The Economic Crisis May Hit Asthmatics Hard

How will asthma care and health be affected by the economy?
It is clear that we are in the midst of difficult economic times. Some of us can no longer bear to even pay attention to the changes in the stock market and the effect it is having on our savings. More importantly, the economic slowdown will cause job losses, and with them, loss of health insurance coverage. For many asthma sufferers, this will have an impact on being able to keep asthma under control, from being able to afford regular doctor appointments to affording quick-relief and controller medications. In addition, some individuals will need to move to a different housing arrangement. This may lead to more difficult trigger control as the home environment is an important factor in asthma control.

The economic slowdown will also have an impact on the role that public and non-profit resources play in controlling asthma. City and state governments across the country are already facing budget shortfalls and mandates to make significant cuts. Programs, both large and small, that provide a safety net for the needy are at risk. For example, the San Francisco Asthma Task Force of their Department of Public Health had their budget essentially eliminated. This program's focus is to educate patients and physicians about ways to minimize asthma triggers in schools. Without this program, headway made on improving the school environment with respect to asthma triggers will be curtailed.

On the non-profit side, the reality is that foundations' and endowments' revenues are directly tied to the performance of financial markets. Many organizations directly contribute to asthma and allergy health through grants, community programs, and the like. While I cannot cite a specific example of where the current economy has affected these initiatives, I fear that they, like municipal resources, will be similarly affected.

While I have discussed some new therapies for asthma in recent entries, the core, standard-of-care treatments have been available for several years. This has some implications for asthma sufferers, particularly on their wallets. For those with and without prescription drug coverage, brand name medications are more expensive than generics.

In this regard, there are a few brand name medications whose patents will expire and will be replaced by generics. Although the outcome is tied up in litigation, there are signs that budesonide (Pulmicort) will be available in a generic form in the next year. Meanwhile, montelukast (Singulair) will go off patent in 2012. This will have an effect on both asthmatics and patients with allergies (or both), as montelukast is effective (and FDA approved) for the treatment of both disorders.

Other asthma and allergy medications that are available in generic form include fexofenadine (Allegra) and fluticasone (Flonase). In contrast, due to the removal of CFC-propelled inhalers (which will occur on December 31, 2008), previously generic albuterol will be replaced by brand-name HFA-propelled albuterol -- Xopenex. I reviewed this transition in several prior entries.