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October 6, 1998

Asthma in America Falls Far Short of National Treatment Standards
Landmark national survey suggests that gap in asthma care is taking a serious toll on the nearly 15 million Americans who have asthma

WASHINGTON, DC (October 6, 1998) -- One in three children with asthma had to go to an emergency room because of an asthma attack in the past year, reports a major survey released today.

The survey also reveals that 41 percent of all asthma patients--an estimated six million Americans--were hospitalized, treated in emergency rooms or required other urgent care for asthma in the last year. The finding is one of several that suggest the nation is falling far short of new government guidelines for asthma care--and that, for many people, a generally controllable disease may be out of control.

This is the conclusion of Asthma in America, one of the largest national surveys ever conducted about asthma, a chronic lung disease that affects nearly half of all American families. Researchers interviewed 2,509 asthma sufferers, 512 doctors and 1,000 members of the general public on many aspects of the condition.

The result is a comprehensive view of asthma in America, one which reveals that the nation is falling short of the goals for asthma care established by the National Heart, Lung and Blood Institute (NHLBI), part of the National Institutes of Health¹. A point-by-point comparison shows that asthma is not being controlled as well as it could be:

> The national goal: no missed school or work because of asthma. The survey: 49 percent of children with asthma and 25 percent of adults with asthma missed school or work due to asthma in the past year.

> The national goal: asthma symptoms should not disrupt sleep. The survey: almost one in three asthma patients (30 percent) is awakened with breathing problems at least once a week.

> The national goal: maintain normal activity levels. The survey: 48 percent say asthma limits their ability to take part in sports and recreation; 36 percent say it limits their normal physical exertion; and 25 percent say it interferes with their social activities.

"These are disturbing findings and further underscore what we know to be a serious health problem in this country," says Dr. Scott Weiss of Harvard Medical School, a leading asthma expert and a medical advisor for the survey. "They show that asthma is often poorly managed and that too many people suffer needlessly."

The survey also shows that people have a tendency to underestimate the severity of their asthma. Only 22 percent of people whose symptoms suggest they have severe, persistent asthma according to NHLBI guidelines actually rated their asthma as severe. At the same time, people overestimate how well their asthma is being controlled. Thirty-two percent of those who had severe symptoms in the past four weeks - and 61 percent of those who had moderate symptoms - said they thought their asthma had been "completely controlled" or "well controlled" during that time.

"Too many people are selling themselves short," says Nancy Sander, the president of Allergy and Asthma Network/Mothers of Asthmatics, and herself an asthma sufferer. "Every day, I hear from people who have been rushed to the hospital or who have given up activities they love. They don't understand how treatable asthma is - most people can live a normal active life if their asthma is treated appropriately."

One reason that asthma is so poorly controlled, the survey suggests, is a communications gap between asthma patients and their healthcare providers. Though most patients give their doctors high marks and most doctors say they follow the NHLBI's asthma management guidelines, there are real disparities between what doctors say and what patients say:

> 70 percent of doctors say they use spirometry to measure a patient's airflow on an ongoing basis, but only 35 percent of patients report having a lung-function test in the past year;

> 92 percent of doctors said that anti-inflammatory drugs were either "essential" or "very important" in the long-term management of persistent asthma, but only 18 percent of asthma patients report using an anti-inflammatory medication in the past four weeks;

> 83 percent of doctors say they prescribe peak-flow meters that allow patients with chronic asthma to monitor their condition, but only 28 percent of asthma patients actually have one and only 9 percent report using one at least once a week; and

> 70 percent of doctors say they prepare a written action plan for all, most or some of their patients, but only 27 percent of patients say their doctor has developed a written action plan for them.
Asthma in America also suggests that one of the reasons for the "treatment gap" revealed by these figures is widespread misunderstanding among patients. Fewer than one in ten patients (9 percent) could name asthma's underlying cause (inflammation) without being prompted. Half of patients said it was possible to treat only asthma attacks and symptoms and not their underlying cause. In fact, the survey suggests that many asthma patients take medication only when they have symptoms: 61 percent of patients with quick-relief inhalers use them three times a week or more - a level of frequency the NHLBI guidelines say indicates a need for greater long-term control medication. In contrast, the survey shows that fewer than one in five patients (19 percent) with persistent asthma takes inhaled corticosteroids, the anti-inflammatory drugs the NHLBI guidelines say are "the most effective long-term control medication for asthma" for patients five years and older.

The answer, say asthma patients, is more education -- 71 percent believe there is a "strong need" for it.

Nearly 15 million Americans have asthma² and the prevalence rate has increased by 75 percent between 1980 and 1994³. In addition, the survey found that nearly four out of five Americans (77 percent) are directly affected by asthma: half (48 percent) of all Americans have asthma in their household or immediate family; an additional 29 percent know someone with the disease.

Asthma in America was conducted by Schulman, Ronca and Bucuvalas, Inc., a national research firm specializing in health issues and was funded by Glaxo Wellcome Inc., a research-based pharmaceutical company.

Survey interviews were conducted by telephone from May 21 to July 7, 1998. The maximum expected sampling error for a simple random sample of 2,500 (e.g., patient survey) is +/- 2.0 percentage points at the 95 percent confidence level; +/- 3.1 percentage points at the 95 percent confidence level for a sample of 1,000 (e.g., public survey); and +/- 4.4 percentage points at the 95 percent confidence level for a sample of 500 (e.g., doctor survey).

Click here to visit the Asthma In America Web Site.
References
1. Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma, National Heart, Lung and Blood Institute, National Institutes of Health, May 1997.
2. Estimated at 14.6 million by the National Center for Health Statistics, Vital and Health Statistics, December 1995; 10(193): table 62.
3. "Surveillance for asthma - United States 1960-1995," Morbidity and Mortality Weekly Report, April 24, 1998; 47(SS-1).