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Smokers may need higher doses of inhaled steroids
Among patients with mild asthma, those who smoke may need
higher doses of inhaled corticosteroids, says a British study in
Thorax. Researchers from the University of Glasgow gave
16 smokers and 28 nonsmokers 400g of beclomethasone daily for 12
weeks, while another group of 20 smokers and 25 nonsmokers
received 2000g daily. Nonsmokers on the lower dose saw
improvement in morning peak expiratory flow, but not the
smokers. In addition, within the lower dose group, smokers had a
mean of six asthma exacerbations, compared with one exacerbation
among nonsmokers. However, in the higher dose group, the PEF
improvement was 18 vs. 11 liter per minute (p = 0.40) among
nonsmokers and smokers, respectively. And, there was no
significant difference between nonsmokers and smokers in number
of exacerbations.
MS drug may help asthma patients with
colds
British scientists say a multiple sclerosis drug may reduce
asthma attacks caused by the common cold virus. Researchers from
the University of Southampton found rhinovirus was able to
replicate at higher levels in the epithelial lung cells of
asthma patients, but the replication could be blocked when
exposed to MS drug interferon-B. The asthma patients’ cells
contained low levels of the interferon-B chemical messenger, and
treating the cells with an interferon-B drug restored the normal
balance, helping to slow the virus' spread, researchers said.
The study was published in the Journal of Experimental
Medicine.
Health care workers at risk for
occupational asthma
Health care workers are at risk for occupational asthma, say
data from four state-based surveillance systems that monitor
work-related asthma cases. During a five-year period, health
care workers accounted for 16 percent of all confirmed cases of
work-related asthma reported in the four states, but only 8
percent of the states' workforce, according to the study.
Sixty-seven percent of the health care workers developed
"new-onset" asthma. The most common exposures were latex and
disinfectants.
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 A word from President Myron
Zitt, M.D.
I have recently returned from an AMA leadership
conference where I was briefed on the anticipated cuts in
Medicare payments over the coming years. Because these
alarming cuts, which are due to go into effect Jan. 1,
2006, will impact all practicing physicians, including
allergists, as well as patient access to care, I feel it
is vital to share this information with you.
Since 1991, Medicare has paid only a fraction of
physicians’ actual costs. In fact, because reimbursement
is based on a flawed formula called the sustainable growth
rate, or SGR, payment to physicians is so low that it
fails to keep pace with the government’s own cost
estimates. This formula is tied to the ups and downs of
the national economy, specifically the Gross Domestic
Product (GDP), rather than to the needs and costs of providing
health care for seniors and the disabled. Physicians are
penalized with decreased payments when growth in the use
of medical care exceeds growth of the GDP. With health
care costs driven by new technology, increasing patient
needs, and public policies that encourage access to care,
a rising SGR to GDP ratio is beyond physician control.
The Centers for Medicare & Medicaid Services (CMS) lacks
the authority to incorporate many policy changes in the
SGR, such as new
Medicare-covered benefits that help to drive utilization
increases. Because CMS includes the cost of
physician-administered drugs in its calculations of
Medicare expenditure for physician services, drug spending
consumes an ever-increasing share of the SGR target and is
a major factor in projected pay cuts.
Recently, the AMA and other medical groups, including the
JCAAI, successfully
lobbied to prevent steep cuts in Medicare payments. As a
result, Congress mandated a 1.5-percent increase in
physicians’ payments for 2004 and 2005. However, Medicare
trustees are now projecting a 5-percent cut in
reimbursement each year from 2006 to 2012, with an
additional 2-percent cut in 2013. The total cut of 31
percent, after adjusting for inflation, will translate
into physicians being paid less than half of their 1991
compensation.
Physicians already strapped with escalating costs and
payments that have not kept up with reimbursement will be
unable to absorb an additional 31 percent Medicare payment
cut. This may force health care providers to limit the
number or stop accepting new Medicare patients entirely,
thus jeopardizing access to care for the elderly and
disabled. As many health programs link their payment
systems directly to Medicare rates, millions of
non-Medicare patients will be affected. Included are
millions of uniformed services members and their families
(Tricare), Medicaid patients in states that link
reimbursement to Medicare, and patients of private
insurers who frequently use Medicare as a benchmark for
paying physicians. Needless to say, allergists will
be affected.
How can this problem be resolved?
Medicare payments to physicians must keep pace with the
cost of treating seniors and the disabled. The Medicare
payment Advisory Commission (MedPAC), a committee that
advises Congress on Medicare issues, recommends
eliminating the unfair SGR formula and replacing it with
an annual payment system that accurately reflects
increases in medical costs. The administration must remove
drug costs from the SGR and develop a fair reimbursement policy. Under
this approach, payments would realistically reflect
practice cost increases. Of significance is that a MedPAC
survey revealed that 22 percent of patients already have
some difficulties in finding a primary care physician and
37 percent report delays in obtaining a physician
appointment.
As we did last year, the ACAAI will be conducting its
Board of Regents meeting during
Asthma Awareness Week, in Washington, D.C. Among our
issues for discussion with
legislators will be the Family Asthma Act, Medical
Malpractice and Liability Reform and the Medicare Payment
issue.
Please feel free to contact us with recommendations for
our legislative visits. As you know, we were successful in
influencing passage of the HR2023 Asthmatic School
Children’s Treatment and Health Management Act during our
2004 visit to Washington. With your help, “nobody does it
better than the allergist” in educating and influencing
legislators on important health care issues.
Myron Zitt, M.D.
President, ACAAI |
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Regulatory Updates |
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Consumer group petitions FDA for safer asthma medications
According to consumer advocacy group Consumer Health
Alliance for Safe Medication, U.S. regulators need to do more to
protect asthma patients from unapproved inhaled drugs created by
pharmacists from bulk ingredients. The drugs are susceptible to
contamination and too strong or not strong enough doses, the
group said in a petition to the Food and Drug Administration.
The petition asks the FDA to clarify its authority over these
medications, and take action to ensure they are properly labeled
to show they are not FDA-approved, as well as inform the public
about the drugs. |
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Association
News |
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Luz Fonacier
testifies at FDA hearing on OTC switch of prescription topical
corticosteroids
ACAAI Dermatological Allergy Committee Chair Luz S. Fonacier,
M.D., testified on behalf of the College at the Joint Meeting
of the FDA Dermatologic and Ophthalmic Drug Advisory Committee
and the Nonprescription Drugs Advisory Committee on March 24,
2005, in Gaithersburg, Md., on the OTC switch of prescription
topical corticosteroids.
In her testimony, Dr. Fonacier discussed concerns to
allergists, including off-label, prolonged use; failure to
recognize and report both systemic and local side effects;
inappropriate labeling; the perception that over-the-counter
is safe; credibility of advertising; and differences in
vehicle that may increase absorption.
She emphasized another major concern for the allergist is how
this issue may impact intranasal and inhaled corticosteroids
for asthma and allergic rhinitis patients.
“We would not like to see difficulty in the access of these
medications, unnecessary panic or concern of the use of
corticosteroids in potentially life-threatening disease such
as asthma, or sub-optimal treatment. But at the same time, we
would like to be able to monitor our patients, not only in
terms of efficacy, but more importantly for safety,” she said.
“Until safer topical corticosteroids are available, more
sensitive tests can be used, better monitoring can be done and
more studies are conducted, we would like the current
prescription cutaneous, intranasal and inhaled corticosteroids
to remain prescription only,” Dr. Fonacier concluded in her
testimony.
ACAAI endorses Dr. Imbeau for the AMA Council on Medical
Service
Stephen A. Imbeau, M.D., a Board certified Allergist and
Internist, is a candidate for the Council on Medical Service.
Dr. Imbeau is endorsed by the ACAAI, the AAAAI, the South
Carolina Medical Association, the Southeastern Delegation to
the AMA, and the AMA Allergy Caucus.
His past experience includes serving as the allergy advisor to
the AMA’s Relative Value Update Committee (RUC), the Health
Care Financing Administration’s Practicing Physicians Advisory
Council (PPAC). Dr. Imbeau is also currently the Treasurer of
the Joint Council of Allergy, Asthma and Immunology. As part
of the Council, he deals with socioeconomic issues for ACAAI
and AAAAI with particular emphasis on coding, compliance,
insurance issues, and government relations and programs.
“I have followed the council’s deliberations closely as they
relate to my ongoing activities,” said Dr. Imbeau. “Over the
years, the AMA has proven to be a valuable resource to me and
I look forward to the possibility of giving back to this
organization through service to this council. I am excited
about personally meeting and speaking with my colleagues as
they prepare to make an informed vote in June.”
Allergy Practice Tip: Talk
Talk Talk
Advice from The Patient-Centered Allergy Practice
Need a simple tool for intra-practice communication? Try
text-messaging pagers or two-way radios. Their prices are
dropping and they are relatively easy to operate. That means
you can tell your nurse what you need without running up and
down the halls looking for her. For more advice on scheduling,
visit
www.patientcenteredallergypractice.com.
These tips are drawn The Patient-Centered Allergy Practice,
a CME Series in Practice Management, endorsed by the
American College of Allergy, Asthma & Immunology. |
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Fellows-in-Training |
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Welcome to the Board Review Corner prepared by Thao Ngoc Tran,
M.D., a representative of ACAAI’s fellows-in-training (FITs) to
the Board of Regents. The Board Review Corner is your chance to
test your Board preparedness.
To refer to a previous Board Review Corner, click the “Archive”
link in the left column.
Immunology Review Corner: Chapter 41 of the 6th edition
of Middleton’s Allergy Principles and Practice, edited by
N. Franklin Adkinson, et al. Review questions were written by
fellows-in-training Drs. Thao Tran, Karla Lowe, John Norvell and
Todd Levin.
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