Cases of asthma in the U.S. are continuing to rise, but the cost of asthma treatment is going up at an even greater rate. Add to that the expectation that the number of adults over age 65 with asthma is expected to double by the year 2030.
In a study published in July 2017 in the Journal of Allergy and Clinical Immunology, researchers looked at 14,076 adults age 65 and up who had active asthma. Among the group, 6 percent reported an asthma-related hospitalization and 11 percent reported going to the emergency room in the previous year because of an asthma problem.
The researchers also noted that patients were more likely to visit the ER because of the high cost of medicine and regular doctor visits. The Centers for Disease Control and Prevention reports that asthma tends to be more deadly for those 65 and up as well.
Who is most keenly affected?
It’s worth asking what the health community can do with this new information. And does it truly reflect the current trend in asthma?
According to the CDC, asthma is more prevalent among African Americans and American Indians compared with Caucasians. African Americans also have higher rates of emergency room visits, hospitalizations, and a higher death rate from asthma.
Children under age 17 did show a higher rate of visits to primary care settings and to emergency rooms because of asthma. The rate of hospitalization in children was an important finding and raised concern, so the researchers also looked at the 10-year data. The results of this part of the study were published in the Journal of Pediatrics in 2013.
Although there was a decrease in the rate of asthma-related hospitalizations for children between 2000 and 2009, those who were admitted tended to be more severe cases. This finding is reflected in the high rate of mechanical ventilation noted in the hospital chart reports; as a result, hospital charges were significantly higher.
Environmental risk factors
The data were corroborated by the Environmental Protection Agency (EPA), which also took into account the indoor environmental factors among those patients. The EPA report found that African Americans and Hispanics had a higher rate of asthma emergency department visits, hospitalizations, and asthma-related deaths compared with Caucasians. Indoor and outdoor environmental factors, including exposure to dust mites, mold, cockroaches, secondhand smoke, ozone, and particle pollution were all implicated in acute asthma attacks.
Asthma’s dangerous mortality rate among African Americans was a factor in the decision to change the guidelines for treatment; it’s now recommended that doctors start with inhaled corticosteroids as a first-line therapy.
The bottom line
Asthma prevalence is on the rise. This may be because it is being recognized earlier.
More attention is now being paid to the disease in children, which may be a reflection of family support and also because schools and other institutions are taking interest in the care and follow-up of pediatric asthma.
Less attention is being paid to adults because they are expected to care for themselves and because asthma is often confused (misdiagnosed) with chronic obstructive pulmonary disease and other respiratory conditions.
Environmental factors, such as indoor and outdoor air pollution, still play an important role in asthma and asthma attacks.
The role of therapy and the risks associated with therapeutic agents is still being analyzed, so criteria for treatment recommendations are still being revised.
Costs are higher. Those who are hospitalized tend to be more serious cases. This is particularly true among African American, Hispanic, and American Indian patients; environmental factors are often blamed.
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Eli Hendel, M.D., is a board-certified internist/pulmonary specialist with board certification in Sleep Medicine. An Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations, his areas include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases. Favorite hobby? Playing jazz music. Find him on Twitter @Lung_doctor.