The Burden of Asthma Symptoms and the Positive Role of Patient Management
Edward C.Y. Wang
Kathryn A. Gaebel
Background: Asthma is a major public health problem in developed countries. In Canada, the prevalence of asthma is approximately 5 to 7%, with some provincial variation. A retrospective study using data collected in 1990 estimated the total costs of asthma in Canada to be between $Can504 million and $Can648 million (1990 dollars). 61% of all asthma costs were direct costs ($Can306 million). Of these, drugs were the single largest component ($Can124 million). Illness-related disability ($Can76 million) was the largest contributor to indirect costs. Objective: To obtain individual patient-derived data on productivity loss and level of function related to severity of asthma symptoms, and briefly review the published data on the role of education and drug therapy in asthma management. Design: This was a community-based prospective study of outpatients identified from the bronchial inhaler study of the Canadian Pharmacy Medication Monitoring Program. Methods: Study patients recruited through community pharmacies were monitored for 6 months. Data were collected through structured telephone interviews at 1, 3 and 6 months. Primary Outcome Measures and Results: The primary outcome measures were symptom-free days (SFDs), productivity-loss days (PLDs) and patient-reported function level. Patients who did not use inhaled corticosteroids had similar numbers of SFDs and PLDs compared with patients who did. Daily corticosteroid usage was a surrogate measure for severe disease because this group also reported fewer SFDs and more PLDs than patients who use corticosteroids as needed and patients who did not use inhaled corticosteroids. Discussion: The evidence suggests that the greatest impact on productivity for the majority of patients comes from the number of days symptoms interfere with usual daily activities as opposed to actual days missed from work. Further, if corticosteroids are used appropriately in current nonusers who are not optimally controlled, a decrease in PLD and an increase in SFD may be seen. Results from another Canadian study have depicted the under-prescribing of inhaled corticosteroids, and the effectiveness of asthma education on improving the quality of life. A meta-analysis of relevant studies has confirmed that education improves important clinical outcomes in adults with asthma. Conclusions: Better patient management in asthma is needed to reduce the economic burden of this disease.
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