Percentage of patients 5-64 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement period.

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Report a total score, and each of the following strata:
Stratum 1: Patients age 5-11 
Stratum 2: Patients age 12-18
Stratum 3: Patients age 19-50
Stratum 4: Patients age 51-64

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Asthma is one of the most prevalent chronic diseases, becoming increasingly more commonplace over the past twenty years. Approximately 24.6 million Americans have asthma, and it is responsible for over 3,000 deaths in the U.S. annually (American Lung Association 2010). In 2006, 13.3 million clinical visits (hospital, outpatient, emergency department, and physician offices) were attributed to asthma (Centers for Disease Control and Prevention 2009). The incidence rate, and subsequently the number of asthma-related health visits, is expected to increase by an additional 100 million globally by 2025 (World Health Organization 2007).

Asthma accounts for over $20 billion spent on health care in the United States. Direct costs, including prescriptions, make up $15.6 billion of that total. Indirect costs, such as lost productivity, add an additional $5.1 billion (Centers for Disease Control and Prevention 2009). Inpatient hospitalization accounts for over 50 percent of overall asthma-related costs (Bahadori et al. 2009). In addition to the direct financial burden, asthma is also a leading cause of absenteeism and productivity, accounting for an estimated 14.2 million missed workdays for adults and over 14 million missed school days for children (Akinbami et al. 2009). Studies have shown that the indirect costs of asthma are becoming a growing financial burden on patients, and resulting in significant additional costs (Bahadori et al. 2009).

Appropriate medication management could potentially prevent a significant proportion of asthma-related costs (hospitalizations, emergency room visits and missed work and school days) (Akinbami et al. 2009). The Asthma Regional Council supported this inference, stating that proper management could potentially save at least 25 percent of total asthma costs, or $5 billion, nationally by reducing health care costs (American Lung Association 2009).

Another initiative, the Children’s Health Fund’s Childhood Asthma Initiative, examined patients enrolled in an asthma intervention program. Results illustrated that treatment that aligned with clinical guidelines reduced the severity of symptoms experienced, as well as asthma-related events (e.g., hospitalizations, emergency room visits, etc.) (Columbia University 2010). Additionally, subsequent savings attributed to improved clinical outcomes totaled to nearly $4.2 million or $4,525 per patient. This translated to a significant reduction in federally subsidized and private insurance-based costs for this population (Columbia University 2010).

National Heart Lung and Blood Institute/National Asthma and Education Prevention Program (2007) 
• Long-term control medications (include inhaled corticosteroids (ICSs), inhaled long-acting bronchodilators, leukotriene modifiers, cromolyn, theophylline, and immunomodulators) are used daily to achieve and maintain control of persistent asthma. The most effective are those that attenuate the underlying inflammation characteristic of asthma. The Expert Panel defines anti-inflammatory medications as those that cause a reduction in the markers of airway inflammation in airway tissue or airway secretions (e.g., eosinophils, mast cells, activated lymphocytes, macrophages, and cytokines; or Eosinophil cationic protein (ECP) and tryptase; or extravascular leakage of albumin, fibrinogen, or other vascular protein). 
• Inhaled corticosteroids are the preferred treatment option for mild persistent asthma in adults and children. Leukotriene Receptor Antagonists (LTRAs) are an alternative, although not preferred, treatment. 
• Long-acting beta-2 agonists (LABAs) should only be used in combination with ICSs for long-term control and prevention of symptoms in moderate or severe persistent asthma (step 3 care or higher in children =5 years of age and adults). There is a strong recommendation against the use of LABAs as monotherapy. Of the adjunctive therapies available, long-acting beta-2 agonists is the preferred therapy to combine with ICS in youths =12 years of age and adults. 
• The beneficial effects of long-acting beta-2 agonists in combination therapy for the great majority of patients who require more therapy than low-dose ICS alone to control asthma (i.e., require step 3 care or higher) should be weighed against the increased risk of severe exacerbations, although uncommon, associated with the daily use of long-acting beta-2 agonists (see discussion in text). 
• The NHLBI/NAEPP guideline strongly recommends against the use of long-acting beta-2 agonists for the treatment of acute symptoms or exacerbations.

Higher score indicates better quality

Akinbami, L.J., J.E. Moorman, P.L. Garbe, E.J. Sondik. 2009. “Status of Childhood Asthma, United States, 1980–2007.” Pediatrics 123 (Supplement 3):S131-45.

American Lung Association. 2010. Trends in Asthma Morbidity and Mortality.  http://www.lung.org/finding-cures/our-research/trend-reports/asthma-trend-report.pdf

Bahadori, K., M.M. Doyle-Waters, C. Marra, L. Lynd, K. Alasaly, J. Swiston, J.M. FitzGerald. 2009. “Economic burden of asthma: a systematic review.” BMC Pulm Med 9(24): 1-16.

Centers for Disease Control and Prevention. 2009. “Asthma: A Presentation of Asthma Management and Prevention.” http://www.cdc.gov/asthma/speakit/default.htm

Columbia University. 2010. “Best Practice Asthma Program Saves the US Healthcare System More than $4500 a Year per Child.” http://www.mailman.columbia.edu/news/best-practice-asthma-program-saves-us-healthcare-system-more-4500-year-child

National Heart Lung and Blood Institute/National Asthma Education and Prevention Program. 2007. Measures of asthma assessment and monitoring: Expert panel report 3: guidelines for the diagnosis and management of asthma. Washington: National Heart Lung and Blood Institute (NHLBI).

World Health Organization. 2007. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach.  http://www.who.int/gard/publications/GARD_Manual/en/index.html

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TBD

Patients 5-64 years of age with persistent asthma and a visit during the measurement period

Equals Initial Patient Population

Patients with emphysema, COPD, cystic fibrosis or acute respiratory failure during or prior to the measurement period

Patients who were dispensed at least one prescription for a preferred therapy during the measurement period

Not Applicable

None

Not Applicable

Not Applicable

For every patient evaluated by this measure also identify payer, race, ethnicity and sex.