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 Managing Asthma Meds Appropriately
Given the difficulties that people with persistent asthma have in taking medications optimally, it is vital that medical providers, patients with asthma, and their families understand the difference between controller and rescue medications, the function they serve, and their appropriate use.
Since the 1991 publication of the Guidelines for the Diagnosis and Management of Asthma,f inhaled corticosteroids have been considered the cornerstone of pharmacologic management of persistent asthma among adults. More than ten years later, the science behind this recommendation has only strengthened.
Updated guidelines from the National Asthma Education and Prevention Program advise that inhaled corticosteroids are the best available therapy for children five years of age and older with mild or moderate persistent asthma.g The same still holds true for adults with persistent asthma.b In addition, improved outcomes may be achieved for persistent asthmatics with the addition of a long-acting inhaled beta2-agonist to low-to-medium doses of inhaled corticosteroids.g
Data in this report reveal a troubling gap between recommendation and practice, however. Perhaps the biggest contributor to this dilemma is that asthma is a chronic disease being cared for in a system designed to care for acute health problems. A recent CD Summaryh suggested that a solution may lie in redesigning the health care system using the Chronic Care Model.
One component of this model is the planned visit?e.g., specifically for asthma care. Such a visit allows support staff to provide physicians with a brief summary of relevant data (for instance, prescription refill history), a list of recommended preventive care now due (for instance, a flu shot) and the patient?s self-management goals. When this concept was tested for diabetes care, physicians reported that more of the visit was spent talking to the patient and less time was wasted searching for information.
Another component of this model involves delegating certain aspects of routine patient care to other members of the team, also known as standing orders. Staff in diabetes test sites reported increased job satisfaction when their roles were expanded in this manner. Yet another feature of the Chronic Care Model is a focus on self-management support. For instance, pharmacists may prove potent allies in improving patients? skills for managing asthma medications. Inhalation techniques, correct dosing, and reinforcing the importance of ICS are all arenas in which pharmacists could buttress patients? abilities to self-manage.
Finally, the concept of a registry may prove invaluable for improving pharmacologic care for asthma. Registries are databases with information on all patients in the clinic with a specific condition. When diabetes registries were created, test sites quickly discovered that the patients they never saw were the ones with the most health problems. The same may also be true for asthma patients who do not seek routine care.
Though the applicability of the Chronic Care Model has not been as thoroughly tested with asthma as with diabetes, preliminary efforts and similarities between the diseases give reason to hope that pursuing these systems changes will, in fact, improve outcomes for patients with asthma.
Why not test some of these concepts out and report back to us? In early 2003 the Oregon Asthma Program will be releasing a request for grant proposals (RFGP) to do just this. Please be on the lookout for more information, or call us to be notified of the RFGP.
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