The cost of asthma

Over the past two decades, the treatment of asthma passed into an entirely new paradigm, reflecting a revolutionary new understanding of its pathophysiology.  For those who haven't experienced or seen an asthma attack, it can be appropriately described as 'the feeling of drowning.' 

We used to think that the fundamental pathophysiology involved 'broncho-spasm' - i.e. squeezing down of the airways, asphyxiating the patient.  The resulting treatment would be to use medicines that dilated the bronchioles during an acute attack.  These broncho-dilaters invariably involved albuterol, or other medicines in its class.

However, we now know that the pathophysiology of asthma involves 'inflammation,' which then causes the the bronchospasm.  So while broncho-dilaters like albuterol still play a part in the acute treatment, anti-inflammatory medicines can actually improve both the acute flare-up and reduce future attacks.  The most common anti-inflammatory medicines are steroids, either taken orally or inhaled through special devices called MDIs (meter dose inhalers).

However, the advance in the treatment paradigm has left two problems. 

1. Many clinicians and patients haven't yet begun using steroids, leaving many patients woefully unprepared to prevent an attack...
2. Inhaled steroids, the medicine which will help prevent an attack, costs markedly more than the medicine used in the acute phase, leaving patients woefully unprepared to prevent an attack:

• Albuterol MDI - $20 per inhaler
• Flovent MDI (a steroid inhaler - usual dose) - $220 per inhaler
• Advair Discus (a steroid inhaler + albuterol equivalent - usual dose) - $199

Comments

[anjali niyogi]

flovent is now generic and costs about $36- still too pricey for most folks, but slightly more affordable, especially if it keeps people out of the ER.