Asthma, Rhinitis, Other Respiratory Diseases
National trends in asthma visits and asthma pharmacotherapy, 1978-2002,☆☆

https://doi.org/10.1067/mai.2003.177Get rights and content

Abstract

Background: Research is limited on physicians' compliance with recent clinical guidelines for asthma treatment. Objective: Our purpose was to investigate the relationships among clinical guidelines, asthma pharmacotherapy, and office-based visits through use of nationally representative data. Methods: Nationally representative data on prescribing patterns by office-based US physicians were extracted from the National Disease and Therapeutic Index. We tracked 1978-2002 trends in the frequency of asthma visits and patterns of asthma pharmacotherapy, focusing on the use of controller and reliever medications. Results: The estimated annual number of asthma visits in the United States increased continuously from 1978 through 1990 (18 million visits); since 1990, it has remained relatively stable. Controller medication use increased 8-fold between 1978 and 2002, inhaled corticosteroids manifesting the biggest increases. The use of reliever medications, particularly short-acting oral β2-agonists, decreased modestly over this period. The aggregate use of controllers (83% of visits) superseded that of relievers (80%) for the first time in 2001. Improved appropriateness of asthma pharmacotherapy was also suggested by an increase in the controller-to-reliever ratio, which reached 92% in 2002. Xanthines, which once dominated asthma therapy (63% of visits in 1978), were used in only 2% of visits in 2002. More recent drug entrants have been adopted rapidly, single-entity long-acting inhaled β2-agonists being used in 9% of visits and leukotriene modifiers in 24% of visits in 2002. Conclusion: Asthma pharmacotherapy has changed extensively in the past 25 years. Practices over the last decade are increasingly consistent with evidence-based guidelines. These changes in medication use might have contributed to the lack of a recent increase in asthma visits. (J Allergy Clin Immunol 2003;111:729-35.)

Section snippets

Methods

Data were extracted from the NDTI, a continuing physician survey conducted by IMS HEALTH (Plymouth Meeting, Pa). The NDTI provides nationally representative diagnostic and prescribing information on patients treated by office-based physicians in the continental United States. A random sample of office-based physicians stratified by specialty and geographic region is selected from the master lists of the American Medical Association (Chicago, Ill) and the American Osteopathic Association

Asthma visits

There was a doubling in the estimated national number of annual visits by patients diagnosed with asthma between 1978 (8.5 million visits) and 1990 (17.7 million visits; Fig 1).

. National trends in the number of office-based visits by patients with asthma, according to IMS HEALTH's NDTI for January 1978 through June 2002. Numbers for 2002 are estimates (E) based on data for January through June 2002.

The number of asthma visits then stabilized at a mean of 16 million between 1991 and 2002. In

Discussion

Using the 1978-2002 NDTI data, this study documents substantial changes in the number of asthma visits and in asthma pharmacotherapy. Our data indicate that the number of annual asthma visits has remained relatively stable since 1991. There has been an increasing trend in the prescription of controller medications, particularly inhaled corticosteroids, and a decreasing trend in reliever medication use, particularly short-acting oral β2-agonists. These trends are congruent with consensus

Acknowledgements

IMS HEALTH provided the data used in the analysis.

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    Supported by a research grant from the Agency for Healthcare Research and Quality (AHRQ) (R01-HS013405).

    ☆☆

    Reprint requests: Randall S. Stafford, MD, PhD, Stanford Center for Research in Disease Prevention, Stanford University, Palo Alto, CA 94304.

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