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    People With Asthma "Talking Themselves Into Care"

    If you have asthma, you may have learned to accept the wheezing, pack your inhaler or even skip out on work or school when necessary. But are you really taking care of your condition? Research presented May 9 at the 96th International Conference of the American Thoracic Society in Toronto, Canada, suggests that asthma care is not meeting national standards, and that patients and doctors need to communicate more effectively.

    "Internationally, we need to treat asthma with a preventative strategy," said lead investigator Dr. Kenneth Chapman, a professor of respiratory medicine at the University of Toronto and director of the Asthma Care Center at Toronto Western Hospital. As part of the Asthma in Canada Survey, his team interviewed 1,001 adults with asthma and parents of children with the condition. "This was a novel survey to ask patients how they control their asthma -- and the news is disheartening," said Dr. Chapman.

    Results showed that 57 percent of Canadians with asthma do not have their condition under control, based on treatment criteria described in the Canadian Asthma Consensus Guidelines. For example, the guidelines (similar to U.S. guidelines) suggest that asthma patients should not need to use their inhalers more than three times per week, should not awaken due to their symptoms more than once per week and should be able to enjoy their normal daily activities at school or work. But of the asthmatics, 21 percent had been absent from school or work during the three months before the study, and 42 percent limited their daily activities because of their condition.

    Of the 57 percent of people with poorly controlled asthma, 91 percent believed that their condition was well managed or sufficient enough for them to continue activities with the help of inhalers or coping methods.

    "Most people simply adapt to their condition and accept their limitations, tolerating often serious symptoms, in effect making them the 'walking wounded' with asthma," said Dr. Chapman.

    And physicians may not realize the extent of the problem. Part of the survey involved questioning 266 physicians, both specialists and general practitioners, on various aspects of the disease. The results showed that 77 percent of doctors believed their patients' asthma was well controlled.

    "There's a disparity between patients and doctors in asthma management. Clearly there is not enough communication in this area," said Dr. Chapman. For example, asthmatics should learn about self-management techniques or contact patient associations and support groups for educational materials or counseling, he suggested.

    Doctors should talk to their patients about the availability and correct use of various treatment methods, including the regular use of anti-inflammatories. Dr. Chapman's team pointed out that only 60 percent of people with poorly controlled asthma currently take an anti-inflammatory and 25 percent rely on "rescue" medications.

    "As part of a preventative strategy, the ultimate goal is for asthmatics to lead symptom-free lives," said Dr. Chapman.

    Asthma affects between five and 10 percent of the population and 15 percent of children, making it the most common chronic disease.

    Dr. Chapman said that his results are similar to other recent U.S. and European studies.


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