Reversible airway diseases, such as
asthma and some forms of chronic
obstructive pulmonary disease
(COPD) that have a reversible obstructive
component, have increased in prevalence
and burdened the healthcare system with
additional attributable costs in recent years.
According to the Centers for Disease
Control and Prevention, the prevalence of
asthma and COPD has been increasing
steadily since the 1970s.1,2 It is estimated
that 17 million American adults have been
diagnosed with asthma1 (10.8% of the adult
population) and another 10 million American
adults (5%-6% of the adult population)
have been diagnosed with COPD.2,3 These
estimates are generally considered low as
data from the National Health and Nutrition
Examination Surveys (NHANES III) estimate
that approximately 24 million
American adults (12% of the adult population)
have evidence of impaired lung function
but are not diagnosed.4
Asthma is a long-term lung disease characterized
by inflammation of the lower airways
and episodes of airflow obstruction.
Asthma severity ranges from intermittent
mild symptoms, such as coughs and wheezing,
to severe, life-threatening attacks that
require immediate hospital treatment. Obstruction
of the airway in asthma is generally
considered reversible, meaning that the
obstruction of the lung can generally be
resolved with treatment and in some cases
can resolve spontaneously.5,6
In 2001, 4268 deaths, 11.3 million physician
office visits, and 1.3 million outpatient
hospital visits were attributable to asthma.7
In 2002, 1.9 million hospital emergency
department visits were caused by asthma.
The estimated direct and indirect monetary
costs for this disease totaled $11.3 billion in
1998.8 Direct costs accounted for $7.5 billion
and indirect costs were $3.8 billion.
Medications accounted for the single largest
portion of the cost of care for asthma.9
COPD refers to a group of diseases that
cause airflow blockage and breathing-related
problems. These diseases include emphysema,
chronic bronchitis, and, in some
cases, asthma. COPD is a progressive condition
in which the airways narrow and
become obstructed, making it difficult to
breathe, eventually leading to a long-term
disabling breathlessness. The World Health
Organization and US Strategy for the
Diagnosis, Management, and Prevention of
Chronic Pulmonary Disease (referred to as
the "GOLD Guidelines") have described
COPD as "a disease characterized by airflow
limitation that is not fully reversible."10,11
Prevalence, incidence, and mortality
rates of COPD increase with age. In 2001,
123 013 deaths, 726 000 hospitalizations,
and 1.5 million emergency department visits
were caused by COPD.12 An additional 8
million cases of hospital outpatient treatment
or treatment by personal physicians
were linked to COPD in 2000. The National
Heart, Lung, and Blood Institute estimated
that total COPD costs were $32.1 billion in
2002 ($18 billion in direct medical costs
and $14.1 billion in indirect medical
While improved understanding of the
underlying pathophysiology of reversible
airway diseases has advanced new treatment
alternatives, the overall burden of
these diseases and the healthcare costs
associated with their treatment and management
are rising. Clearly, a need exists to
update and disseminate clinical guidelines
for these diseases. However, whether such
guidelines impact cost savings and lead to a
decline in overall healthcare resource utilization
has not yet been determined.
This supplement to The American Journal
of Managed Care will focus on the management
and treatment of reversible airway disease
and analyze the management of asthma
and COPD from several different points of
view, enabling the reader to gain a broader
understanding of the overall treatment and
management implications for reversible airway
1. Centers for Disease Control and Prevention. Asthma prevalence and control characteristics by race/ethnicity–United States, 2002. MMWR Morb Mortal Wkly Rep. 2004;53:145-148.
2. Centers for Disease Control and Prevention. Chronic obstructive pulmonary disease surveillance–United States, 1971-2000. MMWR Morb Mortal Wkly Rep. 2002;51:1-20.
3. Lucas JW, Schiller JS, Benson V. Summary health statistics for U.S. adults: National Health Interview Survey, 2001. National Center for Health Statistics. Vital Health Stat. 10. 2004.
4. Mannino DM, Gagnon RC, Petty TL, Lydick E. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med. 2000;160:1683-1689.
5. National Institutes of Health and National Heart, Lung, and Blood Institute. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. Bethesda, Md: National Institutes of Health; 2002. NIH Publication 02-3659.
6. National Heart, Lung, and Blood Institute. Guidelines for the Diagnosis and Management of Asthma: Expert Panel Report No. 2. Bethesda, Md: National Heart, Lung, and Blood Institute; 1997. NIH Publication 97-4051.
7. National Center for Health Statistics. Asthma Prevalence, Health Care Use and Mortality, 2000-2001. 2003. Available at: www.cdc.gov/nchs/products/pubs/pubd/hestats/asthma/asthma.htm. Accessed May 25, 2004.
8. National Institutes of Health. Data fact sheet. Asthma statistics, 1999. Available at: http://www.nhlbi.nih.gov/health/prof/lung/asthma/asthstat.pdf. Accessed May 25, 2004.
9. Weiss KB, Sullivan SD. The health economics of asthma and rhinitis. I. Assessing the economic impact. J Allergy Clin Immunol. 2001;107:3-8.
10. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) workshop summary. Am J Respir Crit Care Med. 2001;163:1256-1276.
11. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: NHLBI/WHO Workshop Report. Bethesda, Md: DHHS, National Institutes of Health; 2001. NIH Publication 01-2701.
12. CDC, National Center for Health Statistics. Asthma prevalence, health care use and mortality, 2000-2001. Available at: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/asthma/asthma.htm. Accessed May 25, 2004.