
"African Americans are a minority population yet they account for nearly one-fourth of asthma-related deaths," said Michael Foggs, M.D, Chicago, of the National Medical Association (NMA). In the inner city he noted, factors contributing to this complex health care crises include under-referral, inappropriate drug therapy, restrictions on medications imposed by Medicaid or Managed Care policies and environmental factors. "We are in the midst of an asthma epidemic," said Dr. Foggs. In response, the NMA has undertaken several initiatives including patient and physician education programs to promote earlier diagnosis in the inner city. Dr. Foggs said more studies are needed to better understand why the African Americans suffer so severely from a disease that is considered manageable.
In the description of his first-hand experience with patient care, Bob Lanier, M.D., Fort Worth, Texas, of the North Texas Health Science Center, said that therapeutic treatments have improved over the years, yet access to some of the newer medications is restricted. For example, the managed care environment has introduced a pre-authorization requirement for emergency medications. Doctors treating a patients in the emergency room must adhere to a list of pre-approved medications that may be less than optimal.
"Managers looking at pharmacy costs are not seeing the bigger picture," said Lanier. In a specific case, levalbuterol - a new and refined version of albuterol (a longstanding and inexpensive mainstay therapy for asthma exacerbations) " is excluded from these pre-approval lists because the cost of the newer drug is about $1.00 more per dose than traditional the albuterol formulation. Managers see a potential for cost-savings when they are looking the cost differential, but what these managers do not observe is the greater costs savings associated with keeping the patients out of the hospital. Dr. Lanier said that the emergency room physicians should be able to manage the patient without restriction and would like to see "compassionate legislation" to endorse this view. He reiterated that, "The least expensive medication can be sweet initially yet a bitter pill to swallow in the long run."
Sandra Fusco-Walker, Fairfax, Va., director of the Asthma & Allergy Network Mothers of Asthmatics said that children with asthma in half the states in the U.S. are at risk because they are unable to carry their measured dose inhalers while in school. The Network lobbies states on behalf of these children and introduced HR2023, a federal bill linking federal asthma funding to states implementing programs that permit children to carry their inhalers.
Another area of concern according to Ms. Fusco-Walker is that the use of measured dose inhalers is less than optimal because it is not always obvious to the patient when the dosage is low or the inhaler is empty. Due to the Networks efforts and her research, some pharmaceutical companies are already addressing the issue. She also appealed to the physicians to use language in a manner that suits the patient, and Mothers of Asthmatics has developed public information materials to address this goal.
Summarizing the discussion, Dr. Berger concluded that "No asthma should be out of control with proper management. Both children and adults who have an asthma action plan and appropriate medication will have fewer hospital visits. We are optimistic that the impact of asthma can be reduced with collective support from healthcare providers, school administrators, teachers, coaches, researchers, community groups and health organizations."
The ACAAI is a professional medical organization, headquartered in Arlington Heights, Ill., comprised of 4,963 qualified allergists-immunologists and related health care professionals. The College is dedicated to the clinical practice of allergy, asthma and immunology through education and research to promote the highest quality of patient care.
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