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New Perspectives on AsthmaAs more is learned about asthma, researchersare discovering that the disease is far morecomplex than previously thought and consistsof several subtypes, such as allergic asthma,exercise-induced asthma, asthma related tobacterial or fungal infections and asthma in theelderly. Each type can have different symptomsor triggers, and each requires a differentapproach to diagnosis and treatment. Allergists,based on extensive experience in treating allforms of the disease, understand its complexitiesand know that it is crucial to distinguish amongdifferent types. They can assess the severity ofeach case and develop case-specific action plansthat have the greatest likelihood of success withindividual patients.The Emerging Role of NewTreatments and PreventionsAllergists are uniquely qualified to ensure thatpatients have access to the latest treatment andsymptom control strategies to keep their asthmacontrolled.• Allergists, with their specialized knowledgeof the relationship between environmentalpollutants and allergens, as well as thedisease and the mechanisms of allergicreactions, have the training and clinicalexperience to deal effectively with thesefactors.• Allergists promote asthma self-managementskills to assist people in eliminating ordecreasing exposure to asthma “triggers.” [38]• Allergists are more likely than generalists toprovide authoritative information to healthcare providers, families and other caregivers.[13, 39-40]• Allergies are specialists at immunotherapy or“allergy shots” that can reduce sensitivity tothe allergens that trigger asthma attacks, andsignificantly reduce the severity of thedisease. [41] Immunotherapy also can preventthe development of asthma in some childrenwith seasonal allergies. [42]Allergists are involved in clinical trials to testother promising techniques, such as the use ofmonoclonal antibodies to inhibit theinflammatory process that leads to asthma.They usually are the first clinicians to becomeaware of and implement proven newtreatments.14
Specialty Care of Asthmain Health Plansuse of asthma medications a key indicator inevaluating the quality of managed careprograms. [44]Even PCPs increasingly aredemanding a greater say inreferring patients to specialistswhen the disease is severe,atypical or requires specializedknowledge for optimummanagement. [45]As asthma management becomes moresophisticated, health care plans are seeking acompetitive edge through programs thatoptimize patient health education, symptomcontrol and aggressive treatment that avoidssevere exacerbations of the disease. Plans withgoals of reducing participant turnover and thatemphasize lifestyle change are most successfulat satisfying patients and reducing costs. In areview of health care trends prepared forManaged Care Medicine, asthma managementwas chosen as a model for the new strategy ofmanaged care. [43] “Asthma is a healthproblem that pays large dividends if a properfront-end investment is made in patienteducation and preventive care,” the authornoted. “Such an intervention can significantlyimprove symptom control and reduce hospitaland emergency room use . . . . The PCP[primary care physician] should have aconsulting relationship with an allergyspecialist who can perform any part of theinitial evaluation for asthma or diseasemanagement that the PCP is not able to provide.”Managed care organizations have an addedmotivation to optimize asthma management.The National Committee for QualityAssurance (NCQA) has made the appropriateAsthma specialists also arespreading the word toconsumers. The AmericanCollege of Asthma, Allergy andImmunotherapy (ACAAI), forexample, has launched aneducation campaign to help consumersevaluate allergy and asthma benefits in healthplans. When individuals with allergies orasthma enroll in a health plan – or have anannual open enrollment period for changingplans – the ACAAI provides a Checklist as aguide to determine whether an employee’sinsurance options allow:• access to specialists for diagnosis of asthmaand other allergic diseases• ongoing management for specialist care ofasthma and allergies• unlimited visits to specialist care for asthmaand allergies• access to diagnostic tests for asthma andallergies• access to medications and tests prescribed byspecialists, including immunotherapy or“allergy shots”• consultation and/or management by aspecialist without co-payments that aregreater than those for generalist care.15
Page 1: Asthma Managementand the Allergist:
Page 5 and 6: SummaryAsthma is among the most com
Page 7 and 8: Asthma in America• Affects 22 mil
Page 9 and 10: When To Refer toan AllergistAccordi
Page 11 and 12: control according to NIH Guidelines
Page 13 and 14: Number of Visits3503002502001501004
Page 15 and 16: Emergency Room VisitsInpatient Care
Page 17: symptoms and when to seek help for
Page 21 and 22: References1. Centers for Disease Co
Page 23 and 24: 40. Legorreta AP, Christian-Herman
Page 25 and 26: Finkelstein JA, Lozano P, Shulruff
Page 27 and 28: two subspecialty groups: allergists
Page 29 and 30: Specific findings: The Epidemiology
Page 32: When To Refer to an AllergistPatien

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