Creative approaches help members keep asthma under control

Costs of disease top $11.6 billion a year

Health plans across the country are coming up with innovative ways to tackle asthma, a disease that costs $11.6 billion a year in direct health care costs, according to the American Lung Association.

Strategies run the gamut from working with local agencies to improve air quality in the community to visiting patients in the intensive care unit following an asthma attack.

More than 20 million Americans suffer from asthma, according to the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics.

Asthma was the primary cause for 12.7 million physician office visits, 1.2 million hospital outpatient department visits, 1.9 million emergency department visits, 484,000 hospital visits, and 4,261 deaths in 2002, the latest year from which statistics are available, according to the CDC.

The condition accounts for 12.8 million lost school days and 24.5 million lost workdays every year, according to the CDC's statistics.

In this issue of Case Management Advisor, we'll profile the asthma management programs of four health plans, which take different approaches to helping members keep their disease under control.

Asthma is one of the few chronic conditions that appear to go away for a period of time. The lack of ongoing symptoms prompts people to stop taking their medication, thus precipitating an asthma attack, says Janis Sabol, RRT, team coordinator for the asthma program at Optima Health, a Virginia Beach, VA, insurer.

The American Lung Association's National Asthma survey revealed that although patients and parents of patients say asthma is easy to control, most have a high tolerance for recurring asthma symptoms, lifestyle accommodations, and negative family impact.

Among those replying to the survey, 83% of parents of asthma patients and 75% of adult patients with asthma reported unscheduled visits to the physician over the past year due to asthma attacks.

Most patients and parents of patients who responded to the survey believed that asthma should be treated when symptoms appear and do not recognize the difference between controller and reliever medications.

The lack of understanding of the treatment and management of asthma is present even among those with persistent asthma, the survey showed.

When asked to name a controller medication, 73% of adult patients and 79% of parents of asthmatics named a reliever medication.

"One of the reasons people are not compliant with their medication regime is that they don't see immediate results from inhaled steroids. Patients have to use them every day for a while before they notice a change in symptoms. When they use the rescue medication, they notice a difference as quickly as 30 seconds later," Sabol says.

When she talks to members about asthma management, Amy Vissing, RN, BSN AE/C, asthma disease manager for Passport Health Plan, compares using the controller medication to using sunscreen when you go out into the sun.

"People with asthma have sensitive airways, and they are very sensitive to things they breathe in. The controller medication helps them avoid attacks, just like sunscreen helps them avoid a sunburn," she says.

Among the misconceptions that people with asthma have is thinking that they outgrow asthma. Although the symptoms can abate as people age, once someone has asthma, they always have sensitive airways and can experience an asthma attack at any age, adds Terry Watson, RN, manager of Passport's health management department.

"We need to circle the wagons to get around this disease process. We have to work together because there are so many people being diagnosed," says Pamela Persichilli, RNC, director of clinical operations for Horizon NJ Health.