CDC: Asthma Rates Continue to Rise

Despite national efforts to improve the quality of care and health outcomes of individuals with asthma, the overall prevalence of the chronic respiratory disease in the United States increased by more than 12% between 2001 and 2009, according to a report released May 3 by the Centers for Disease Control and Prevention.

Based on data from the 2001-2009 National Health Interview Survey and the 2001, 2005, and 2009 state-based Behavioral Risk Factor Surveillance System, the prevalence of asthma among people of all ages increased from 20.3 million (7.3%) in 2001 to 24.6 million (8.2%) in 2009, the agency reported in the May 3 issue of the Morbidity and Mortality Weekly Report. The prevalence among children younger than 18 years increased from 8.7% to 9.6% during this period, with the highest prevalence rates observed among poor children, at 13.5%; non-Hispanic black children, at 17.0%; and boys, at 11.3%. Among adults, asthma prevalence increased from 6.9% in 2001 to 7.7% in 2009, with the highest rates seen in poor adults (10.6%) and in women (9.7%), according to the report (MMWR 2011;60:1-7).

"Approximately 1 out of every 12 individuals in the United States has asthma, and the number is rising," said Ileana Arias, Ph.D., principal deputy director of the CDC. "The estimated total cost of asthma in terms of medical expenses, lost school or work days, and premature death was $56 billion in 2007," she said in a press briefing. Although the reasons for the increased prevalence of the condition are unclear, particularly in light of improvements that have been made in outdoor air quality and the reduction of two common asthma triggers (smoking and second-hand smoke), "we do know that there are measures that can be taken to control asthma symptoms to avoid exacerbations and many attacks, and health care providers, insurers, people with asthma, and others should work together to implement these measures," she said.

A review of the disease characteristics and self-management education status data for 2008 showed that "more than half [52.6%] of the people with asthma reported having an attack within the prior year. Nearly 42% missed 1 or more days of work or school because of their asthma, 26% visited the emergency department or urgent care center for treatment, and 7% were hospitalized," Paul Garbe, DVM, chief of the CDC’s Air Pollution and Respiratory Health Branch, said during the press briefing. "The estimated per person/per year medical expenses associated with asthma between 2002 and 2007 was $3,259."

Assessing gaps in health care coverage and access could alter the asthma landscape, Dr. Garbe said. "Of the nearly 90% of asthma patients with health insurance, approximately 12% reported not being able to afford their prescription medicine, 37% had ever seen or talked to a specialist physician about their asthma, and 86% had ever talked to a primary care provider about it," he said. Among the uninsured asthma population, 40% reportedly couldn’t afford medication, nearly 20% had seen or talked to an asthma specialist, and 60% had seen or talked to a primary care physician about their asthma.

Further, although it is well understood that optimal asthma control includes self-management training, appropriate use of inhaled corticosteroids, and avoidance of environmental allergens and irritants, only one-third of the population had ever been given an action plan as recommended by the National Institute of Health’s National Asthma Education and Prevention Program (NAEPP), Dr. Garbe said. An action plan, as defined by the NAEPP, is a written form developed by health care providers that addresses the asthma-related needs and circumstances of individual patients, including how to monitor symptoms, when to make medication changes, how to identify and avoid irritants and allergens, how to recognize worsening symptoms, and when to take action.

The CDC has worked with health departments in some states to develop and implement interventions based on the guidelines. In Connecticut, for example, "a program for in-home education and environmental assessment has been implemented in an effort to reduce the number of children and adults who rely on the emergency department as their primary source of health care," Dr. Garbe said. "Since the program began, there has been a dramatic reduction in the average number of emergency/urgent care visits for asthma, from approximately three in a 6-month period to fewer than one." Rhode Island and New York also have developed asthma education programs designed to reduce the human and economic costs of asthma, he said.

Although potentially limited by the fact that the databases from which the results were obtained are based on adult self-report or adult proxy responses for children and thus are vulnerable to recall bias, the findings do suggest that people with asthma are doing a suboptimal job of managing their symptoms and that coordinated efforts at the local, state, and national levels should target patient education. Evidence-based interventions to reduce environmental risk factors for asthma also are needed, Dr. Garbe said.