Managing asthma takes physician diligence

The aggressive treatment of asthma with anti-inflammatories is sometimes overlooked.

By Susan J. Landers, amednews staff. June 11, 2001.

Washington -- The seriousness of asthma can go unrecognized.

This became alarmingly clear in a Washington, D.C., courtroom in April when a 54-year-old man, appearing for a misdemeanor hearing, collapsed and died following an asthma attack, despite telling a judge, lawyers and nurse that he was unable to breathe.

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This event serves as a reminder this chronic illness is not always recognized as the life-threatening disease that it can be.

The incidence of asthma in this country has increased dramatically in recent years, yet many patients, and even some physicians, fail to take the disease as seriously as they should, according to a new report.

"Asthma is an extremely common problem that has been neglected for a number of years," said E. Regis McFadden Jr., MD, professor of medicine and the program director of the General Clinic Research Center at Case Western Reserve University School of Medicine in Cleveland.

Dr. McFadden spoke at a press conference on Capitol Hill May 9 to unveil the report "Asthma: Separating Facts from Fiction," released by the Annapolis Center for Science-Based Public Policy, a nonprofit organization located in Annapolis, Md.

The report was prepared from discussions held at the center by a group of physicians and scientists knowledgeable about the disease.

"Asthma is a chronic illness with enormous amounts of morbidity," said Dr. McFadden, who participated in the discussions. But the disease can be very manageable if the proper treatment guidelines are followed, said the center's president and chair, Harold M. Koenig, MD.

Although Alvin V. Thomas, MD, chief of pulmonary and critical care at Howard University Hospital in Washington, D.C., believes physicians do take the disease seriously, he also believes that some doctors don't understand the best way to treat it.

For years, asthma was thought to be a disease in which bronchial spasms were the only symptom, Dr. Thomas said. "But over the past decade or so it has become clear that there is also a component of inflammation that is an ongoing, smoldering problem in the lungs that needs to be treated just as aggressively."

Treatment with corticosteroids is very effective, Dr. Thomas said. "If there is a problem, ... it is that [the medical community doesn't] use corticosteroids often enough."

A new study in the May 23/30 Journal of the American Medical Association echoed this sentiment, recommending that physicians should continue to prescribe inhaled corticosteroids for patients whose asthma is well-controlled by that medication, even when prescribing a long-acting beta-2-agonist. Researchers found that patients were at risk for a clinically significant loss of asthma control if they discontinued the use of the inhaled steroid in favor of salmeterol xinafoate, a long-acting beta-2-agonist.

A treatment path

Guidelines that cover treat-ment options, including the need to use anti-inflammatories, were developed by the National Institutes of Health in 1997.

But fewer than half of physicians follow them, said Norman H. Edelman, MD, consultant for scientific affairs at the American Lung Assn.

Although following the guidelines and treating asthma aggressively with steroids is basic, Dr. Edelman said, physicians also need to diagnose the asthma in the first place. "Several studies have shown that perhaps one-third of people, especially children with asthma severe enough to need treatment, go undiscovered," he said.

Physicians need to do more breathing tests in the office and be sensitive to the less typical symptoms of asthma, such as the child who coughs a lot after running or who is always waking up during the night coughing, Dr. Edelman said.

Reps. Edolphus Towns (D, N.Y.) and Cliff Stearns (R, Fla.) also appeared at the press conference. Towns noted that he had seen a recent increase in the number of asthma cases in his Brooklyn district, particulary among blacks and Hispanics.

Nationally, the incidence has increased from 6.7 million in 1980 to 17.3 million in 1998, the report said. And the prevalence of asthma in children has doubled during the past 15 years.

Stearns said asthma has a disproportionate impact on poorer people and noted that he supports President Bush's proposal to increase the NIH budget as a way to bolster necessary research in several areas of health care.