Asthma care in Canada is not meeting national standards, according to a landmark national survey being presented at the American Thoracic Society's international conference in Toronto.
Researchers interviewed 1,001 adults with asthma and parents of children with asthma, as well as 266 physicians on many aspects of the disease. The survey, Asthma in Canada, reveals 57 per cent of Canadians with asthma do not have their illness adequately controlled, according to the key treatment criteria set out in the Canadian Asthma Consensus Guidelines.
"Canadian patients with asthma are like the walking wounded," says the study's lead author Dr. Kenneth Chapman, professor in the division of respiratory medicine at the University of Toronto and director of the Asthma Centre at Toronto Western Hospital. "Asthma patients may not be at immediate risk of death but they are still suffering disability they need not suffer. In addition to the human costs of uncontrolled asthma, these patients also place excess burden on the health care system by their need for emergency room care and hospitalization." As a disease, asthma should be completely controllable, Chapman says.
According to the national guidelines, asthma patients should not need to use their quick relief inhalers more than three times per week and should not be awakening because of their asthma more than once per week, Chapman says. The guidelines, similar to those in other countries, also suggest asthma sufferers should be able to pursue normal daily activities including regular attendance at school and work.
The survey shows that both patients and physicians have a tendency to underestimate the severity of asthma and overestimate how well it is being controlled. Although 57 per cent of patients have asthma that is poorly controlled, most (91 per cent) believe their asthma is well managed. As well, most general practitioners (77 per cent) believe their patients' asthma is well controlled.
"Many Canadians have a false sense of security when it comes to their asthma control, tolerating often serious symptoms and accepting them as normal," says Andrew Grenville, senior vice-president of the Angus Reid Group, who conducted the survey. "Unfortunately, patients seem to accept poor control as an inevitable part of their illness and physicians don't realize the extent of the problem. These misperceptions are a major reason why asthma is so poorly controlled in this country.
Also contributing to the problem is the widespread unfamiliarity with and inappropriate use of asthma medications by patients. For example, the researchers say, while it has long been recognized that asthma is a chronic inflammatory condition, only six in 10 patients with poorly controlled asthma currently take an anti-inflammatory while -one quarter simply rely on "rescue" medications alone.
"Managing asthma simply by using rescue medications is dangerous," says Dr. Pierre Ernst, professor of medicine in the respiratory and clinical epidemiology divisions of the McGill University Health Centre, who also served as medical adviser to the survey. "As physicians, we need to do a better job of explaining to patients the role of various medications, including the regular use of anti-inflammatories, in managing their disease."
Chapman says Canadians with asthma can lead active, symptom-free lives if their asthma is managed properly. "Asthma shouldn't prevent patients from doing just about anything they want to do," he says, noting a large number of American athletes at the Los Angeles summer Olympics were using inhalers for their asthma. "If you're not relatively free of symptoms and not enjoying full daily activities, you need to review that with your physician."
Asthma affects between five and 10 per cent of the general population and 15 per cent of children. This study was funded by Glaxo Wellcome Inc. The survey is being presented in abstract form at the 96th International Conference of the American Thoracic Society in Toronto, May 5 to May 10, 2000.