"Asthma is a more manageable disease than it was three decades ago. "The philosophy of asthma management has changed," said Peter Gergen, director of the Office of Epidemiology and Clinical Trials at the National Institute of Allergy and Infectious Diseases. "The role of inflammation in asthma became more accepted. The use of anti-inflammatory drugs and the monitoring of peak flow [a measure of the ability to exhale air from the lungs] has been increasing through the 1980s." Rather than focusing on asthma attacks already in progress, physicians emphasize prevention of wheezing and maintenance of optimal lung function, said Gergen. The National Asthma Education Program, sponsored by the NHLBI, has provided physicians and patients with guidelines for treating asthma and helped change their understanding and management of the disease.
Still, during the last three decades, asthma prevalence and morbidity in the United States has been rising. "The paradox of asthma is that we've had good treatment and quite adequate medications, and yet we're still having this problem," said Gergen. From 1982 to 1992, the number of people 5-34 years old who were afflicted with asthma increased by 52%, according to a recent CDC report. This seems to follow an earlier trend found by Gergen and associates in the 1970s, when asthma prevalence among 6-11 year olds increased by 58%.
The increase in asthma is not unique to the United States. Asthma appears to be growing worse in other economically developed countries as well. In Great Britain, deaths and hospital admissions due to asthma doubled between 1979 and 1985. In Finland, the proportion of military recruits with asthma increased 20-fold between 1961 and 1989. Sweden and Denmark also saw increasing death rates from asthma through the 1970s.
Health statistics are only one measure of asthma's high cost. Health care expenses for asthma reach $6.2 billion per year, or nearly 1% of all U.S. health care expenses in 1985, according to a 1992 study by Kevin Weiss, director of research at the Rush Presbyterian St. Luke's Medical Center in Chicago, published in the New England Journal of Medicine. Of that amount, $1.6 billion was spent for inpatient hospital costs.
Asthma exacts an equally significant personal cost. Asthma is the number one cause of absenteeism for schoolchildren and a common reason for adult absenteeism from work. In 1985, adults with asthma lost nearly 3 million work days, at a cost of $285 million, according to an analysis by Weiss.
Though death from asthma is relatively rare, it is becoming more frequent. Asthma mortality in the United States declined by nearly 8% per year during the 1970s, but by 1977, the trend reversed, and the number of deaths due to asthma began to climb steadily, increasing about 6% per year. Asthma killed 1,674 Americans in 1977, but by 1991 the death rate had risen to 5,106 (from 0.8 to 2.0 per 100,000 people). Although most asthmatics who die of the disease are over 50 years old, rates of asthma death have increased in almost all age groups, according to Michael Sly, chairman of Allergy and Immunology at the Children's National Medical Center in Washington, DC. "