Objective: To describe the current status of asthma management in the United States, including the role of the Guidelines for the Diagnosis and Management of Asthma, developed by the National Institutes of Health (NIH), and the Health Plan Employer Data and Information Set (HEDIS) 2000, developed by the National Committee for Quality Assurance (NCQA).
Data sources: This article is based on a presentation given by the author at a symposium entitled. Optimizing Clinical and Economic Outcomes in Asthma Management. at the Academy of Managed Care Pharmacy.s 2000 Educational Conference in San Diego, California, on October 5, 2000.
Conclusions: Health care professionals have not yet fully convinced patients that asthma is a chronic disease requiring appropriate medication therapy and routine follow-up care. Asthma is often treated episodically, which is related to increased emergency room visits, hospitalizations, and acute-care visits. The appropriate treatment of asthma incorporates concepts from the NIH guidelines and begins with accurately classifying asthma based on pulmonary function and clinical symptoms. Inhaled corticosteroids (ICSs) are preferred first-line therapy for children as well as adults with persistent asthma. HEDIS 2000 defined a performance measure for asthma with which health care plans can be compared; this measure is based on administrative rather than clinical parameters. Use of fewer canisters of short-acting beta2-agonists per year is associated with relatively less risk of hospitalization for patients using ICS; even low-dose ICS therapy is effective in decreasing the asthma death rate.