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 Use of Rescue and Controller Meds for Asthma in Oregon
So how does the use of medications among Oregonians with persistent asthma stack up? It turns out that a significant proportion overuse rescue medication. Data from Oregon?s health plans show that on average, 30-42% of those aged 4 to 55 years old with persistent asthma are filling prescriptions for 6 or more beta2-agonists canisters or nebulizer prescriptions in a year. As shown in Figure 1, overuse of beta2-agonists increases with age, and is consistently higher among those with Medicaid than those with commercial insurance.
Poorly controlled asthma, which the overuse of beta2-agonists indicates, is a significant contributor to asthma morbidity and mortality in the United States. In 1999, uncontrolled asthma accounted for over 1.9 million emergency department visits, 478,000 hospitalizations, and 4,657 deaths in the United States. In 1994-96, asthma accounted for an annual average of 14.5 million work absence days and 14 million school absence days.c
Some argue that filling numerous rescue medication prescriptions does not necessarily correlate with overuse of these medications ? that it is really a function of having duplicate inhalers at work, school, and grandma?s house. This may sometimes be the case, but evidence shows that patients who receive one or more metered-dose inhaler per month on average have an increased risk of death or near-fatal asthma, even among those who appear to have less severe asthma.d
So far we know that many Oregonians with persistent asthma overdepend on their rescue medications, but what about their use of controller medications? Data from Oregon?s health plans indicate that 26-37% of people aged 4 to 55 years old with persistent asthma did not fill even one prescription for a controller medication within a year. As shown in Figure 2, this finding is consistent across age groups, and similar between those with commercial and Medicaid insurance. Although these data are worrisome, they do not tell the whole story. Of equal concern is that even among those who take inhaled corticosteroids, many do not attain doses sufficient to control their asthma. National studies estimate that people with asthma who use ICS take less than the recommended dose 24 to 69% of days.e This situation occurs when patients do not take their medications as prescribed, either purposely or unwittingly.
A less obvious issue is that even those who have been prescribed and are taking appropriate doses may not be receiving therapeutic doses. Inhalation methods affect delivery of ICS, and studies have found that 46 to 59% of patients use effective techniques.e For instance, properly coordinating inhalation and actuation of a metered-dose inhaler can be a challenging skill to master. It has been demonstrated, however, that training can improve the efficacy with which people use their inhalers.
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