2004 OPEN FORUM Abstracts
Disease Variability in Patients With Mild, Moderate, or Severe Persistent Asthma Adhering to National Asthma Education and Prevention Program Asthma Therapy Guidelines
SM Perry, BS, RRT,1 IA Gilbert, MD,1 A
Olivares, CRT,1 JA Nelson, CRT,2
LF Strauss, RN,2 AM Maguire, MD.2 1Medical
College of Wisconsin, Milwaukee, WI, and 2Case Western
Reserve University, Cleveland, OH
BACKGROUND: Optimal asthma control should be achieved if
patients adhere to National Asthma Education and Prevention Program
(NAEPP) therapy guidelines. The variability of asthma in patients
adhering to NAEPP-recommended therapy is reported for the first time.
METHOD: Morbidity and variability indices were compared for
125 inner-city patients aged ≥18
years (74% female, 69% minority, 80% treated by primary care
physicians) 6 months before and 6 months after entry into a NAEPP
guidelines-directed clinical and educational program aimed at
minimizing barriers to adherence.
RESULTS: Following the
6-month program, patients experienced a significant (P<.01)
overall decrease in asthma morbidity indices, including improvements
in lung function (52% of patients had % predicted FEV1
<80% at baseline compared with 32% on average over the 6-month
study); decreases in asthma symptoms (21% mild intermittent or mild
persistent at baseline compared with 61% mild intermittent or mild
persistent on average over the 6-month study); less lifestyle
impairment due to asthma (70% reporting moderate or severe life
impairment at baseline compared with 31% with moderate to severe
perceived life impairment on average over the 6 months); fewer
emergency department visits and hospitalizations (decreased by >85%);
less rescue bronchodilator use (decreased by 33%); and fewer
nighttime awakenings and days lost from school or work (60% decrease
for each). The percentage of patients using inhaled corticosteroids
and long-acting 2-adrenergic
agonists increased significantly over the course of the study (P<.001
for each). Although marked improvements occurred when NAEPP
guidelines were rigidly followed, considerable asthma variability was
still observed. Of the 125 patients enrolled, 29% demonstrated ≥3
changes (improvements or declines) in classification of lung function
(mild, moderate, severe) over the course of the study, 31%
experienced ≥3 changes in
lifestyle impairment, and 47% experienced a similar number of changes
in classification of symptoms. Patients’ medication
requirements varied >1½ times during the 6-month program,
with 25% of patients requiring ≥3
adjustments. Medication adjustments did not occur as frequently as
changes in symptom severity class and lifestyle impairment. Increases
in medication occurred as frequently as declines in symptoms;
however, step-down of medication was less frequent than improvements
in lung function and symptoms.
CONCLUSIONS: While adherence to
NAEPP-recommended therapy improves asthma morbidity, it does not
eliminate asthma variability.