Opinion

POSTED: Friday, May. 15, 2009

Time for our state to do a better job treating asthma

Untreated asthma is a serious health issue that can lead to death. Patients with asthma have been identified by the Centers for Disease Control as at high risk for serious illness in a flu outbreak, like the current swine (H1N1) flu pandemic. Undertreated asthma means more frequent visits to doctors and emergency rooms, occasionally ending in an expensive stay in a hospital intensive care unit.

While Washington likes to think of itself as a leader in health care, we are no better than average when it comes to asthma. The disease is more prevalent in rural areas and among low-income populations who often lack access to medical care and are more likely to have untreated or undertreated asthma.

When I conduct asthma screenings at public locations, I usually find that about one in five people have symptoms of pulmonary obstruction, most likely due to asthma. I know asthma is a serious disease and, when I give the results of the screening and advise seeing a doctor for treatment, I hope they will get what they need to keep their asthma under control. Unfortunately, some will not get the treatment they need. Too many will end up in an emergency room with a severe asthma attack.

There are many barriers to receiving proper care for asthma. People with asthma often have to settle for second-line medicines that relieve symptoms temporarily but do not provide the ongoing relief that allows them to perform normal work or sit in a classroom for a full day.

Busy primary care doctors often do not have the time to keep up with the latest asthma treatment guidelines. Even if they know about the guidelines, doctors seeing as many as 30 patients a day do not have time to determine the severity of their patients' asthma, which is important in determining the right medicine to prescribe.

Even with a prescription in hand, the patient may not get the right drugs. Many health plans have not yet caught up with national treatment guidelines and will not cover some asthma medicines even when prescribed by a doctor. Some plans only cover one type of asthma medicine called an inhaled corticosteroid, or ICS, that reduces inflammation. For patients with persistent moderate or severe asthma, national guidelines specify a use of relatively new asthma medicines that provide a combination of ICS with another type of medicine that relaxes the bronchial muscles to ease breathing.

I am frustrated that we are not doing a better job of dealing with asthma. It is a very widespread disease: Approximately one in 11 adults and one in nine children in our state have asthma. It is the leading cause of school absences due to chronic disease. Asthma costs more than $450 million annually, about half for treatment and half in lost productivity. Most importantly, though, people with uncontrolled asthma are less able to participate in physical activity, are more prone to obesity and other chronic diseases, and are less productive in their work life.

We can do a better job. We have scientifically determined guidelines for treatment; we need to make sure they are followed throughout the health system. We know more about environmental factors that trigger asthma attacks; we can reduce exposure. Our medicines keep getting better; we need to be sure they are covered by health plans and that they are accessible to the people who need them.

We know what to do, but we too often fail to do it. Asthma must be recognized for the serious disease it is. Payments for patient visits for asthma must compensate physicians for the time to do full evaluations of their patients with asthma. Health plans, particularly those covering low-income and rural populations, must make it easier for patients to get access to the right medicines. Employers, schools and parents need to know how to reduce exposure to asthma triggers.

In May, health officials around the world are calling attention to asthma and what needs to be done to deal with it. It's a good time for us to start getting it right for all of the people in our own state.

Dr. Greg Ledgerwood, M.D., has practiced family medicine in North Central Washington for 36 years. He chairs the Practitioner Support Committee of the Washington Asthma Initiative, is a certified asthma educator and lectures widely about treatment of asthma throughout the United States.