Study finds inappropriate use of asthma medication

Points to need for increased education

A majority of moderate to severe adult asthmatics are underusing inhaled corticosteroids, while some patients are overusing inhaled beta-agonists, according to a study by the Managed Health Care Association's Outcomes Management Consortium.

Only 67% of patients surveyed used a steroid inhaler, and of those, some 63% were using too little of it to get an adequate dose. On the other hand, 24% of severe asthmatics reported overuse - more than two puffs, four times a day - of their beta-agonist inhalers, despite indications that overuse can lead to toxicity or even death.

The study points to the need to improve both asthma management and patient education, says David Radosevich, PhD, RN, director of the Center for Applied Research at the Health Outcomes Institute/Stratis Health in Bloomington, MN, which coordinated the asthma project. "The patients are inappropriately using a lot of the medications for asthma."

And there are other indications that they don't understand their asthma care needs, he says. "They lack knowledge of what to do in an asthma crisis. They don't have a peak flow meter to measure asthma condition at home." A peak flow meter allows moderate to severe asthmatics to monitor their daily lung functions and to seek care before their symptoms become acute, he says.

Managed care organizations used a variety of interventions to educate patients as well as providers. The methods ranged from mailings to classes or home visits.

Intensive patient education led to greater knowledge about asthma self-care. In turn, the study found that patients who reported knowing how to manage at least one of three key aspects of asthma care experienced fewer asthma symptoms in a year and had fewer asthma attacks, higher levels of physical functioning, and better general health perceptions.

The consortium study also found better outcomes among patients treated by specialists or by generalist physicians with specialized knowledge about asthma care. Patients of specialists reported fewer work days lost due to asthma and better physical health summary scores on the SF-36 health status questionnaires.

The consortium is comprised of 15 managed care organizations and 12 employers. Researchers from the Johns Hopkins School of Hygiene and Public Health in Baltimore conducted the study.

[Editor's note: For a copy of the study or for more information, contact David Radosevich, Director, Center for Applied Research, Health Outcomes Institute/Stratis Health, 2901 Metro Drive, Suite 400, Bloomington, MN 55425-1525. Telephone: (612) 858-9188.]