Journal of General Internal Medicine

, Volume 26, Issue 12, pp 1465–1470 | Cite as

National Trends in Ambulatory Asthma Treatment, 1997–2009

  • Ashley Higashi
  • Shu Zhu
  • Randall S. Stafford
  • G. Caleb Alexander
Original Research



Despite reductions in morbidity and mortality and changes in guidelines, little is known regarding changes in asthma treatment patterns.


To examine national trends in the office-based treatment of asthma between 1997 and 2009.


We used the National Ambulatory Care Survey (NAMCS) and the National Disease and Therapeutic Index™ (NDTI), nationally representative audits of office-based physicians, to examine patients diagnosed with asthma less than 50 years of age.


Visits where asthma was diagnosed and use of six therapeutic classes (short-acting β2 agonists [SABA], long-acting β2 -agonists [LABA], inhaled steroids, antileukotrienes, anticholinergics, and xanthines).


Estimates from NAMCS indicated modest increases in the number of annual asthma visits from 9.9 million [M] in 1997 to 10.3M during 2008; estimates from the NDTI suggested more gradual continuous increases from 8.7M in 1997 to 12.6M during 2009. NAMCS estimates indicated declines in use of SABAs (from 80% of treatment visits in 1997 to 71% in 2008), increased inhaled steroid use (24% in 1997 to 33% in 2008), increased use of fixed dose LABA/steroid combinations (0% in 1997 to 19% in 2008), and increased leukotriene use (9% in 1997 to 24% in 2008). The ratio of controller to total asthma medication use increased from 0.5 (1997) to a peak of 0.7 (2004). In 2008, anticholinergics, xanthines, and LABA use without concomitant steroids accounted for fewer than 4% of all treatment visits. Estimates from NDTI corroborated these trends.


Changes in office-based treatment, including increased inhaled steroid use and increased combined steroid/long-acting β2-agonist use coincide with reductions in asthma morbidity and mortality that have been demonstrated over the same period. Xanthines, anticholinergics, and increasingly, LABA without concomitant steroid use, account for a very small fraction of all asthma treatments.


primary care respiratory disease pharmacotherapy 



The statements, findings, conclusions, views, and opinions contained and expressed in this article are based in part on data obtained under license from the following IMS Health Incorporated information service(s): National Disease and Therapeutic Index™ (1997–2009), IMS Health Incorporated. All Rights Reserved. The statements, findings, conclusions, views, and opinions contained and expressed herein are not necessarily those of IMS Health Incorporated or any of its affiliated or subsidiary entities.


Dr. Alexander is supported by the Agency for Healthcare Research and Quality (K08 HS15699-01A1; RO1 HS0189960) and the Robert Wood Johnson Physician Faculty Scholars Program. The funding sources had no role in the design and conduct of the study, analysis or interpretation of the data; and preparation of final approval of the manuscript prior to publication.


Conception and design: GCA and RSS; Analysis and interpretation: ASH, SZ, GCA, and RSS; Manuscript drafting: GCA; Substantive manuscript revision: ASH, SZ, GCA, and RSS; Approval of final manuscript: ASH, SZ, GCA, and RSS; Study supervision: GCA

Conflicts of Interest

Dr. Alexander is a consultant for IMS Health.


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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Ashley Higashi
    • 1
  • Shu Zhu
    • 1
  • Randall S. Stafford
    • 2
  • G. Caleb Alexander
    • 1
    • 3
    • 4
    • 5
  1. 1.Section of General Internal Medicine, Department of MedicineUniversity of ChicagoChicagoUSA
  2. 2.Program on Prevention Outcomes and Practices, Stanford Prevention Research CenterStanford University School of MedicineStanfordUSA
  3. 3.Center for Health and Social SciencesUniversity of ChicagoChicagoUSA
  4. 4.MacLean Center for Clinical Medical EthicsUniversity of ChicagoChicagoUSA
  5. 5.Department of Pharmacy PracticeUniversity of Illinois at Chicago School of PharmacyChicagoUSA

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