Approximately one in five older people even those with good health insurance misuse their asthma drugs, and doctors fail an even greater proportion by not managing their care aggressively or giving them enough information to manage symptoms on their own, according to a report from Johns Hopkins researchers expected at the American Thoracic Society's annual meeting today.
"This is a wake-up call that doctors need to review medications that patients are using and improve other aspects of care," says Linda Wolfenden, M.D., a postdoctoral fellow in the division of pulmonary and critical care medicine at Johns Hopkins. "We are missing opportunities to control this disease. Doctors need to increase their efforts to implement all components of the asthma guidelines, and patients need to remind themselves that asthma care involves more than just taking medications." The shortcomings, she says, may explain why almost one in five older people studied ended up in the hospital.
To examine how older individuals are coping with asthma, the Hopkins team reviewed information from 237 insured men and women 70 or older. They found that their lackluster care fell significantly short of care described in the National Asthma and Education Prevention Program (NAEPP) guidelines. Twenty percent did not use an inhaled corticosteroid. Taken once or twice daily to quiet lung inflammation, this drug reduces the likelihood of an asthma attack before it begins, helps change the course of the disease, and is considered the first line of defense against the disease. Underuse of the drug increases the risk of an asthma attack triggered by allergens such as dust, cockroaches, pets, perfume or pollution.
The researchers also identified overuse of other drugs, beta agonists and theophylline, that provide short-term relief. "These drugs stimulate the nervous system, revving up heart rate and blood pressure," says Wolfenden, lead author of the study. "They
Contact: Kate O'Rourke
Johns Hopkins Medical Institutions