Targeting Asthma's Tremendous Toll
Advertisements for asthma drugs abound, promising patients better control of their illness with a simple daily regimen. Studies show, however, that the number of patients who actually stick to this preventive regimen is surprisingly low. The result is a real possibility of activity limitations, impaired quality of life and asthma attacks that can lead to emergency hospitalization - or even death.
Asthma results in a half-million hospitalizations each year and is the fourth-leading cause of lost workdays among adults, according to the Asthma and Allergy Foundation of America (AAFA). These effects carry major costs to the community: The U.S. Centers for Disease Control and Prevention (CDC) estimates that direct and indirect spending on asthma totaled more than $14.5 billion in 2000.
Could a basic change in how physicians communicate with patients help patients and reduce expenses?
Long focused on improving asthma care, the Department of Health Services Research is currently participating in a multi-site study that examines whether asking patients to play a more active and informed role in decisions about their asthma care will make them more likely to use preventive medications regularly and effectively.
The Better Outcomes of Asthma Treatment (BOAT) study contrasts two models of asthma care. In the "traditional" approach, the clinician chooses a patient's drug regimen based mainly on medical factors. In a "shared decision-making" model, patients are asked to discuss lifestyle factors, cost concerns and other preferences that might influence treatment acceptability. Together, the clinician and patient select a regimen that is "medically effective and that the patient feels he or she is able and willing to implement," said Principal Investigator Sandra Wilson, Ph.D., the department chair.
Another department study, LET'S Manage Asthma, examines whether helping family members change their behavior can reduce exposure to environmental tobacco smoke (ETS) for children with asthma. ETS is a known contributor to asthma symptoms that may require acute medical care.
Educators meet individually with family members to discuss the child's ETS exposure level - determined by measuring urine samples for cotinine, a byproduct of nicotine metabolism - and to identify ways to reduce this exposure, such as helping a parent stop smoking. Through subsequent urine testing, researchers then assess whether children whose families receive the intervention show greater reduction in their ETS levels than do children in a comparable control group. The study also analyzes health care utilization trends among enrolled children.
Previous work by Health Services Research investigators has had a national impact on asthma education for families with young children. This year, the AAFA began nationwide dissemination of the department's Wee Wheezers and Wee Wheezers at Home programs, which in 2001 were selected by the CDC as the premier asthma education programs for children under 7 and their families. Available in English, Spanish and Hmong, Wee Wheezers is already used nationwide by hospitals, clinics, Head Start and other child care programs.
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