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Barriers to Good Asthma Care Detailed

Allergists say poor access, distrust of docs behind inequalities in treatment

MONDAY, Nov. 10 (HealthDay News) -- Poor access to appropriate care and distrust of doctors are among the issues posing barriers to good asthma management, leading experts say.

Allergists were expected to discuss these issues and several others hampering national asthma care efforts at the American Academy of Allergy, Asthma & Immunology (ACAAI) annual meeting, in Seattle.

"Lack of access to high-quality care contributes to disparities in asthma care, especially for vulnerable populations," Dr. Michael B. Foggs, chief of Allergy, Asthma and Immunology, Advocate Health Centers of Advocate Health Care in Chicago, said in a news release issued by the academy. "Uninsured individuals do worse than privately insured individuals on almost 90 percent of quality measures and on all access measures."

Minorities, for example, are less likely to visit an asthma specialist, instead receiving asthma care for asthma in emergency departments and with irregular follow-up.

Delays in diagnosis among all groups is another great concern, Phillip L. Lieberman, a clinical professor of medicine and pediatrics at the University of Tennessee Health Science Center in Memphis, said in the same news release. "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.

Even when a diagnosis is made, patients and doctors sometimes stay at odds.

"Half the time, patients and physicians disagree on what the problem is, and two-thirds of the time, patients and physicians disagree on what the goals of treatment are," Dr. Alan T. Luskin, an associate professor of medicine at the University of Wisconsin in Madison, said in the news release. "We must be able to assess our patients' beliefs and expectations and consider what features of the available therapies meet their needs."

Failure to stick to an asthma management plan is believed to account for up to 60 percent of hospitalizations for the condition. While factors such as low health literacy, financial hardship, and cultural or religious beliefs toward medicine cause some of this, Luskin said people don't realize active management can make a great difference.

"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," he said.

More information

The U.S. Centers for Disease Control and Prevention has more about asthma.

-- Kevin McKeever

SOURCE: American Academy of Allergy, Asthma & Immunology, news release, Nov. 9, 2008

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