BACKGROUND: Despite reductions in morbidity and mortality and changes in guidelines, little is known regarding changes in asthma treatment patterns. OBJECTIVE: To examine national trends in the office-based treatment of asthma between 1997 and 2009. PARTICIPANTS AND DESIGN: We used the National Ambulatory Care Survey (NAMCS) and the National Disease and Therapeutic Index™ (NDTI), nationally representative audits of office-based physicians, to examine patients diagnosed with asthma less than 50 years of age. MEASUREMENTS: Visits where asthma was diagnosed and use of six therapeutic classes (short-acting β(2) agonists [SABA], long-acting β(2) -agonists [LABA], inhaled steroids, antileukotrienes, anticholinergics, and xanthines). RESULTS: Estimates from NAMCS indicated modest increases in the number of annual asthma visits from 9.9 million [M] in 1997 to 10.3M during 2008; estimates from the NDTI suggested more gradual continuous increases from 8.7M in 1997 to 12.6M during 2009. NAMCS estimates indicated declines in use of SABAs (from 80% of treatment visits in 1997 to 71% in 2008), increased inhaled steroid use (24% in 1997 to 33% in 2008), increased use of fixed dose LABA/steroid combinations (0% in 1997 to 19% in 2008), and increased leukotriene use (9% in 1997 to 24% in 2008). The ratio of controller to total asthma medication use increased from 0.5 (1997) to a peak of 0.7 (2004). In 2008, anticholinergics, xanthines, and LABA use without concomitant steroids accounted for fewer than 4% of all treatment visits. Estimates from NDTI corroborated these trends. CONCLUSIONS: Changes in office-based treatment, including increased inhaled steroid use and increased combined steroid/long-acting β(2)-agonist use coincide with reductions in asthma morbidity and mortality that have been demonstrated over the same period. Xanthines, anticholinergics, and increasingly, LABA without concomitant steroid use, account for a very small fraction of all asthma treatments.
BACKGROUND: Despite reductions in morbidity and mortality and changes in guidelines, little is known regarding changes in asthma treatment patterns. OBJECTIVE: To examine national trends in the office-based treatment of asthma between 1997 and 2009. PARTICIPANTS AND DESIGN: We used the National Ambulatory Care Survey (NAMCS) and the National Disease and Therapeutic Index™ (NDTI), nationally representative audits of office-based physicians, to examine patients diagnosed with asthma less than 50 years of age. MEASUREMENTS: Visits where asthma was diagnosed and use of six therapeutic classes (short-acting β(2) agonists [SABA], long-acting β(2) -agonists [LABA], inhaled steroids, antileukotrienes, anticholinergics, and xanthines). RESULTS: Estimates from NAMCS indicated modest increases in the number of annual asthma visits from 9.9 million [M] in 1997 to 10.3M during 2008; estimates from the NDTI suggested more gradual continuous increases from 8.7M in 1997 to 12.6M during 2009. NAMCS estimates indicated declines in use of SABAs (from 80% of treatment visits in 1997 to 71% in 2008), increased inhaled steroid use (24% in 1997 to 33% in 2008), increased use of fixed dose LABA/steroid combinations (0% in 1997 to 19% in 2008), and increased leukotriene use (9% in 1997 to 24% in 2008). The ratio of controller to total asthma medication use increased from 0.5 (1997) to a peak of 0.7 (2004). In 2008, anticholinergics, xanthines, and LABA use without concomitant steroids accounted for fewer than 4% of all treatment visits. Estimates from NDTI corroborated these trends. CONCLUSIONS: Changes in office-based treatment, including increased inhaled steroid use and increased combined steroid/long-acting β(2)-agonist use coincide with reductions in asthma morbidity and mortality that have been demonstrated over the same period. Xanthines, anticholinergics, and increasingly, LABA without concomitant steroid use, account for a very small fraction of all asthma treatments.
Authors: Michael Schatz; Robert S Zeiger; William M Vollmer; David Mosen; Guillermo Mendoza; Andrea J Apter; Thomas B Stibolt; Albin Leong; Michael S Johnson; E Francis Cook Journal: Chest Date: 2006-07 Impact factor: 9.410
Authors: Michael Schatz; Randy Nakahiro; William Crawford; Guillermo Mendoza; David Mosen; Thomas B Stibolt Journal: Chest Date: 2005-10 Impact factor: 9.410
Authors: R Evans; D I Mullally; R W Wilson; P J Gergen; H M Rosenberg; J S Grauman; F M Chevarley; M Feinleib Journal: Chest Date: 1987-06 Impact factor: 9.410
Authors: Matthew Daubresse; Susan Hutfless; Yoonsang Kim; Rachel Kornfield; Dima M Qato; Jidong Huang; Kay Miller; Sherry L Emery; G Caleb Alexander Journal: Am J Respir Crit Care Med Date: 2015-07-01 Impact factor: 21.405
Authors: Rachel Kornfield; Sydeaka Watson; Ashley S Higashi; Rena M Conti; Stacie B Dusetzina; Craig F Garfield; E Ray Dorsey; Haiden A Huskamp; G Caleb Alexander Journal: Psychiatr Serv Date: 2013-04-01 Impact factor: 3.084
Authors: Lee M Hampton; Matthew Daubresse; Hsien-Yen Chang; G Caleb Alexander; Daniel S Budnitz Journal: JAMA Psychiatry Date: 2014-09 Impact factor: 21.596