American Journal of Respiratory and Critical Care Medicine Vol 166. pp. 1044-1049, (2002)
© 2002 American Thoracic Society
The Burden of Asthma in the United States
Level and Distribution Are Dependent on Interpretation of the National Asthma Education and Prevention Program Guidelines
Anne L. Fuhlbrigge,
Robert J. Adams,
Theresa W. Guilbert,
Evie Grant,
Paula Lozano,
Susan L. Janson,
Fernando Martinez,
Kevin B. Weiss and
Scott T. Weiss
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Medicine, The University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia; University of Arizona, Respiratory Sciences Center, Tucson, Arizona; Center for Healthcare Studies, Northwestern University, Chicago, Illinois; Center for Health Studies, Group Health Cooperative of Puget Sound, and Department of Pediatrics, University of Washington, Seattle, Washington; and Departments of Community Health Systems and Medicine, University of California, San Francisco, California
Correspondence and requests for reprints should be addressed to Anne Fuhlbrigge, M.D., M.S., Channing Laboratory, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA 02115. E-mail: anne.fuhlbrigge{at}channing.harvard.edu
ABSTRACT
Asthma imposes a growing burden on society in terms of morbidity, quality of life, and healthcare costs. Although federally sponsored national surveys provide estimates of asthma prevalence, these surveys are not designed to characterize the burden of asthma by self-reported disease activity. We sought to characterize asthma burden in the United States. This study was based on a cross-sectional random-digit-dial household telephone survey designed to identify adult patients and parents of children with current asthma. Global asthma burden was comprised of three components: short-term symptom burden (4-week recall), long-term symptom burden (past year), and functional impact (activity limitation). Using this construct, only 10.7% of individuals were classified as having a global asthma burden consistent with mild intermittent disease, and 77.3% had moderate to severe persistent disease. These results suggest that a majority of the United States population with asthma experiences persistent rather than intermittent asthma burden. In addition, the discordance in type and distribution of asthma symptoms reported by individual subjects suggests that the exact estimate of the burden of asthma is related to how the National Asthma Education and Prevention Program classification is operationalized. Inquiry into recent day or nighttime symptoms alone underestimates the burden of asthma and may lead to inadequate treatment of asthma based on national guideline recommendations.
Key Words: asthma • epidemiology • burden of illness • severity of illness index
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Copyright © 2002 American Thoracic Society
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