4 Reasons Severe Asthma Rates Are Declining

When I was a kid growing up in the 1980s I was a bad asthmatic who spent many nights in a hospital bed.  I met many respiratory therapists (RT), and got to know some of them really well.  This experience inspired me to become an RT.  No one would have more empathy for these kids than myself.

Yet once I became an RT in 1997, I noticed something stunning: there were no asthmatic kids for me to empathise with.  I know none "really well."  I take care of an occasional asthmatic kid, but once they are dischared I never see them again.

Twelve years later there are still no asthmatic kids. I had many theories why this might be, yet I had no real evidence. Then I read the following post:  "Severe Asthma Less Common than Decade Ago." Apparently I was not alone in my observations.

According to this article, researchers concluded that "patients treated from 2004 to 2007 showed significantly lower use of oral corticosteroids and rescue albuterol than patients from 1993 to 1997."

What follows are the theories why severe asthma rates are declining:

1.  Better medicine: I'd say the best medicines so far for asthma are Advair and Symbicort.  Both these medicines work to prevent asthma flare ups by treating both components of asthma:  airway constriction and inflammation. 

Likewise, leukotreine inhibitors like Singulair allow asthmatics to prevent allergy flare ups that may trigger their asthma. 

With better asthma medicines doctors can place a greater emphasis on asthma education.

2.  Better Asthma Education:  There was something similar to Asthma Action Plans when I was a kid, but most doctors didnt' know about them -- at least my doctors didn't.  That was one of the reasons I was referred to National Jewish Health in 1985 when I was 15.

Today, however, most doctors work with their patients on creating an Asthma Action Plan that is just right for them.  Following the plan to a tee can help asthma patients stay out of hospitals. 

3.  Improved asthma wisdom:  In 1984 doctors knew inhaled corticosteroids worked for asthma, but they were afraid of the steroid side effects.  They also did not think of asthma as a disease of chronic inflammation, so they would often tell asthmatics to only use steroid inhalers during an asthma flare up.

Doctors are now wiser.  They now know asthma is a disease of chronic inflammation, and a small amount of corticosteroid in your lungs all the time is not only safe, but it prevents asthma flare ups. (I wrote about this in greater detail here).

Because of this, asthmatics who are compliant with their inhaled corticosteroid are less likely to need Albuterol. 

4.  Improved Compliance:  When I was a kid I had to take four puffs four times a day of Azmacort. You can see how easily it would be to slip in the compliance department.  The inhaler was also a bulky thing that was a nuisance to lug around.