One in three asthma patients are hospitalized, reveals new national survey

Nov 6 2009

In the past year, an estimated more than one million patients were hospitalized and nearly three million visited emergency rooms in the United States as a result of asthma, according to a new comprehensive national survey.

Additionally, approximately one in three asthma patients 12 and older surveyed were hospitalized, visited emergency rooms or had other unscheduled healthcare visits due to their asthma in the past year.  Findings from Asthma Insight and Management (AIM), a survey of 2,500 current asthma patients 12 and older, 1,004 adults without asthma and 309 physicians in the United States, showcase the burden of this chronic disease. AIM was conducted to provide a benchmark on progress in asthma care since the last landmark asthma survey in the U.S., Asthma in America (AIA), conducted in 1998. AIM is the largest and most comprehensive national survey of asthma in the United States conducted in more than a decade.

AIM revealed that while there have been incremental declines in emergency room visits and the number of patients reporting missed work or school days due to asthma, there have been no improvements in hospitalizations or other unscheduled emergency visits for asthma over the past decade.  The percentage of adults with asthma who were hospitalized, due to asthma, seven percent, was the same in 2009 as in 1998, and slightly more patients reported other unscheduled emergency visits due to asthma in 2009 (26 percent) than in 1998 (25 percent). There were incremental improvements in emergency room visits and the number of patients reporting missed work or school days due to asthma in 2009; 16 percent of adults with asthma visited the emergency room in 2009 compared with 19 percent of patients in 1998, and 20 percent of patients reported missed work or school days in 2009 compared to 25 percent in 1998.

"The AIM survey reveals significant unmet needs with regard to the current state of asthma care in the United States," said Eli Meltzer, M.D., AIM physician advisor and co-director of the Allergy and Asthma Medical Group and Research Center, San Diego, California. "We know more about how to manage asthma and prevent symptoms than ever before, but that knowledge is apparently not being translated into better outcomes for patients."

According to AIM, asthma has a significant impact on patients' daily lives, with significantly more adults with asthma reporting activity limitations when compared to adults without asthma. In the AIM survey, adults with asthma took more than three times as many sick days in the past year compared to adults without asthma, and had to limit their daily activities more than twice as often. Additional findings include:
•One in five asthma patients live in fear of hospitalizations or emergency room visits due to asthma and 29 percent of patients say that fear of asthma exacerbations keeps them from doing the things they want.
•Twelve percent of asthma patients who had an episode in the past year when asthma symptoms were more frequent or severe than normal report that these episodes last between seven and 13 days, while 18 percent reported that these episodes last three to four days. The mean duration of these episodes is 6.5 days.
•Asthma patients report a 33 percent decline in average productivity at times of the year when asthma was at its worst compared to a typical day.
•Adult asthma patients reported taking an average of 12.4 sick days compared with 3.6 sick days for adults without asthma in the past year, and 37.9 days in which they limited their activities compared with 15.8 days for adults without asthma in the past year.
•Twenty-eight percent of adult asthma patients say they feel "a lot" or "some" limitations in social activities due to their asthma compared to 14 percent of adults without asthma who say they feel "a lot" or "some" limitations in social activities due to their health.

"These results demonstrate that too many patients may simply accept a high burden of asthma symptoms," said Stuart Stoloff, M.D., AIM physician advisor and clinical professor of family and community medicine, University of Nevada School of Medicine, Reno, Nevada. "Through education, physicians can help patients understand current asthma treatment guidelines and help them avoid symptoms when possible and get back to the daily activities they enjoy."

Despite the physical and emotional burden of asthma, the majority of current asthma patients surveyed believe their asthma is well managed. More than 70 percent of patients surveyed believe that their asthma is either completely or well controlled. However, nearly half (47 percent) of these patients were classified as having very poorly controlled asthma according to the survey's classification of control, which is based on accepted guidelines, and another 24 percent were defined as not well-controlled.

Results from AIM also suggest that based on frequency of use of quick-relief inhalers, many patients may not be managing their asthma properly. Sixteen percent of asthma patients surveyed said they use their quick-relief inhaler daily, while an additional seven percent reported using their quick-relief inhaler three to six times a week. The National Asthma Education and Prevention Program (NAEPP) guidelines state that asthma patients 12 and older could, in part, be classified as having not well controlled disease if they use their quick-relief inhaler for symptom control more than two days per week, and more frequent use may indicate a need for maintenance medication.³ Based on the guidelines, daily use of asthma maintenance medications may be needed to prevent asthma symptoms in patients whose disease is not well managed, yet 39 percent of patients agree "strongly" or "somewhat" that maintenance medications are not necessary when asthma symptoms are not experienced regularly.² In addition, 42 percent of survey respondents reported that they had stopped taking their maintenance medication for a week or longer in the past year.

Patients' lack of an accurate understanding of well-controlled asthma based on the guidelines may be a result of ineffective communication with their physicians. The AIM survey reveals that physicians often use terms that patients are unfamiliar with, such as "asthma exacerbations," making effective communication difficult. The term "asthma exacerbations" is frequently used by physicians - 69 percent of family practice physicians, 93 percent of pulmonologists and 76 percent of allergists report regularly using this term when discussing asthma with their patients - yet only 24 percent of asthma patients say they have heard the term. Patients report being most familiar with the term "asthma attack" (97 percent report they have heard the term), while 71 percent of family practice physicians, 57 percent of pulmonologists and 58 percent of allergists use this term regularly when discussing asthma. Patients and physicians also report familiarity with the term "asthma flare-up." Seventy-one percent of patients say they have heard of asthma "asthma flare-ups" and 73 percent of family practice physicians, 57 percent of pulmonologists and 78 percent of allergists report using this term regularly when discussing asthma.

http://www.aim.edu.ph/