19 Jul 2016
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A first in a series of posts about common chronic illnesses and what happens when people cannot afford prescription medications to treat them.

Asthma is a chronic lung disease very common in the United States and worldwide. The disease is characterized by a narrowing of the airways in the lungs that is treatable with various medications and avoiding environmental factors that trigger asthma attacks. When patients don’t take prescribed medications to treat their asthma the consequences can be deadly. The Centers for Disease Control and Prevention reports that in 2010 asthma accounted for 3,404 deaths, 439,400 hospitalizations, 1.8 million emergency room visits, and 14.2 million physician office visits. Drug costs are one of the main reasons people are not taking their asthma medications.

Symptoms of asthma include wheezing, coughing, tightness in the chest, and shortness of breath. These symptoms tend to ebb and flow for most people. The airways are sensitive to a variety of stimuli, which may include colds, physical exercise, and airborne allergens such as dust, mold, pollen, and animal dander along with environmental pollutants such as tobacco smoke, chemicals, and more.

Numbers from the Centers for Disease Control and Prevention’s National Center for Health Statistics latest study (2014) reveals the number of American adults who currently have asthma is 17.7 million. That’s 7.4 percent of American adults. The number of children in the United States who have asthma is 6.3 million or 8.6 percent.

Most people with asthma who see a doctor are generally prescribed medication to control their condition and relieve their symptoms. Bronchodilators are short-acting inhalers that relieve asthma symptoms quickly by temporarily relaxing the muscles around narrowed airways. Albuterol is the most common and often referred to as a “rescue inhaler.”

People with persistent asthma may need to take medication on a daily basis to control their asthma:

  • Inhaled steroids, also known as corticosteroids, decrease swelling of the airways over time. Regular treatment with an inhaled steroid reduces the frequency of symptoms and decreases the risk of serious asthma attacks.
  • Long-acting bronchodilators, in combination with an inhaled steroid, are often prescribed for adults with persistent asthma. These work for a longer period than short-acting bronchodilators. A device that contains both an inhaled steroid and a long-acting bronchodilator such as Advair or Symbicort, is usually used.
  • Leukotriene modifiers such as Singulair, Accolate, Zyflo are an alternative to inhaled glucocorticoids. These work by opening narrowed airways, decreasing inflammation, and decreasing mucus production. They are taken as a pill daily.

When people with asthma don’t take their prescribed medications, their symptoms almost always worsen. For example, not taking an asthma controller such as Singulair may increase the need for a rescue inhaler. Skipping doses of a bronchodilator might have the same effect. However, rescue inhalers provide only temporary relief and are not intended as a long-term treatment. Increased tightness in the chest, wheezing and coughing, shortness of breath, and being unable to breathe to the point of hospitalization often occur. In extreme cases, people with asthma who have not taken their medication for an extended period can experience an asthma attack that leads to their death. These deaths are preventable.

In 2013 the New York Times reported, “The Centers for Disease Control and Prevention puts the annual cost of asthma in the United States at more than $56 billion, including millions of potentially avoidable hospital visits and more than 3,300 deaths, many involving patients who skimped on medicines or did without.”

The CDC additionally reports: “Regular visits to a primary care physician or asthma specialist along with the ability to purchase prescription asthma medications are vital to asthma care and management. Cost barriers to obtaining these services can lead to a lack of continuity and delays in obtaining needed medical care. This can contribute to an increase in emergency visits and hospitalizations.” The organization’s 2010 report revealed more adults than children reported cost as a barrier to seeing a primary care physician (13.5% compared with 5.4%) or an asthma specialist (7.8% compared with. 2.3%), and purchasing prescription asthma medication (18.6% compared with 9.8%).

The Affordable Care Act (Obamacare) requires all individuals to procure health insurance coverage, either individually or through employment-based insurance programs – or be financially penalized. This means that securing their medication is the responsibility of each individual – generally under the terms of their health insurance. However, everyone cannot afford to purchase health insurance, see a doctor, or afford prescribed medications, even with a prescription drug plan. High deductibles and expensive co-pays are a deterrent. For the above reasons, cost barriers are an urgent threat for Americans with asthma.

To afford your medication, please consult Prescription Justice Action Group’s information on how to afford prescription medication.

By Stephanie Schroeder
 
Sources:

Asthma. National Center for Health Statistics, 2014 http://www.cdc.gov/nchs/fastats/asthma.htm. Related tables:

Summary Health Statistics Tables for U.S. Adults: National Health Interview Survey, 2014, Table A-2

Summary Health Statistics Tables for U.S. Children: National Health Interview Survey, 2014, Table C-1

Asthma Facts, Centers for Disease Control and Prevention’s National Asthma Control Program, 2013. PDF: http://www.cdc.gov/asthma/pdfs/asthma_facts_program_grantees.pdf

“Asthma in the US: Growing every year.” http://www.cdc.gov/vitalsigns/asthma/ Vital Signs, Centers for Disease Control and Prevention, May 2011

“Beliefs that influence cost-related medication non-adherence among the “haves” and “have nots” with chronic diseases”. Piette et. al., Dove Medical Press Ltd., August 3, 2011. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3176178/

“Factors Affecting Non-adherence in Bronchial Asthma and Impact of Health Education.” Gajanan S. Gaude, Indian J Allergy Asthma Immunol 2011; 25(1) : 1-8. PDF: http://medind.nic.in/iac/t11/i1/iact11i1p1.pdf.

“Patient information: Asthma treatment in adolescents and adults (Beyond the Basics).” UpToDate, Christopher H Fanta, MD, April 5, 2016 http://www.uptodate.com/contents/asthma-treatment-in-adolescents-and-adults-beyond-the-basics

“Risk for Cost-related Medication Nonadherence Among Emergency Department Patients.” Maryann Mazer PharmD, MD, et. al. Academic Emergency Medicine, Volume 18, Issue 3, pages 267–272, March 2011.

http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2011.01007.x/full

The Soaring Cost of a Simple Breath. New York Times, Elizabeth Rosenthal, October 12, 2013. http://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-simple-breath.html

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