Physicians must close the gap in asthma care

CMAJ 2000;162(13):1861

The survey of 1001 adults with asthma or parents of children with asthma and 266 physicians was conducted by the Angus Reid Group and endorsed by the Asthma Society of Canada (ASC), the Lung Association and the Canadian Thoracic Society. Asthma affects 2 million Canadians, including 10% to 15% of children, and claims the lives of 10 Canadians a week.

In a related survey, the ASC found that asthma care is falling far short of the national standards set in the 1999 Canadian Asthma Consensus Guidelines (CMAJ 1999;161[11 Suppl]).

Those guidelines state there should be minimal need for urgent medical care, yet 51% of respondents required it at some time. The guidelines also say there should be no sleep disruption, but 35% of respondents said they awaken with breathing problems at least once a week. Finally, 37% of respondents exceed the recommended weekly use (maximum 3 doses) of "rescue" drugs.

"There is a gap in care," explains Dr. Mark Greenwald, a Toronto asthma specialist and vice-president of the ASC. "To patients, 'control' means that they are out of the acute state. Now we've raised the bar. People with asthma need routine chronic care follow-up."

Follow-up includes asking how often patients use their short-acting bronchodilators, watching them take their medications, asking about peak flows and following up with environmental-control measures, such as dust-proof bedding. "GPs, who treat most asthma sufferers, need a mindset shift from acute to chronic disease," says Greenwald.

The ASC has created a Web site with educational information, the guidelines, pamphlets and the opportunity to "talk" to a certified specialist in asthma education (www.asthma.ca). — Barbara Sibbald, CMAJ

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