PREVENTIVE PHARMACOLOGICAL THERAPY AMONG ASTHMATICS - 5 YEARS AFTER PUBLICATION OF GUIDELINES

Background: Guidelines from the National Heart, Lung, and Blood Instit ute first published in 1991 have recommended anti-inflammatory (AI) ag ents as a first-line therapy and the bronchodilator as an acute reliev er of symptoms. Objective: To examine the current usage of anti-inflam matory steroids (inhaled corticosteroids, Cromolyn, systemic steroids) and bronchodilators and compare them with the national guidelines. Th e relationship between preventive Al usage and the characteristics of the asthma patients and their providers was also examined. Methods: Cr oss-sectional survey data linked with 6-month pharmacy claims of asthm atic members at an HMO in California. Results: AI usage increased with current severity (mild, 36.9%; moderate, 47.3%; and severe, 56.8%), t hough a large percentage are not receiving this emphasized treatment. Bronchodilators were used at a higher rate and 24% of asthmatics relie d solely on bronchodilators. Use of bronchodilators without AI (BWAI) was present at all severity levels (mild, 19.5%; moderate, 24.6%; and severe, 24.7%). Advancing age, increasing severity, care by an asthma specialist, and not smoking increased the likelihood of using AIs. Inc reasing severity, longer duration of asthma, smoking, younger age grou p, care by a generalist, and no chronic bronchitis increased the likel ihood of BWAI. Conclusions: These results suggest that there is a low level of Al usage despite emphasis in guidelines. Current asthma manag ement in a community-based setting depicts a significant underutilizat ion of long-term control agents and, conversely, an overutilization of symptom relief agents compared with guidelines published 5 years ago. Actively involving patients in the guideline dissemination process, r ather than just the medical community, may increase preventive medicat ion usage.