April 22, 1996
Media Contact: Michael Purdy
Phone (410) 955-8725
A new Johns Hopkins study reaffirms that physicians and other medical staff are not giving severe inner-city asthma patients the treatment and the education necessary to prevent dangerous asthma episodes and costly visits to hospital emergency rooms.
"The bottom line is that doctors are very much undertreating and undercoaching these people," says Alkis Togias, M.D., an associate professor of medicine at Hopkins. "Many of the patients we studied were not getting adequate medications, and their doctors hadn't shown them how to use the medication they had correctly. Doctors also hadn't worked out aggressive, proactive steps that their patients could take when they began to feel their asthma symptoms worsening."
For the study, published in this month's issue of the American Journal of Medicine, Togias and his team visited admissions offices daily at Johns Hopkins Hospital and Hopkins Bayview Medical Center for a year. Anyone admitted as an asthma patient was asked to fill out a questionnaire about how they and their doctors treat their asthma.
Less than half of the patients were using drugs that reduce the likelihood of asthma attacks before they begin. Most were using bronchodilators--inhaled drugs designed to ease the effects of an asthma attack after it has started. Only 11 percent of the patients knew how to take these drugs properly.
Doctors had given less than 28 percent of their patients an "action plan" to reduce the effects of a severe asthma attack as it begins. In addition, some 30 percent of the patients had contacted their doctors as the symptoms began to worsen, and the majority were told to do nothing.
"None of these characteristics comply with guidelines for severe asthma care established five years ago by the National Asthma Education Program," according to Togias.
Togias doesn't agree with calls to increase asthma education for doctors and nurses in the inner-city community.
"I think the only way to improve asthma treatment in an underprivileged community is to get these severe asthmatics to specialized centers where the doctors will give them very consistent, very aggressive treatment, and where the patients will also feel that the people who work with them do care about asthma and do know what they are doing."
Severe asthmatics would be referred to these centers immediately, Togias says. The centers could implement a much more organized and aggressive approach to educating patients about their disease and helping them better self-manage their condition.
Other authors on the study include Tina Hartert; Hugh Windom; Stokes Peebles, Jr.; and Linda Freidhoff. The study was funded by Johns Hopkins.