For Immediate Release
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STUDY SHOWS GUIDELINES REDUCE ASTHMA-RELATED ILLNESS:
But Many Patients Don't Follow Treatment Recommendations

SAN FRANCISCO, May 20--Three months after the National Institutes of Health (NIH) released updated asthma treatment guidelines, new research presented here at the American Lung Association/American Thoracic Society International Conference indicates that many asthma patients are not following treatment recommendations from an earlier 1991 report. But one new study shows that when patients with asthma follow the recommended guidelines, their asthma improves and hospital visits dramatically decrease.

The NIH guidelines recommend that asthma patients rely heavily on daily anti-inflammatory medication that targets underlying inflammation in the airways for long-term control of asthma, while recommending more limited use of short-acting beta-agonist asthma medication for quick relief of acute asthma symptoms.

Dr. Stuart Hartz of Medical Research International in Burlington, MA and co-investigators at Harvard Medical School found, however, that most patients prescribed daily anti-inflammatory asthma medications on average appear to take less than the minimum recommended dose. Many of these patients were heavy users of short-acting beta-agonist asthma medication. The study of 605 patients found that physicians were prescribing medication in accordance with the government's asthma guidelines, but many patients were not following their doctor's advice. "We found some patients weren't even filling their prescriptions for anti-inflammatory medication," Dr. Hartz said.

A study of urban minority asthma patients that was presented at the ALA/ATS conference found that following national asthma guidelines can reduce asthma-related illness and emergency room visits. Dr. Mahmood Siddique of Case Western University in Cleveland studied 67 asthma patients, most of them African-American and Hispanic, who attended the hospital's asthma clinic. Patients were put on asthma treatment regimens in accordance with the guidelines and were educated about asthma management.

At the beginning of the study, 50% used inhaled anti-inflammatory medications. By the end of the study, all patients were using inhaled anti-inflammatory medications. At the start of the study more than two-thirds of the patients had moderate to severe lung function impairments, but by their last clinic visit, there was a significant change: 60% of patients showed only mild lung function abnormalities.

In the six months before the study, patients had a total of 114 emergency room visits and 75 hospitalizations for asthma. An average of five-and-a-half months after the study, only four ER visits occurred, with no hospitalizations. Patients rated themselves as healthier after the study as well. Before the study, 30% of patients said their asthma was mild, compared with more than two-thirds of patients by the end of the study.

"We found that by following the asthma guidelines, this high-risk inner city population not only improved their lung function, but also their knowledge of asthma," Dr. Siddique said.

Dr. Sonia Buist of the Oregon Health Sciences Center in Portland, who represents the American Thoracic Society on the national asthma panel, said that the original asthma guidelines, released in 1991, have had a major impact on the way asthma has been managed. "But there was recognition that physicians aren't following them in many parts of the country, and it's clear that many patients are not being treated in accordance with the guidelines," Dr. Buist said. She identified two challenges to achieving better compliance with the guidelines. First, while the guidelines rely heavily on daily use of anti-inflammatory medication to attack the underlying inflammation of the airways that leads to asthma attacks, this medication doesn't produce immediate relief from asthma symptoms. Instead, many patients rely heavily on short-acting beta-agonist medication, which opens up airways and provides quick relief from asthma symptoms.

A second challenge is that many patients and physicians are hesitant to use the most potent of the anti-inflammatory medications, corticosteroids, because they incorrectly assume these drugs have the same side effects as oral steroids. In fact inhaled steroids are delivered straight to the lungs and therefore side effects are minimal, Dr. Buist said.

"In countries where there has been a great emphasis on the early use of anti-inflammatory medication, there's been an enormous decrease in hospitalizations and death from asthma," Dr. Buist said.

The NIH's National Asthma Education and Prevention Program (NAEPP) new asthma guidelines, "The Report of the Second Expert Panel on the Guidelines for the Diagnosis and Management of Asthma," replace the first asthma clinical practice guidelines released in 1991. The new guidelines put a heavier emphasis on:
*early use of anti-inflammatory medication;
*reducing exposures to environmental allergens and secondhand tobacco smoke;
*teaching asthma self-management and prevention to patients;
*more aggressive detection and treatment of asthma in children;
*practical tools for physicians to help ensure that the guidelines are incorporated into actual
practice.

Dr. Shirley Murphy, professor and chair of the Department of Pediatrics at the University of New Mexico in Albuquerque and chair of the panel that developed the new asthma guidelines, said an important aspect of the new guidelines is guided self-management, in which patients take responsibility for their disease in partnership with their physician. "Patients need to have a daily medication plan as well as a crisis plan--what to do when they start to get into trouble, so they don't end up in the emergency room," Dr. Murphy said.

An estimated 14.6 million Americans, 4.8 million of them children, suffer from asthma.

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