Lay Organization News

Doctors faulted on asthma treatments
By Andrew Bowser - Medical Tribure News Service

NEW ORLEANS - Many doctors aren't properly educated about the dangers of asthma and the best ways to treat the potentially fatal condition, an asthma expert said here Sunday at a meeting of the American College of Emergency Physicians.

Untrained physicians can provide poor follow-up and may not provide adequate counseling to asthma patients, said Dr. Russ J. Kino, an assistant clinical professor of medicine and emergency medicine at the UCLA Medical Center in Los Angeles.

And many patients underestimate the severity of their symptoms and may sabotage proper management of their disease by neglecting to take prescribed medication, he said.

Physician confusion about optimal asthma treatment may result from conflicting medical reports on many critical points of asthma management, said Kino, describing a widely-publicized report published a few years ago that linked frequent use of inhaled beta aerosols - commonly used to treat asthma symptoms - to risk of death.

But the fear that inhalant drugs are responsible for killing asthma patients is unfounded, he said. The study made it clear that the researchers didn't know whether the deaths were caused by heavy aerosol use, or that the patients who died had severe asthma and so happened to use their inhalers more frequently.

A more recent review of 200 studies of inhaler use showed only "weak associations between beta aerosols and mortality," Kino said.

Inhalants, such as albuterol, are frequently used by patients to manage asthma attacks, he said. And researchers are finding that the more drug that is inhaled, the more the patient's asthma improves, with no or little increase in side effects, he said.

While tremors and palpitations are possible side effects of inhalers, studies show the number of side effects produced "boils down to no big deal," Kino said. "We all worry whether we're going to create side effects in these patients, and the answer is probably not."

Patients in a recent study who were given repeat doses of beta aerosols every 20 minutes showed significant breathing improvement at 60 minutes, he noted. Patients who were given repeat doses for 120 minutes showed an even greater improvement, yet there was virtually no difference in number of side effects reported between the two groups.

But inhalers can sometimes lead to a worsening of an asthma case, Kino cautioned. Because asthma patients get a rapid boost in breathing ability when they take a puff from an inhaler, they may forego steroid treatment, which is crucial in the management of asthma, he said.

"Use of steroids is a critical factor," Kino said. "Beta aerosols treat the symptoms, but steroids treat the disease."

Another researcher said that improperly-trained doctors should bear more of the blame for poor asthma management.

"Many doctors are doing a pretty lousy job keeping up with the literature," said Dr. Emil Skobeloff, a clinical assistant professor of emergency medicine at Allegheny University of the Health Sciences in Philadelphia.

Studies of physicians have uncovered a "substantial lack of adherence" to asthma-treatment guidelines that have been issued by the National Institutes of Health, according to Skobeloff, co-author of one study that found that a minority of emergency physicians reported using lung-function tests recommended in the guidelines.

© Copyright 1996 Medical Tribure News Service

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