Management and Treatment of Reversible Airway Disease

July 1, 2004

Reversible airway diseases, such asasthma and some forms of chronicobstructive pulmonary disease(COPD) that have a reversible obstructivecomponent, have increased in prevalenceand burdened the healthcare system withadditional attributable costs in recent years.According to the Centers for DiseaseControl and Prevention, the prevalence ofasthma and COPD has been increasingsteadily since the 1970s.

Reversible airway diseases, such asasthma and some forms of chronicobstructive pulmonary disease(COPD) that have a reversible obstructivecomponent, have increased in prevalenceand burdened the healthcare system withadditional attributable costs in recent years.According to the Centers for DiseaseControl and Prevention, the prevalence ofasthma and COPD has been increasingsteadily since the 1970s.1,2 It is estimatedthat 17 million American adults have beendiagnosed with asthma1 (10.8% of the adultpopulation) and another 10 million Americanadults (5%-6% of the adult population)have been diagnosed with COPD.2,3 Theseestimates are generally considered low asdata from the National Health and NutritionExamination Surveys (NHANES III) estimatethat approximately 24 millionAmerican adults (12% of the adult population)have evidence of impaired lung functionbut are not diagnosed.4

Asthma

Asthma is a long-term lung disease characterizedby inflammation of the lower airwaysand episodes of airflow obstruction.Asthma severity ranges from intermittentmild symptoms, such as coughs and wheezing,to severe, life-threatening attacks thatrequire immediate hospital treatment. Obstructionof the airway in asthma is generallyconsidered reversible, meaning that theobstruction of the lung can generally beresolved with treatment and in some casescan resolve spontaneously.5,6

In 2001, 4268 deaths, 11.3 million physicianoffice visits, and 1.3 million outpatienthospital visits were attributable to asthma.7In 2002, 1.9 million hospital emergencydepartment visits were caused by asthma.The estimated direct and indirect monetarycosts for this disease totaled $11.3 billion in1998.8 Direct costs accounted for $7.5 billionand indirect costs were $3.8 billion.Medications accounted for the single largestportion of the cost of care for asthma.9

COPD

COPD refers to a group of diseases thatcause airflow blockage and breathing-relatedproblems. These diseases include emphysema,chronic bronchitis, and, in somecases, asthma. COPD is a progressive conditionin which the airways narrow andbecome obstructed, making it difficult tobreathe, eventually leading to a long-termdisabling breathlessness. The World HealthOrganization and US Strategy for theDiagnosis, Management, and Prevention ofChronic Pulmonary Disease (referred to asthe "GOLD Guidelines") have describedCOPD as "a disease characterized by airflowlimitation that is not fully reversible."10,11

Prevalence, incidence, and mortalityrates of COPD increase with age. In 2001,123 013 deaths, 726 000 hospitalizations,and 1.5 million emergency department visitswere caused by COPD.12 An additional 8million cases of hospital outpatient treatmentor treatment by personal physicianswere linked to COPD in 2000. The NationalHeart, Lung, and Blood Institute estimatedthat total COPD costs were $32.1 billion in2002 ($18 billion in direct medical costsand $14.1 billion in indirect medicalcosts).10

While improved understanding of theunderlying pathophysiology of reversibleairway diseases has advanced new treatmentalternatives, the overall burden ofthese diseases and the healthcare costsassociated with their treatment and managementare rising. Clearly, a need exists toupdate and disseminate clinical guidelinesfor these diseases. However, whether suchguidelines impact cost savings and lead to adecline in overall healthcare resource utilizationhas not yet been determined.

The American Journalof Managed Care

This supplement to will focus on the managementand treatment of reversible airway diseaseand analyze the management of asthmaand COPD from several different points ofview, enabling the reader to gain a broaderunderstanding of the overall treatment andmanagement implications for reversible airwaydisease.

MMWR Morb Mortal Wkly Rep

1. Centers for Disease Control and Prevention. Asthmaprevalence and control characteristics by race/ethnicity–United States, 2002. . 2004;53:145-148.

MMWR Morb Mortal Wkly Rep

2. Centers for Disease Control and Prevention. Chronic obstructive pulmonary disease surveillance–UnitedStates, 1971-2000. . 2002;51:1-20.

Vital Health Stat

3. Lucas JW, Schiller JS, Benson V. Summary health statistics for U.S. adults: National Health Interview Survey,2001. National Center for Health Statistics. . 10. 2004.

Arch Intern Med

4. Mannino DM, Gagnon RC, Petty TL, Lydick E. Obstructive lung disease and low lung function in adultsin the United States: data from the National Health andNutrition Examination Survey, 1988-1994. . 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 ofAsthma: 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. AccessedMay 25, 2004.

J Allergy Clin Immunol

9. Weiss KB, Sullivan SD. The health economics of asthmaand rhinitis. I. Assessing the economic impact. . 2001;107:3-8.

Am J Respir Crit Care Med

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 ChronicObstructive Lung Disease (GOLD) workshop summary. . 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.