Asthma disease management: friend or foe?

The evolution of health care in the United States has recently given rise to a movement commonly referred to as "Disease Management" in which improved outcomes are sought by using a data-driven process to direct appropriate resources to patients most likely to benefit from them. Related to asthma, debate has tended to focus on studies that have demonstrated better patient-centered outcomes for patients managed by asthma specialists, rather than the ability of the goals of asthma DM to serve the interests of patients, health care providers, and health plans. This article reviews the major forces that propel the disease management movement, describes the nature of DM programs, and presents a proposal that underscores the viability of specialty care in asthma disease management. Also presented are several examples from the author's experience in Texas of practical ways that asthma specialists can become constructively engaged in the evolution of effective and efficient systems of care for patients with asthma.