Dr. Andy

Reflections on medicine and biology among other things

Monday, March 20, 2006

No symptoms, no asthma

It is widely recognized (at least by physicians and scientists) that asthma is a chronic disease. In a simplified view, ongoing inflammation in the lung underlies contraction of smooth muscle which causes symtpoms. Blocking or treating the underlying inflammation, by means such as allergen avoidance and use of inhaled steroids, helps prevent exacerbations triggered by things like exercise, viral infections and exposure to allergens (think cat).

Patients, however, may not share this view, believing instead that they only have asthma when they are having symptoms. Thus one of the hardest things asthma doctors face is convincing patients (or thier parents) that they need medicine everyday when they only have symptoms intermittently. Even when we think we've explained ourselves, patients often returns saying they stopped the medicine because they were all better.

Halm et al. have now shown just how prevalent that belief can be; more than 1/2 of patients HOSPITALIZED with asthma at Mt. Sinai in New York City believe that they only have asthma when they have symptoms. This even though 1/4 of the sample has been intubated for an asthma exacerbation in the past.

This helps explain why many patients are resistant to use of daily controller medications to prevent asthma flares.

They authors identify the question "Do you think you have asthma all of the time, or only when you are having symptoms?" as an effective means of identifying patients who need further education.

My only criticism of the study is that it doesn't tell us much about the level of persistent symptoms the patients have. If you have symptoms most or all days, which many of these patients presumably do, the idea that you only have asthma when you have symptoms may not be relevant. The authors do show that among patients with daily symptoms, the "no symptoms, no asthma" belief is less common.


At 3:57 PM, Anonymous Anonymous said...

another reason we stop giving our kids the meds is financial. Do the math--zyrtec plus flonase plus advair equals $120.00 per month in COPAYS -- I have 3 asthmatics in my house and in addition one has other (kidney) health problems and takes allergy shots. I already work a parttime job in addition to my full time job to cover medical costs----

At 5:10 PM, Blogger Bad Penny said...

Maybe asthma needs rebranding. Tell patients they have "persistant asthma syndrome", the kind of asthma that is there, waiting to flare up, even when they don't have symptoms. Patients with PTS need to take meds every day.

I know docs can't make up a new name on the spur of the moment, but is there some existing name that would do the trick? Just something more sciencey would convey the message to pateints. The message being, this is not asthma-as-you-think-it-is, this is asthma-that-requires-daily-meds.


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