Moving Toward Better Asthma Care and Outcomes: What Will It Take?

November 8, 2024 · Becky Kolinski

Asthma is a complex, chronic disease that affects approximately 24 million people in the U.S. today. Despite decades of advances in respiratory care that can help make the condition manageable, patients with asthma accounted for nearly 1 million emergency department visits in 2020, and approximately 95,000 inpatient hospital stays.

There is a critical gap between best practices for asthma care and patients’ reality—and the gap widens depending on a patient’s race, socioeconomic status and place of residence. To better understand the factors that may enable or inhibit high-quality care for chronic conditions such as asthma, NCQA convened a diverse panel of clinicians, public/community health experts and patient advocates—the Asthma Management & Education Roundtable—with support from AstraZeneca Pharmaceuticals, LP.

“The roundtable allowed us to gather perspectives from diverse stakeholders about the barriers and challenges for delivery of optimal asthma care,” says Caroline Blaum, Assistant Vice President of the Chronic Conditions and Complex Care Knowledge Center at NCQA. “These insights will be useful for practitioners, health care organizations and policymakers seeking to improve the quality and equity of asthma care.”

The discussion from the roundtable is captured in a white paper, Improving Outcomes for People with Asthma: Challenges & A Call to Action.

The Reality for Patients Living With Asthma

Patients suffer from asthma exacerbations that interfere with daily activities and health-related quality of life—even though there are evidence-based best practices that could help patients manage their asthma more effectively.

• 4% of people with asthma had at least one asthma exacerbation in 2022.
• 9% of children 0–5 with asthma experienced at least one asthma exacerbation in 2022.
• In 2018, asthma caused 7.9 million missed school days for children 5–17, 10.9 million missed workdays for employed adults and 62.8 missed days of housework for unemployed adults.

Many asthma exacerbations could be avoided with appropriate preventive care and medication regimens that align with clinical guidelines for asthma control—especially if clinicians also provide education and support for patients that focuses on social factors and living conditions.

“As an industry, we know a lot about asthma management,” says Blaum. “The clinical practice guidelines are there, but they are not always followed due to fragmentation and resource constraints.”

Drivers of Positive Asthma Outcomes

Roundtable participants identified three drivers of positive asthma outcomes and some associated barriers and challenges.

1. Access to appropriate medical care. Patients with asthma need robust, equitable insurance coverage and access to clinicians trained to deliver appropriate asthma care. Many nonphysician health professionals—such as nurses, asthma education specialists, community health workers and pharmacists—are underutilized. Leaders in health care delivery, policy and payment should consider appropriate financial support that would allow these professionals to provide routine asthma care for patients.
2. Clinical care aligned with a quality framework and a strong evidence base. Even if access is improved, it’s challenging for clinicians to deliver care aligned with best practices for asthma management. The health care system must provide incentives and resources that enable clinicians to follow best practices for asthma management. Clinical guidelines should be simplified to make it easier for busy primary care practitioners to follow.
3. Patient-centeredness. Although the health care system and clinicians—not patients—are ultimately responsible for producing high-quality outcomes, patient self-management strategies and education enables people with asthma to manage their symptoms and the factors that drive them. Not all patients and families understand that control of asthma symptoms and exacerbations is achievable. Engaging with people with asthma—and promoting a culture of wellness—is essential for good asthma outcomes.

Strategies and Recommendations

There is much work to do to make high-quality care available to all patients with asthma. As identified by our asthma expert roundtable participants, a broad range of barriers and challenges need to be addressed, and all stakeholders must work together to achieve key goals.

“We need to start treating asthma like a chronic disease and provide resources—like paid asthma educators—to help people manage their condition and address the environmental and social forces that impact asthma outcomes,” says Blaum. “We’ve been using this model for diabetes care for years, and we know it can work. It’s time to bring that same focus to asthma care.”

Download the white paper Improving Outcomes for People with Asthma: Challenges & A Call to Action to dive deeper into the findings and recommendations in six areas: coverage, workforce, quality framework, care delivery, person-centered care and policy.

This research, and the resulting white paper, were made possible with support from AstraZeneca Pharmaceuticals, LP.