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.