A matter of control
PROPERLY controlled, asthma has little or no effect on a person’s life. And yet, each year, millions of Americans miss days of school and work because of their disease -- unable to participate in normal day-to-day activities. Many land in the hospital, struggling to breathe.
Asthma attacks are responsible for more than 1.5 million emergency room visits each year and more than 500,000 hospitalizations, according to the National Heart, Lung and Blood Institute. Overall, the group says, the disease costs the nation $11.3 billion each year in both direct and indirect costs.
In people with asthma, inflammation and spasm of the small breathing tubes of the lungs make it difficult to move air into and out of the lungs. Although effective medications are available, studies suggest that asthma is adequately controlled in no more than half of all people with the disease.
“People are not doing nearly as well as they should be,” says Dr. Michael Schatz, an asthma specialist at Kaiser Permanente in San Diego.
Controlling asthma means preventing troublesome symptoms such as coughing, wheezing and shortness of breath, and all but eliminating frightening asthma attacks, in which the narrowing of the airways hampers breathing. It also means ensuring that people with asthma can remain fully active and do all of the things they usually enjoy.
This kind of control requires the correct use of two types of medications: “control” medications, which treat the underlying disease, and “quick-relief,” or “rescue,” medications, which are designed to reverse asthma symptoms. Ideally, control medications are taken on a regular, daily basis -- whether symptoms are present or not. Rescue drugs, on the other hand, should be used only occasionally to relieve acute symptoms when they occur.
But many people who should be taking control medications are not. Instead, they depend on rescue medications to bail themselves out of trouble -- treating only the symptoms of their disease, not the disease itself.
“Patient expectations are a big part of the problem,” says Schatz. Because many people with asthma don’t expect to feel 100%, they’re often satisfied with simply feeling a little better.
Research clearly shows that many people with asthma overestimate how well their asthma is being controlled. In a large national survey published in 2004 in the Journal of Allergy and Clinical Immunology, three in five people experiencing moderate symptoms and almost one in three suffering severe symptoms considered their asthma to be well controlled or completely controlled.
Doctors are partly to blame. “Physicians often don’t recognize the lack of control,” says Schatz. When their patients tell them that they are doing well, they generally take them at their word and frequently delve no further. Gauging asthma control is particularly difficult with children, because parents’ perceptions of their child’s disease often differ dramatically from what the child is actually experiencing. In a 2004 survey conducted by GlaxoSmithKline, a manufacturer of asthma medications, children with asthma and their parents consistently disagreed on how asthma was affecting their lives.
While 40% of children responded that they had experienced breathing problems in the last four weeks, only 18% of their parents believed that they had. Wheezing or whistling was reported by 45% of the children and only 24% of their parents. Complicating the problem, some children admitted hiding symptoms from their parents in order not to worry them.
Tests of lung function can be a useful, objective measure to aid doctors in evaluating asthma control, but the tests do not always correlate well with symptom severity. Someone with seemingly near normal lung function, for example, might still suffer from persistent coughing or wheezing. But a new questionnaire endorsed by the American Lung Assn. appears to be quite useful in evaluating these more subjective factors. In a recent study published in the Journal of Allergy and Clinical Immunology, scores on this five-item questionnaire correlated closely with asthma control.
People with asthma can use the questionnaire (available at www.asthmacontrol.com) to help determine whether they are achieving optimal results with their therapy.
Once identified, poorly controlled asthma can almost always be treated -- and the place to start is with one’s own expectations.
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Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. She can be reached at themd@att.net.
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Test your breath management
The Asthma Control Test was designed to help people with the disease describe how it affects them. Each response has a point value from 1 to 5. To score the test, add the point values of each response.
* In the last 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school or at home?
“All of the time” (1 point), “Most of the time” (2 points), “Some of the time” (3 points), “A little of the time” (4 points), “None of the time” (5 points).
* During the last 4 weeks, how often have you had shortness of breath?
“More than once a day” (1 point), “Once a day” (2 points), “3 to 6 times a week” (3 points), “Once or twice a week” (4 points), “Not at all” (5 points).
* During the last 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning?
“4 or more nights a week” (1 point), “2 to 3 nights a week” (2 points), “Once a week” (3 points), “Once or twice” (4 points), “Not at all” (5 points).
* During the last 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as Albuterol, Ventolin, Proventil, Maxair or Primatene Mist)?
“3 or more times per day” (1 point), “1 or 2 times per day” (2 points), “2 or 3 times per week” (3 points), “Once a week or less” (4 points), “Not at all” (5 points).
* How would you rate your asthma control during the past 4 weeks?
“Not controlled at all” (1 point), “Poorly controlled” (2 points), “Somewhat controlled” (3 points), “Well controlled” (4 points), “Completely controlled” (5 points).
If your total point value is 19 or below, your asthma may not be well controlled.
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Source: QualityMetric Inc.
