Washington, Nov 10 : Access to appropriate care, patient adherence, distrust of the medical profession, delayed asthma diagnosis, culture, lifestyle choices and genetic discrepancies, are some of the barriers in managing asthma, according to experts.
Allergists detailed factors that act as barriers in asthma care at the annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI) in Seattle.
"Lack of access to high quality care contributes to disparities in asthma care, especially for vulnerable populations. Uninsured individuals do worse than privately insured individuals on almost 90 percent of quality measures and on all access measures," said Michael B. Foggs, M.D., chief of Allergy, Asthma and Immunology, Advocate Health Centers of Advocate Health Care in Chicago.
He added: "A combination of poor patient understanding of asthma management and inadequate physician monitoring may contribute to disparities in asthma care."
The experts said that African Americans, Hispanics/Latinos and uninsured have a tendency to get asthma care by a hospital provider, or in poorer facilities with irregular follow-up, and receive treatment for asthma in emergency departments.
On the other hand, minorities were found less likely to be seen by an asthma specialist. ess than 50 percent of Asthma patients were found to use NIH-recommended anti-inflammatory medication, and a most of them managed symptoms with an inhaled bronchodilator medication. Health care disparity exists for asthma care even among the insured.
Phillip L. Lieberman, clinical professor of medicine and paediatrics at the University of Tennessee Health Science Centre in Memphis said that delays in diagnosis in asthma occur with significant frequency.
"These delays can have a deleterious effect on outcomes including causing fatalities, increasing days with symptoms, and resulting in a rapid decline in lung function. Timely diagnosis will result in appropriate treatment, which can prevent these undesirable effects," he said.
Alan T. Luskin, M.D., associate professor of medicine at the University of Wisconsin in Madison said that in order to have optimal treatment outcomes, patients must be involved in all aspects of care-right from defining the problem to determining therapy.
He claimed that the factors limiting adherence to a patient's asthma management plan are low health literacy; financial and economic barriers; environmental factors at home; customs, cultural or religious beliefs that impact use of health care services. Patients generally only see their physician when symptoms interfere with daily life.
They adapt to their disease and lower their expectations, often viewing asthma episodes as facts of life," said Luskin.
Michael S. Blaiss, M.D., clinical professor of pediatrics and medicine at the University of Tennessee Health Science Center in Memphis said that obesity, food and smoking play a significant role in effecting asthma outcomes.
"As a group, subjects with asthma are heavier than subjects without asthma, and studies show obesity may worsen asthma control," he said.
It has been found that greater initial weight and greater weight change in adults increases the risk of development of asthma later in life and the effect of overweight and obesity in children increases the risk of development of asthma. Asthma and obesity in children are common chronic conditions and both disorders have been increasing in the last 2 to 3 decades. The changes of dietary habits and a sedentary life style could have played a role in increasing the prevalence of both conditions," said Blaiss.
Consumption of fast food has been named as a risk factor for asthma. Also, smoking has been found to be a risk factor for asthma. Cultural factors, such as language limitations and parental beliefs are also barriers to asthma care.
"Current smoking has been associated with increased severity of asthma, worse asthma-specific quality of life, worse mental health status, and a greater risk of hospitalization for asthma. Smoking is also associated with poor asthma control, and new evidence suggests that smoking reduces the benefits of inhaled corticosteroids. Exposure to passive smoke at home may delay recovery from an acute attack," said Blaiss.
Parents with strong beliefs against use of medication, or preferences for holistic approaches to treatment may present obstacles to a child's asthma care.