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Greater use of guideline-recommended asthma medication in the past decade may have contributed to the leveling off of office-based asthma visits, according to a study supported by the Agency for Healthcare Research and Quality (HS13405). Updated Federal guidelines emphasize the importance of long-term control of underlying airway inflammation in asthma treatment, a significant shift from traditional relief therapies.
Inhaled corticosteroids, either alone or in combination with long-acting beta agonists, are recommended as first-line therapy for persistent asthma. Short-acting inhaled beta-agonists, adrenaline-like medications that quickly open up the airways, are preferred only for intermittent asthma, to relieve acute exacerbations, or to prevent exercise-induced asthma.
To examine the link between clinical guidelines, asthma medication, and office-based visits, researchers led by Randall S. Stafford, M.D., Ph.D., of Stanford University, analyzed data from the National Disease and Therapeutic Index to track 1978-2002 trends in asthma-related office visits and prescribing of asthma medication. Although there was a doubling in the estimated annual number of asthma visits between 1978 and 1990 (from 8.5 to 17.7 million) in the United States, the number of asthma visits stabilized at a mean of 16 million between 1991 and 2002. In other words, asthma visits increased from 4 to 7 per 100 people between 1980 and 1990, but that number has stabilized at 6 per 100 people since then.
Controller medication use increased eight-fold between 1978 and 2002, with inhaled corticosteroids manifesting the biggest increases. The use of reliever medications decreased modestly over this period. Improved appropriateness of asthma medication was also suggested by an increase in the ratio of inhaled steroids to short-acting inhaled beta agonists, which reached 92 percent in 2002. More recent drug entrants have been adopted rapidly. Single-entity long-acting inhaled beta-agonists (salmeterol and formoterol) were used in 9 percent of visits and leukotriene modifiers (montelukast, zafirlukast, and zileuton) were used in 24 percent of visits in 2002.
More details are in "National trends in asthma visits and asthma pharmacotherapy, 1978-2002," by Dr. Stafford, Jun Ma, M.D., Ph.D., R.D., Stan N. Finkelstein, M.D., and others, in the Journal of Allergy and Clinical Immunology 111, pp. 729-735, 2003.
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