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May 20, 2001
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Doctors Failure To Reevaluate Asthma Severity Hurts Wheezing Sufferers

Doctors who do not periodically reevaluate their patientsí asthma severity are failing to provide good care to asthma sufferers, report Johns Hopkins physicians May 20 at the American Thoracic Societyís annual meeting.

"We found that doctors were not reevaluating their patientís underlying asthma severity estimates and that these estimates anchor their treatment decisions," says Gregory Diette, M.D., an assistant professor of pulmonary and critical care medicine at Hopkins. "Doctors need to frequently update their severity assessments in order to provide care that meets the patientís needs."

According to most treatment guidelines, doctors should base asthma therapy on an individualís symptoms prior to medication use, a profile known as underlying severity estimate. But how physiciansí estimates influenced care has been a black box. To examine the issue, the Hopkins team gathered data from 1,510 patients who had moderate asthma, as determined by self-reported symptoms and treatment guidelines. Through surveys, they discovered that their doctors had classified 849 of them as having an underlying severity estimate of mild; they deemed the other 761 as moderate or greater.

When the researchers compared the two groups with National Asthma and Education Prevention Program (NAEPP) guidelines, they found that the lower the estimate, the worse the care. Doctors gave many more moderately asthmatic patients guidance and information about how to manage their symptoms and handle an attack, in comparison to mild asthmatics. Roughly 60 percent of the moderate cases, for example, had a peak flow meter, a device patients use frequently to measure lung capacity and adjust anti-asthma drugs to prevent severe episodes. Only 16 percent of the mildly asthmatic patients owned these devices.

"Doctors need to reevaluate patients periodically to ensure an accurate, up-to-date diagnosis, and ensure quality treatment," says Linda Wolfenden, M.D., presenter of the study and postdoctoral fellow in the division of pulmonary and critical care medicine at Johns Hopkins.

The Hopkins study relied on the Managed Health Care Association Outcomes Management System Asthma Project. This project, launched by researchers at Hopkins and other institutions, gathered information from 6,612 sicker-than-average asthmatic individuals about their gender, race, education, symptom severity, medication use, health care access and satisfaction, and physician specialists. All were employees and dependents of some of the largest U.S. companies and had health insurance coverage through managed care.

For more information on asthma, visit http://www.hopkins-lungs.org and http://www.hopkins-allergy.org/ Other researchers involved in the study include Gregory Diette, Jerry Krishnan, Elizabeth Skinner, Donald Steinwachs, and Albert Wu. The National Institutes of Health and the Managed Health Care Association funded the study.

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