Asthma Exacerbations Can Last a Week or Longer

November 13, 2011 (Boston, Massachusetts) — Episodes of asthma worsening, when symptoms become more severe or frequent, commonly last for a week or more and can seriously affect a patient's quality of life, according to a study presented in a poster session here at the American College of Allergy, Asthma & Immunology 2011 Annual Scientific Meeting.

Patients can also experience worsening of several symptoms at once, Michael Blaiss, MD, from the University of Tennessee at Memphis, told Medscape Medical News.

Dr. Blaiss and his team conducted the Asthma Insight and Management (AIM) survey to examine the reported duration of episodes with asthma symptoms that were frequent or severe.

The survey is the sequel to the Asthma in America study, which was done more than a decade ago.

"We wanted to know what has happened as far as asthma management in patients since that survey was done. We also added some new questions to get a better idea of how asthma was affecting the adult and adolescent population," Dr. Blaiss explained.

AIM quizzed 2500 asthma patients 12 years and older about duration of episodes with asthma symptoms that were frequent or severe. The participants were interviewed from July to September 2009.

Of these, 1321 patients reported that they had experienced episodes of worsening of their asthma symptoms — including wheezing, chest tightness, coughing, and shortness of breath — in the previous 12 months, and that these episodes lasted for an average of 6.5 days.

Although the majority (45%) reported that their worsening episodes lasted from 1 to 3 days, 12% reported that their episodes lasted from 7 to 13 days, 7% said they lasted from 14 to 20 days, and 6% reported that they lasted 21 days or longer. Only 11% reported that their episodes lasted less than 1 day.

Dr. Blaiss said he found it striking that patients reported a variety of symptoms.

"There really isn't any one symptom that most patients with asthma always have. The bottom line is that you have to screen for all of those symptoms in the asthma population," he said. "If you just ask: 'How often are you wheezing?', the patient may answer 'rarely', but if you ask about chest tightness, you may find that it is a chronic problem. Chest tightness, coughing, wheezing, and shortness of breath are all common symptoms of asthma, not just wheezing."

Physicians often think that an asthma flare up will last 1 or 2 days and then be gone, but this survey shows that is not true, he added.

"When you start looking at the impact on the patient — on their quality of life and their ability to do normal activities — and you see an average duration of almost a week (in about 25% of these patients, it's greater than a week), that is a big indirect cost associated with the condition," he said. "Doctors have to realize that asthma flare-ups last more than a day or 2 and that they need to aggressively manage the patient to try to improve these long spells of severe frequent episodes."

Commenting on this study for Medscape Medical News, John Oppenheimer, MD, from Cedar Knolls, New Jersey, and scientific program chair of the meeting, said that this survey points to the importance of patients having an emergency plan in place, as well as a relationship with their doctor.

The study also highlights the need for more research on managing asthma, he said.

"We have not developed good plans to intervene when patients are experiencing an exacerbation. This study reinforces the fact that there is a prolonged period of exacerbation occurring. If we can find something to help change that, that would be nirvana in my mind."

Dr. Oppenheimer also noted that studies have shown that when exacerbations do occur, many patients fail to contact their doctor.

"This study is one more reaffirmation that these exacerbations last longer than most doctors think they do. We need to find better ways to make those episodes of asthma worsening to go away and stay away," he said.

Dr. Blaiss reports financial relationships with ISTA, Merck, Proctor and Gamble, Allergan, Sanofi US, Sunovion, GlaxoSmithKline, AstraZeneca, and Genentech. Dr. Oppenheimer reports financial relationships with AstraZeneca, GlaxoSmithKline, Merck, and Novartis.

American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Scientific Meeting: Abstract P66. Presented November 6, 2011.

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Cite this: Asthma Exacerbations Can Last a Week or Longer - Medscape - Nov 13, 2011.