Medicaid Spotlight: Coprevalence of Asthma and Allergies

Mar 15, 2013
Children with insurance coverage under a Medicaid program have a higher risk of complications and hospitalizations related to asthma than children with commercial insurance. For the Medicaid population, asthma also has the highest per-member-per-year cost of any of the traditional drug therapy classes.
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  • Medicaid
  • Allergies
  • Asthma

Comorbidity of Asthma and Allergies

Because asthma is most prevalent among children1 and low-income families,2 it is an especially important disease for the Medicaid program. In fact, children with insurance coverage under a Medicaid program have a higher risk of complications and hospitalizations related to asthma than children with commercial insurance.3 For the Medicaid population, asthma also has the highest per-member-per-year cost of any of the traditional drug therapy classes.

The symptoms of asthma, which include shortness of breath, chest tightness, wheezing and coughing, stem from inflammation of the airways. Many factors can inflame an asthma patient’s airways, including infections, air pollutants, weather changes and external allergens such as pet dander and dust mites. Allergic asthma – the airway inflammation and obstruction linked to external allergens – affects more than half of all asthma patients.4

Respiratory allergies such as allergic rhinitis are actually a different disease from asthma, although asthma and allergies are related through similarities in immunopathology5 and presentation of certain symptoms. Studies suggest that 70% to 80% of asthma patients also have a respiratory allergy.6,7 Because of the known overlap of asthma and allergies, it is essential for high-risk Medicaid beneficiaries and their caregivers to understand how the two conditions may work together.

The comorbidity of asthma and respiratory allergies has implications for both asthma control and the treatment of asthma, as well as economic considerations.

Asthma Control

Children with asthma who also have the respiratory allergy known as allergic rhinitis may have an impaired ability to manage their asthma symptoms, more limitations on their activity and more inhaler use than asthmatic children without allergic rhinitis.8 Studies also show that some allergies often precede the development of asthma; allergic rhinitis is a known risk factor for the development of asthma.9

Treatment Considerations

Some medications are indicated to treat both asthma and allergies, and there is evidence that certain allergy treatments may also be beneficial in treating asthma symptoms. Treating allergies with nasal corticosteroids, for example, has been shown to decrease upper airway inflammation and reduce bronchoconstriction in asthma patients.10 However, decisions about when to initiate therapy may be different for asthma patients with and without allergies, and questions about the appropriate time to initiate therapy are further compounded by the seasonal nature of asthma and allergies.11 It is also important to note that non-medical treatments aimed at reducing allergic reactions may be a key component in the alleviation of asthma attacks in patients with respiratory allergies. For example, the use of high-efficiency particulate air filtration systems to limit exposure to environmental tobacco smoke has been shown to reduce the number of unscheduled asthma-related physician visits in children.12

Economic Considerations

The annual direct costs associated with asthma have been estimated at $3,259 per person.13 The cost of treating asthma may increase when the condition is coupled with allergies. Evidence suggests that asthma patients with comorbid allergic rhinitis had more prescriptions for asthma medications, saw more medical specialists and incurred more costs (both for medications and for medical care) than asthma patients who did not have comorbid allergic rhinitis.14

Footnotes

1 Centers for Disease Control and Prevention. Asthma. Data and Surveillance. March 2013. Available at: http://www.cdc.gov/asthma/asthmadata.htm. Accessed March 28, 2013.

2 Akinbami LJ, Moorman JE, Bailey C, Zahran HS, et al. Trends in asthma prevalence, health care use and mortality in the United States, 2001-2010. NCHS data brief no. 94. Hyattsville, Md.: National Center for Health Statistics. 2012.

3 Ortega AN, Belanger KD, Paltiel AD, et al. Use of health services by insurance status among children with asthma. Med Care. 2001; 39(10): 1065-1074.

4 Asthma and Allergy Foundation. Allergic asthma. Available at: http://aafa.org/display.cfm?id=8&sub=16. Accessed March 28, 2013.

5 Braunstahl GJ. The unified immune system: respiratory tract—nasobronchial interaction mechanisms in allergic airway disease. J Allergy Clin Immunol. 2005; 115(1): 142-148.

6 American Academy of Allergy, Asthma & Immunology. Asthma Statistics. May 2011. Available at: http://www.aaaai.org/about-the-aaaai/newsroom/asthma-statistics.aspx. Accessed March 29, 2013.

7 de Groot EP, Nijkamp A, Duiverman EJ, Brand PLP. Allergic rhinitis is associated with poor asthma control in children with asthma. Thorax. 2012; 67(7): 582-587.

8 Boulay ME, Morin A, Laprise C, Boulet LP. Asthma and rhinitis: what is the relationship? Curr Opin Allergy Clin Immunol. 2012; 12(5): 449-454.

9 Vinuya RZ. Upper airway disorder and asthma: a syndrome of airway inflammation. Ann Allergy Asthma Immunol. 2002; 44(4 suppl 1): 8-15.

10 Scichilone N, Arrigo R, Paterno A, et al. The effect of intranasal corticosteroids on asthma control and quality of life in allergic rhinitis with mild asthma. J Asthma. 2011; 48(1): 41-47.

11 National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (EPR-3). Bethesda, Md.: National Institutes of Health. 2007. Available at: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm. Accessed April 4, 2013.

12 Rao D, Phipatanakul W. Impact of environmental controls on childhood asthma. Curr Allergy Asthma Rep. 2011; 11(5): 414-420.

13 Barnett SB, Nurmagambetov TA. Costs of asthma in the United States: 2002-2007. J Allergy Clin Immunol. 2011; 127(1): 145-152.

14 Halpern MT, Schmier JK, Richner R, et al. Allergic rhinitis: a potential cause of increased asthma medication use, costs and morbidity. J Asthma. 2004; 41(1): 117-126.




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