"The medication playing the greatest role in this improvement to date is inhaled corticosteroids," said Dr. Alissa Hersh, an assistant clinical professor in the division of allergy and immunology at Morgan Stanley Children's Hospital of New York-Presbyterian in New York City. "If we can keep them on preventive medications, we can keep them from having acute exacerbations."
Dr. Jennifer Appleyard, chief of allergy and immunology at St. John Hospital in Detroit, agreed that inhaled steroids are the most effective first-line treatment. However, she also pointed out that the U.S. National Institutes of Health first issued their asthma management guidelines in the mid-'90s, and she said that guidance has likely played a role in improved asthma management as well.
Appleyard said she wished the authors had also looked at hospitalization and death rates to see if there were any differences.
"Newer medications are much more effective in treating people with severe asthma, but this doesn't mean the battle is over. People are still dying from asthma," she said.
One problem may be compliance with the doctor's orders when it comes to taking medications. A second study that was expected to be presented at the same meeting found that even when people have insurance, and they have a regular doctor, they may not always follow their asthma management plans. The study found that about one in four children with insurance were using inhaled corticosteroids while just one in five uninsured children were. The published study information did not identify the severity of the asthma.
Another study, this one from the Agency for HealthCare Research and Quality, suggests that insurance status does affect com
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