Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: Asthma Deaths on the Increase



At the recent College of Allergy and Immunology meeting in Orlando, Florida, much discussion was made of the paradox of increasing mortality from asthma despite improved therapy. This has been pointed out in several papers from the world allergy literature over the past five years. Studies ongoing in the United States, England, New Zealand, Australia, Scandinavia and Germany all point to the same findings. That is, that despite better therapy and better medical access in general, there seems to be a slight but steady decrease in hospitalizations and deaths in the general population. This is more prevalent in adults than in children, however it is present in both. There are several speculated reasons for this and a discussion at the recent meeting was on the importance of each of these. The speculated reasons include:

(1) Changes in the diagnosis of asthma itself. Because of Medicare coding changes in 1979 asthma is now separated from chronic bronchitis and emphysema and so more asthma may be diagnosed in adults.

(2) Improved recognition of asthma by physicians. There is a better access of diagnosis of tricky cases today with pulmonary function studies, as well as other means of diagnosing asthma in children and adults.

(3) An increased prevalence of asthma. For some unexplained reason there seems to be more asthma diagnosed than ever both in young children and in older adults.

(4) An increase in the severity of asthma. In other words certain asthmatics have a more aggressive hard to control disease than in the past.

(5) And, most important, massive under-treatment of asthma. In other words, these studies show that a large number of the moderate to severe asthmatic patients are not getting enough of the proper medications to control their asthma.

(6) A tendency for patients to self medicate themselves with over the counter medicines such as Primatine Mist and other medicines which are not state of the art for asthma.

(7) Changes in weather and air quality. There is some suggestion that pollution, particularly in inner cities, is a big factor in controlling severe asthma and possibly a global climatic change may be affecting asthma in countries as far apart as the United States and Australia. This is presently being studied but is not conclusive.

In considering all of these possible causes of increase in asthma, the increase in the severity of asthma, and increasing mortality from asthma, the one area that we certainly have control over is the massive under treatment of asthma, worldwide. There are so many good medicines to control asthma these days. In particular, anti-inflammatory medicines such as inhaled corticosteroids and inhaled chromalin are very safe and effective particularly for chronic moderate to severe asthma. These are being under-used and used improperly in many cases and should be the thrust of all physicians who take care of asthmatics to increase the proper use of these medicines.

Any moderate to severe asthmatic who has had scary episodes of "out of control" asthma in the past should have a written "step by step" plan worked out with their doctor. This would include exactly what to do step by step for different degrees of severity in the progression of their asthma and how to get in touch with that doctor or the nearest emergency room or acute care center should things not respond according to the plan.

The ultimate goal of the recent conference in Orlando as well as the hope of all asthma specialist is that we can decrease the increasing asthma mortality through better patient education. Recognizing asthma early, treating it appropriately and following it closely with good monitoring by the doctor or health unit or school nurse does make a difference as was shown by several papers presented at the conference. As in any chronic disease, the more you understand it the less threatening it is and the better you can control it. In the next article I will go into detail about understanding asthma and controlling it better.