M. Alexander Otto

SAN FRANCISCO – Marijuana hypersensitivity might be more common than previously thought, according to the results of a case series.

Though there are only a few case reports in the literature, "Marijuana allergy, I think, is fairly common," said lead investigator Dr. Gordon Sussman, acting division director of clinical allergy and immunology at the University of Toronto. Even so, "It's something physicians don't really generally ask about. People should consider it in the diagnosis of rhinitis [and other allergic symptoms], and even in people that have asthma and anaphylaxis."

Photo credit: ©ron hilton/iStockphoto.com

The 17 patients who were included in the series reported that marijuana gave them runny noses or other problems; all ended up having positive marijuana skin prick test results, he reported. One patient in the series had an anaphylactic reaction after drinking marijuana tea.

That was the first patient in whom Dr. Sussman diagnosed a marijuana allergy. "I asked him in a detailed history what it could have been, and he actually had drunk marijuana tea. We knew at that point he had an IgE-mediated reaction to marijuana," he said.

Curiosity piqued, and Dr. Sussman began asking allergy patients about marijuana use and reactions. A significant percentage reported symptoms from both contact and inhalation.

To confirm the diagnosis, he and his colleagues did skin-prick tests on the 17 patients between 21 and 58 years old, mostly men. They extracted buds or flowers in 5 mL of water for 15 minutes and pricked beneath drops placed on patients' skin.

After 15 minutes, the 17 patients had wheals of 4-19 mm and surrounding flares. Fifteen presented with inhalation symptoms, including rhinitis and conjunctivitis, periorbital angioedema, wheezing, sinusitis, and throat swelling. Thirteen also reported hives from contact.

The anaphylaxis patient presented with anxiety, chest tightness, wheezing, GI cramping, and vomiting after drinking the tea.

"I don't think it's a contaminant; I'm pretty sure it's an allergen in the marijuana they are reacting to," Dr. Sussman said, adding that such reactions shouldn't be a surprise because "marijuana is a weed, and weeds are generally known to be allergenic."

Asking about marijuana use and past reactions should be a routine part of allergy work-ups, especially with expanding medical marijuana use. "People could actually be sensitized to marijuana and have a serious reaction. It's important for people to recognize this," Dr. Sussman said.

The researchers' next step is to identify the actual allergens responsible for the reactions using a marijuana extract from a U.S. federal laboratory, serum from positive patients, and Western blot assays.

There was no outside funding for the study. Dr. Sussman said he had no disclosures.

SAN FRANCISCO – Marijuana hypersensitivity might be more common than previously thought, according to the results of a case series.

Though there are only a few case reports in the literature, "Marijuana allergy, I think, is fairly common," said lead investigator Dr. Gordon Sussman, acting division director of clinical allergy and immunology at the University of Toronto. Even so, "It's something physicians don't really generally ask about. People should consider it in the diagnosis of rhinitis [and other allergic symptoms], and even in people that have asthma and anaphylaxis."

Photo credit: ©ron hilton/iStockphoto.com

The 17 patients who were included in the series reported that marijuana gave them runny noses or other problems; all ended up having positive marijuana skin prick test results, he reported. One patient in the series had an anaphylactic reaction after drinking marijuana tea.

That was the first patient in whom Dr. Sussman diagnosed a marijuana allergy. "I asked him in a detailed history what it could have been, and he actually had drunk marijuana tea. We knew at that point he had an IgE-mediated reaction to marijuana," he said.

Curiosity piqued, and Dr. Sussman began asking allergy patients about marijuana use and reactions. A significant percentage reported symptoms from both contact and inhalation.

To confirm the diagnosis, he and his colleagues did skin-prick tests on the 17 patients between 21 and 58 years old, mostly men. They extracted buds or flowers in 5 mL of water for 15 minutes and pricked beneath drops placed on patients' skin.

After 15 minutes, the 17 patients had wheals of 4-19 mm and surrounding flares. Fifteen presented with inhalation symptoms, including rhinitis and conjunctivitis, periorbital angioedema, wheezing, sinusitis, and throat swelling. Thirteen also reported hives from contact.

The anaphylaxis patient presented with anxiety, chest tightness, wheezing, GI cramping, and vomiting after drinking the tea.

"I don't think it's a contaminant; I'm pretty sure it's an allergen in the marijuana they are reacting to," Dr. Sussman said, adding that such reactions shouldn't be a surprise because "marijuana is a weed, and weeds are generally known to be allergenic."

Asking about marijuana use and past reactions should be a routine part of allergy work-ups, especially with expanding medical marijuana use. "People could actually be sensitized to marijuana and have a serious reaction. It's important for people to recognize this," Dr. Sussman said.

The researchers' next step is to identify the actual allergens responsible for the reactions using a marijuana extract from a U.S. federal laboratory, serum from positive patients, and Western blot assays.

There was no outside funding for the study. Dr. Sussman said he had no disclosures.

SAN FRANCISCO – Marijuana hypersensitivity might be more common than previously thought, according to the results of a case series.

Though there are only a few case reports in the literature, "Marijuana allergy, I think, is fairly common," said lead investigator Dr. Gordon Sussman, acting division director of clinical allergy and immunology at the University of Toronto. Even so, "It's something physicians don't really generally ask about. People should consider it in the diagnosis of rhinitis [and other allergic symptoms], and even in people that have asthma and anaphylaxis."

Photo credit: ©ron hilton/iStockphoto.com

The 17 patients who were included in the series reported that marijuana gave them runny noses or other problems; all ended up having positive marijuana skin prick test results, he reported. One patient in the series had an anaphylactic reaction after drinking marijuana tea.

That was the first patient in whom Dr. Sussman diagnosed a marijuana allergy. "I asked him in a detailed history what it could have been, and he actually had drunk marijuana tea. We knew at that point he had an IgE-mediated reaction to marijuana," he said.

Curiosity piqued, and Dr. Sussman began asking allergy patients about marijuana use and reactions. A significant percentage reported symptoms from both contact and inhalation.

To confirm the diagnosis, he and his colleagues did skin-prick tests on the 17 patients between 21 and 58 years old, mostly men. They extracted buds or flowers in 5 mL of water for 15 minutes and pricked beneath drops placed on patients' skin.

After 15 minutes, the 17 patients had wheals of 4-19 mm and surrounding flares. Fifteen presented with inhalation symptoms, including rhinitis and conjunctivitis, periorbital angioedema, wheezing, sinusitis, and throat swelling. Thirteen also reported hives from contact.

The anaphylaxis patient presented with anxiety, chest tightness, wheezing, GI cramping, and vomiting after drinking the tea.

"I don't think it's a contaminant; I'm pretty sure it's an allergen in the marijuana they are reacting to," Dr. Sussman said, adding that such reactions shouldn't be a surprise because "marijuana is a weed, and weeds are generally known to be allergenic."

Asking about marijuana use and past reactions should be a routine part of allergy work-ups, especially with expanding medical marijuana use. "People could actually be sensitized to marijuana and have a serious reaction. It's important for people to recognize this," Dr. Sussman said.

The researchers' next step is to identify the actual allergens responsible for the reactions using a marijuana extract from a U.S. federal laboratory, serum from positive patients, and Western blot assays.

There was no outside funding for the study. Dr. Sussman said he had no disclosures.

SAN FRANCISCO – Marijuana hypersensitivity might be more common than previously thought, according to the results of a case series.

Though there are only a few case reports in the literature, "Marijuana allergy, I think, is fairly common," said lead investigator Dr. Gordon Sussman, acting division director of clinical allergy and immunology at the University of Toronto. Even so, "It’s something physicians don’t really generally ask about. People should consider it in the diagnosis of rhinitis [and other allergic symptoms], and even in people that have asthma and anaphylaxis."

Photo credit: ©ron hilton/iStockphoto.com

The 17 patients who were included in the series reported that marijuana gave them runny noses or other problems; all ended up having positive marijuana skin prick test results, he reported. One patient in the series had an anaphylactic reaction after drinking marijuana tea.

That was the first patient in whom Dr. Sussman diagnosed a marijuana allergy. "I asked him in a detailed history what it could have been, and he actually had drunk marijuana tea. We knew at that point he had an IgE-mediated reaction to marijuana," he said.

Curiosity piqued, and Dr. Sussman began asking allergy patients about marijuana use and reactions. A significant percentage reported symptoms from both contact and inhalation.

To confirm the diagnosis, he and his colleagues did skin-prick tests on the 17 patients between 21 and 58 years old, mostly men. They extracted buds or flowers in 5 mL of water for 15 minutes and pricked beneath drops placed on patients’ skin.

After 15 minutes, the 17 patients had wheals of 4-19 mm and surrounding flares. Fifteen presented with inhalation symptoms, including rhinitis and conjunctivitis, periorbital angioedema, wheezing, sinusitis, and throat swelling. Thirteen also reported hives from contact.

The anaphylaxis patient presented with anxiety, chest tightness, wheezing, GI cramping, and vomiting after drinking the tea.

"I don’t think it’s a contaminant; I’m pretty sure it’s an allergen in the marijuana they are reacting to," Dr. Sussman said, adding that such reactions shouldn’t be a surprise because "marijuana is a weed, and weeds are generally known to be allergenic."

Asking about marijuana use and past reactions should be a routine part of allergy work-ups, especially with expanding medical marijuana use. "People could actually be sensitized to marijuana and have a serious reaction. It’s important for people to recognize this," Dr. Sussman said.

The researchers’ next step is to identify the actual allergens responsible for the reactions using a marijuana extract from a U.S. federal laboratory, serum from positive patients, and Western blot assays.

There was no outside funding for the study. Dr. Sussman said he had no disclosures.

SAN FRANCISCO – Marijuana hypersensitivity might be more common than previously thought, according to the results of a case series.

Though there are only a few case reports in the literature, "Marijuana allergy, I think, is fairly common," said lead investigator Dr. Gordon Sussman, acting division director of clinical allergy and immunology at the University of Toronto. Even so, "It’s something physicians don’t really generally ask about. People should consider it in the diagnosis of rhinitis [and other allergic symptoms], and even in people that have asthma and anaphylaxis."

Photo credit: ©ron hilton/iStockphoto.com

The 17 patients who were included in the series reported that marijuana gave them runny noses or other problems; all ended up having positive marijuana skin prick test results, he reported. One patient in the series had an anaphylactic reaction after drinking marijuana tea.

That was the first patient in whom Dr. Sussman diagnosed a marijuana allergy. "I asked him in a detailed history what it could have been, and he actually had drunk marijuana tea. We knew at that point he had an IgE-mediated reaction to marijuana," he said.

Curiosity piqued, and Dr. Sussman began asking allergy patients about marijuana use and reactions. A significant percentage reported symptoms from both contact and inhalation.

To confirm the diagnosis, he and his colleagues did skin-prick tests on the 17 patients between 21 and 58 years old, mostly men. They extracted buds or flowers in 5 mL of water for 15 minutes and pricked beneath drops placed on patients’ skin.

After 15 minutes, the 17 patients had wheals of 4-19 mm and surrounding flares. Fifteen presented with inhalation symptoms, including rhinitis and conjunctivitis, periorbital angioedema, wheezing, sinusitis, and throat swelling. Thirteen also reported hives from contact.

The anaphylaxis patient presented with anxiety, chest tightness, wheezing, GI cramping, and vomiting after drinking the tea.

"I don’t think it’s a contaminant; I’m pretty sure it’s an allergen in the marijuana they are reacting to," Dr. Sussman said, adding that such reactions shouldn’t be a surprise because "marijuana is a weed, and weeds are generally known to be allergenic."

Asking about marijuana use and past reactions should be a routine part of allergy work-ups, especially with expanding medical marijuana use. "People could actually be sensitized to marijuana and have a serious reaction. It’s important for people to recognize this," Dr. Sussman said.

The researchers’ next step is to identify the actual allergens responsible for the reactions using a marijuana extract from a U.S. federal laboratory, serum from positive patients, and Western blot assays.

There was no outside funding for the study. Dr. Sussman said he had no disclosures.

SAN FRANCISCO – Marijuana hypersensitivity might be more common than previously thought, according to the results of a case series.

Though there are only a few case reports in the literature, "Marijuana allergy, I think, is fairly common," said lead investigator Dr. Gordon Sussman, acting division director of clinical allergy and immunology at the University of Toronto. Even so, "It’s something physicians don’t really generally ask about. People should consider it in the diagnosis of rhinitis [and other allergic symptoms], and even in people that have asthma and anaphylaxis."

Photo credit: ©ron hilton/iStockphoto.com

The 17 patients who were included in the series reported that marijuana gave them runny noses or other problems; all ended up having positive marijuana skin prick test results, he reported. One patient in the series had an anaphylactic reaction after drinking marijuana tea.

That was the first patient in whom Dr. Sussman diagnosed a marijuana allergy. "I asked him in a detailed history what it could have been, and he actually had drunk marijuana tea. We knew at that point he had an IgE-mediated reaction to marijuana," he said.

Curiosity piqued, and Dr. Sussman began asking allergy patients about marijuana use and reactions. A significant percentage reported symptoms from both contact and inhalation.

To confirm the diagnosis, he and his colleagues did skin-prick tests on the 17 patients between 21 and 58 years old, mostly men. They extracted buds or flowers in 5 mL of water for 15 minutes and pricked beneath drops placed on patients’ skin.

After 15 minutes, the 17 patients had wheals of 4-19 mm and surrounding flares. Fifteen presented with inhalation symptoms, including rhinitis and conjunctivitis, periorbital angioedema, wheezing, sinusitis, and throat swelling. Thirteen also reported hives from contact.

The anaphylaxis patient presented with anxiety, chest tightness, wheezing, GI cramping, and vomiting after drinking the tea.

"I don’t think it’s a contaminant; I’m pretty sure it’s an allergen in the marijuana they are reacting to," Dr. Sussman said, adding that such reactions shouldn’t be a surprise because "marijuana is a weed, and weeds are generally known to be allergenic."

Asking about marijuana use and past reactions should be a routine part of allergy work-ups, especially with expanding medical marijuana use. "People could actually be sensitized to marijuana and have a serious reaction. It’s important for people to recognize this," Dr. Sussman said.

The researchers’ next step is to identify the actual allergens responsible for the reactions using a marijuana extract from a U.S. federal laboratory, serum from positive patients, and Western blot assays.

There was no outside funding for the study. Dr. Sussman said he had no disclosures.

SAN FRANCISCO – Marijuana hypersensitivity might be more common than previously thought, according to the results of a case series.

Though there are only a few case reports in the literature, "Marijuana allergy, I think, is fairly common," said lead investigator Dr. Gordon Sussman, acting division director of clinical allergy and immunology at the University of Toronto. Even so, "It’s something physicians don’t really generally ask about. People should consider it in the diagnosis of rhinitis [and other allergic symptoms], and even in people that have asthma and anaphylaxis."

Photo credit: ©ron hilton/iStockphoto.com

The 17 patients who were included in the series reported that marijuana gave them runny noses or other problems; all ended up having positive marijuana skin prick test results, he reported. One patient in the series had an anaphylactic reaction after drinking marijuana tea.

That was the first patient in whom Dr. Sussman diagnosed a marijuana allergy. "I asked him in a detailed history what it could have been, and he actually had drunk marijuana tea. We knew at that point he had an IgE-mediated reaction to marijuana," he said.

Curiosity piqued, and Dr. Sussman began asking allergy patients about marijuana use and reactions. A significant percentage reported symptoms from both contact and inhalation.

To confirm the diagnosis, he and his colleagues did skin-prick tests on the 17 patients between 21 and 58 years old, mostly men. They extracted buds or flowers in 5 mL of water for 15 minutes and pricked beneath drops placed on patients’ skin.

After 15 minutes, the 17 patients had wheals of 4-19 mm and surrounding flares. Fifteen presented with inhalation symptoms, including rhinitis and conjunctivitis, periorbital angioedema, wheezing, sinusitis, and throat swelling. Thirteen also reported hives from contact.

The anaphylaxis patient presented with anxiety, chest tightness, wheezing, GI cramping, and vomiting after drinking the tea.

"I don’t think it’s a contaminant; I’m pretty sure it’s an allergen in the marijuana they are reacting to," Dr. Sussman said, adding that such reactions shouldn’t be a surprise because "marijuana is a weed, and weeds are generally known to be allergenic."

Asking about marijuana use and past reactions should be a routine part of allergy work-ups, especially with expanding medical marijuana use. "People could actually be sensitized to marijuana and have a serious reaction. It’s important for people to recognize this," Dr. Sussman said.

The researchers’ next step is to identify the actual allergens responsible for the reactions using a marijuana extract from a U.S. federal laboratory, serum from positive patients, and Western blot assays.

There was no outside funding for the study. Dr. Sussman said he had no disclosures.

SAN FRANCISCO – Marijuana hypersensitivity might be more common than previously thought, according to the results of a case series.

Though there are only a few case reports in the literature, "Marijuana allergy, I think, is fairly common," said lead investigator Dr. Gordon Sussman, acting division director of clinical allergy and immunology at the University of Toronto. Even so, "It’s something physicians don’t really generally ask about. People should consider it in the diagnosis of rhinitis [and other allergic symptoms], and even in people that have asthma and anaphylaxis."

Photo credit: ©ron hilton/iStockphoto.com

The 17 patients who were included in the series reported that marijuana gave them runny noses or other problems; all ended up having positive marijuana skin prick test results, he reported. One patient in the series had an anaphylactic reaction after drinking marijuana tea.

That was the first patient in whom Dr. Sussman diagnosed a marijuana allergy. "I asked him in a detailed history what it could have been, and he actually had drunk marijuana tea. We knew at that point he had an IgE-mediated reaction to marijuana," he said.

Curiosity piqued, and Dr. Sussman began asking allergy patients about marijuana use and reactions. A significant percentage reported symptoms from both contact and inhalation.

To confirm the diagnosis, he and his colleagues did skin-prick tests on the 17 patients between 21 and 58 years old, mostly men. They extracted buds or flowers in 5 mL of water for 15 minutes and pricked beneath drops placed on patients’ skin.

After 15 minutes, the 17 patients had wheals of 4-19 mm and surrounding flares. Fifteen presented with inhalation symptoms, including rhinitis and conjunctivitis, periorbital angioedema, wheezing, sinusitis, and throat swelling. Thirteen also reported hives from contact.

The anaphylaxis patient presented with anxiety, chest tightness, wheezing, GI cramping, and vomiting after drinking the tea.

"I don’t think it’s a contaminant; I’m pretty sure it’s an allergen in the marijuana they are reacting to," Dr. Sussman said, adding that such reactions shouldn’t be a surprise because "marijuana is a weed, and weeds are generally known to be allergenic."

Asking about marijuana use and past reactions should be a routine part of allergy work-ups, especially with expanding medical marijuana use. "People could actually be sensitized to marijuana and have a serious reaction. It’s important for people to recognize this," Dr. Sussman said.

The researchers’ next step is to identify the actual allergens responsible for the reactions using a marijuana extract from a U.S. federal laboratory, serum from positive patients, and Western blot assays.

There was no outside funding for the study. Dr. Sussman said he had no disclosures.

SAN FRANCISCO – Marijuana hypersensitivity might be more common than previously thought, according to the results of a case series.

Though there are only a few case reports in the literature, "Marijuana allergy, I think, is fairly common," said lead investigator Dr. Gordon Sussman, acting division director of clinical allergy and immunology at the University of Toronto. Even so, "It’s something physicians don’t really generally ask about. People should consider it in the diagnosis of rhinitis [and other allergic symptoms], and even in people that have asthma and anaphylaxis."

Photo credit: ©ron hilton/iStockphoto.com

The 17 patients who were included in the series reported that marijuana gave them runny noses or other problems; all ended up having positive marijuana skin prick test results, he reported. One patient in the series had an anaphylactic reaction after drinking marijuana tea.

That was the first patient in whom Dr. Sussman diagnosed a marijuana allergy. "I asked him in a detailed history what it could have been, and he actually had drunk marijuana tea. We knew at that point he had an IgE-mediated reaction to marijuana," he said.

Curiosity piqued, and Dr. Sussman began asking allergy patients about marijuana use and reactions. A significant percentage reported symptoms from both contact and inhalation.

To confirm the diagnosis, he and his colleagues did skin-prick tests on the 17 patients between 21 and 58 years old, mostly men. They extracted buds or flowers in 5 mL of water for 15 minutes and pricked beneath drops placed on patients’ skin.

After 15 minutes, the 17 patients had wheals of 4-19 mm and surrounding flares. Fifteen presented with inhalation symptoms, including rhinitis and conjunctivitis, periorbital angioedema, wheezing, sinusitis, and throat swelling. Thirteen also reported hives from contact.

The anaphylaxis patient presented with anxiety, chest tightness, wheezing, GI cramping, and vomiting after drinking the tea.

"I don’t think it’s a contaminant; I’m pretty sure it’s an allergen in the marijuana they are reacting to," Dr. Sussman said, adding that such reactions shouldn’t be a surprise because "marijuana is a weed, and weeds are generally known to be allergenic."

Asking about marijuana use and past reactions should be a routine part of allergy work-ups, especially with expanding medical marijuana use. "People could actually be sensitized to marijuana and have a serious reaction. It’s important for people to recognize this," Dr. Sussman said.

The researchers’ next step is to identify the actual allergens responsible for the reactions using a marijuana extract from a U.S. federal laboratory, serum from positive patients, and Western blot assays.

There was no outside funding for the study. Dr. Sussman said he had no disclosures.

HUNTINGTON BEACH, CALIF. – Underrecognized and undertreated obstructive sleep apnea is the most likely cause of unexplained deaths following bariatric surgery, according to results of a small pilot study.

Because of that, continuous positive airway pressure (CPAP) and continuous pulse oximetry monitoring – with alarms to alert nursing staff to hypoxic episodes and rouse oxygen-desaturated patients from sleep – should be included in postoperative care, said Dr. Scott Gallagher, a bariatric surgeon at the University of South Florida, Tampa, where the study was conducted.

In previous work, the researchers found that severe, prolonged, and frequent arterial hypoxemia is common in sleeping bariatric surgery patients. They sought to determine why such patients – who seemed to be doing well after surgery – died suddenly in their sleep, without pulmonary embolism or any other obvious cause.

In 15 gastric bypass patients monitored for 24 hours after surgery, they found that the average episode of hypoxemia lasted 21 minutes, and the longest for hours. Blood oxygen saturation fell as low as 60% (J. Surg. Res. 2010;159:622-6).

Right-to-left shunt, diminished inspired oxygen partial pressure, and other textbook explanations did not provide a rationale for the hypoxemia. Such causes “did not exist in these patients,” Dr. Gallagher said.

That left either postoperative, narcotic-induced hypoventilation or obstructive sleep apnea as the most likely explanation. Narcotic pain control is common after bariatric surgery, as is sleep apnea.

Dr. Gallagher and his team measured carbon dioxide partial pressures transcutaneously (PtcCO₂) to gauge hypoventilation in 20 patients (14 female) during the first 24 hours after Roux-en-Y gastric bypass.

Patients also wore blood oxygen saturation (SpO₂) ear-clip sensors.

Their mean body mass index was 54 kg/m

As in the previous study, all the patients had multiple episodes of prolonged hypoxemia, with a mean of 191 episodes per patient lasting a mean of 1 minute.

Mean SpO₂ was 94%, and mean minimum SpO₂ was 60%. Patients spent about 5% of their time (75 minutes) with SpO₂ below 88%; hypoxemia lasted longer than 5 minutes in three patients.

All patients also had mild hypercarbia, suggesting mild, chronic hypoventilation.

They had a mean PtcCO₂ of 44 mm Hg and a mean maximum of 56 mm Hg. The maximum PtcCO₂ value recorded in any patient was 75 mm Hg. Heart rates temporarily dropped below 50 bpm in 14 patients.

However, “in no patient could hypoxemia be explained entirely by hypoventilation, and there was no obvious relationship between hypoxemic episodes and [hypoventilation],” said Dr. Krista Haines, a recent University of South Florida graduate now with the University of Nevada, Las Vegas, who presented the findings at the congress.

Dr. Stefan Holubar, a colorectal surgeon and comoderator of the session, thinks that needs to change.

“The standard of care should include formal obstructive sleep apnea [screening] for all patients undergoing bariatric surgery, or they should all be empirically treated [with CPAP] regardless of whether or not they have the diagnosis,” said Dr. Holubar, of Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

“Although it's a small pilot study, there are profound implications,” he added.

Dr. Gallagher believes what the team has found thus far is “the tip of the iceberg.”

Dr. Gallagher and Dr. Haines said they have no conflicts of interest. The study received no outside funding.

CPAP and continuous pulse oximetry monitoring, with alarms, should be included in postop care.

Source DR. GALLAGHER

'Although it's a small pilot study, there are profound implications.'

Source DR. HOLUBAR

HUNTINGTON BEACH, CALIF. – Underrecognized and undertreated obstructive sleep apnea is the most likely cause of unexplained deaths following bariatric surgery, according to results of a small pilot study.

Because of that, continuous positive airway pressure (CPAP) and continuous pulse oximetry monitoring – with alarms to alert nursing staff to hypoxic episodes and rouse oxygen-desaturated patients from sleep – should be included in postoperative care, said Dr. Scott Gallagher, a bariatric surgeon at the University of South Florida, Tampa, where the study was conducted.

In previous work, the researchers found that severe, prolonged, and frequent arterial hypoxemia is common in sleeping bariatric surgery patients. They sought to determine why such patients – who seemed to be doing well after surgery – died suddenly in their sleep, without pulmonary embolism or any other obvious cause.

In 15 gastric bypass patients monitored for 24 hours after surgery, they found that the average episode of hypoxemia lasted 21 minutes, and the longest for hours. Blood oxygen saturation fell as low as 60% (J. Surg. Res. 2010;159:622-6).

Right-to-left shunt, diminished inspired oxygen partial pressure, and other textbook explanations did not provide a rationale for the hypoxemia. Such causes “did not exist in these patients,” Dr. Gallagher said.

That left either postoperative, narcotic-induced hypoventilation or obstructive sleep apnea as the most likely explanation. Narcotic pain control is common after bariatric surgery, as is sleep apnea.

Dr. Gallagher and his team measured carbon dioxide partial pressures transcutaneously (PtcCO₂) to gauge hypoventilation in 20 patients (14 female) during the first 24 hours after Roux-en-Y gastric bypass.

Patients also wore blood oxygen saturation (SpO₂) ear-clip sensors.

Their mean body mass index was 54 kg/m

As in the previous study, all the patients had multiple episodes of prolonged hypoxemia, with a mean of 191 episodes per patient lasting a mean of 1 minute.

Mean SpO₂ was 94%, and mean minimum SpO₂ was 60%. Patients spent about 5% of their time (75 minutes) with SpO₂ below 88%; hypoxemia lasted longer than 5 minutes in three patients.

All patients also had mild hypercarbia, suggesting mild, chronic hypoventilation.

They had a mean PtcCO₂ of 44 mm Hg and a mean maximum of 56 mm Hg. The maximum PtcCO₂ value recorded in any patient was 75 mm Hg. Heart rates temporarily dropped below 50 bpm in 14 patients.

However, “in no patient could hypoxemia be explained entirely by hypoventilation, and there was no obvious relationship between hypoxemic episodes and [hypoventilation],” said Dr. Krista Haines, a recent University of South Florida graduate now with the University of Nevada, Las Vegas, who presented the findings at the congress.

Dr. Stefan Holubar, a colorectal surgeon and comoderator of the session, thinks that needs to change.

“The standard of care should include formal obstructive sleep apnea [screening] for all patients undergoing bariatric surgery, or they should all be empirically treated [with CPAP] regardless of whether or not they have the diagnosis,” said Dr. Holubar, of Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

“Although it's a small pilot study, there are profound implications,” he added.

Dr. Gallagher believes what the team has found thus far is “the tip of the iceberg.”

Dr. Gallagher and Dr. Haines said they have no conflicts of interest. The study received no outside funding.

CPAP and continuous pulse oximetry monitoring, with alarms, should be included in postop care.

Source DR. GALLAGHER

'Although it's a small pilot study, there are profound implications.'

Source DR. HOLUBAR

HUNTINGTON BEACH, CALIF. – Underrecognized and undertreated obstructive sleep apnea is the most likely cause of unexplained deaths following bariatric surgery, according to results of a small pilot study.

Because of that, continuous positive airway pressure (CPAP) and continuous pulse oximetry monitoring – with alarms to alert nursing staff to hypoxic episodes and rouse oxygen-desaturated patients from sleep – should be included in postoperative care, said Dr. Scott Gallagher, a bariatric surgeon at the University of South Florida, Tampa, where the study was conducted.

In previous work, the researchers found that severe, prolonged, and frequent arterial hypoxemia is common in sleeping bariatric surgery patients. They sought to determine why such patients – who seemed to be doing well after surgery – died suddenly in their sleep, without pulmonary embolism or any other obvious cause.

In 15 gastric bypass patients monitored for 24 hours after surgery, they found that the average episode of hypoxemia lasted 21 minutes, and the longest for hours. Blood oxygen saturation fell as low as 60% (J. Surg. Res. 2010;159:622-6).

Right-to-left shunt, diminished inspired oxygen partial pressure, and other textbook explanations did not provide a rationale for the hypoxemia. Such causes “did not exist in these patients,” Dr. Gallagher said.

That left either postoperative, narcotic-induced hypoventilation or obstructive sleep apnea as the most likely explanation. Narcotic pain control is common after bariatric surgery, as is sleep apnea.

Dr. Gallagher and his team measured carbon dioxide partial pressures transcutaneously (PtcCO₂) to gauge hypoventilation in 20 patients (14 female) during the first 24 hours after Roux-en-Y gastric bypass.

Patients also wore blood oxygen saturation (SpO₂) ear-clip sensors.

Their mean body mass index was 54 kg/m

As in the previous study, all the patients had multiple episodes of prolonged hypoxemia, with a mean of 191 episodes per patient lasting a mean of 1 minute.

Mean SpO₂ was 94%, and mean minimum SpO₂ was 60%. Patients spent about 5% of their time (75 minutes) with SpO₂ below 88%; hypoxemia lasted longer than 5 minutes in three patients.

All patients also had mild hypercarbia, suggesting mild, chronic hypoventilation.

They had a mean PtcCO₂ of 44 mm Hg and a mean maximum of 56 mm Hg. The maximum PtcCO₂ value recorded in any patient was 75 mm Hg. Heart rates temporarily dropped below 50 bpm in 14 patients.

However, “in no patient could hypoxemia be explained entirely by hypoventilation, and there was no obvious relationship between hypoxemic episodes and [hypoventilation],” said Dr. Krista Haines, a recent University of South Florida graduate now with the University of Nevada, Las Vegas, who presented the findings at the congress.

Dr. Stefan Holubar, a colorectal surgeon and comoderator of the session, thinks that needs to change.

“The standard of care should include formal obstructive sleep apnea [screening] for all patients undergoing bariatric surgery, or they should all be empirically treated [with CPAP] regardless of whether or not they have the diagnosis,” said Dr. Holubar, of Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

“Although it's a small pilot study, there are profound implications,” he added.

Dr. Gallagher believes what the team has found thus far is “the tip of the iceberg.”

Dr. Gallagher and Dr. Haines said they have no conflicts of interest. The study received no outside funding.

CPAP and continuous pulse oximetry monitoring, with alarms, should be included in postop care.

Source DR. GALLAGHER

'Although it's a small pilot study, there are profound implications.'

Source DR. HOLUBAR

SAN FRANCISCO – A new skin prick test detects type-1 hypersensitivity to nitrile, the synthetic rubber in the gloves increasingly used by hospitals.

With latex allergies not uncommon among health care workers, "most hospitals have been switching over to nitrile gloves," said allergist and immunologist Dr. Santhosh Kumar of Virginia Commonwealth University, Richmond.

Photo credit: Anton Gvozdikov/Fotolia.com

But nitrile gloves can cause reactions, too, a problem not often recognized in the medical community and one that may emerge as a significant issue with expanded use, he said.

Since hospitals have been making the switch, "We’ve seen more and more people present with contact sensitivity [to nitrile], with hives and rashes on their hands. Some have it all over their body. It starts off initially on the hands, and then it gradually progresses," Dr. Kumar said.

To detect nitrile hypersensitivity, "we came up with a new skin prick test," he said.

Dr. Kumar and his colleagues tried it out on three people who had reacted to nitrile gloves in the past.

They cut 5-cm-square pieces from blue and purple nitrile gloves, and soaked them in normal saline for 2 hours.

They then applied the pieces to the underside of the patients’ forearms, and pricked the skin through the patches with Greer DermaPIKs. The pieces were removed and rubbed over the pricked areas a few times.

Skin tests were read 15 minutes later and considered positive if the wheal was 3 mm larger than saline control pricks.

All three patients had positive tests with mean wheal diameters of 5.5 mm. The mean saline prick wheal diameter was 2.17 mm, the mean diameter of histamine pricks—also used as controls—was 5.17 mm.

Latex IgE was positive in the one patient who had previously reacted to latex gloves.

The test "is a simple and effective method to detect type-1 hypersensitivity reactions to nitrile products," Dr. Kumar and his colleagues concluded.

"If a patient is positive, we tell them to avoid nitrile gloves," he said. Vinyl gloves are option, though less elastic than latex and nitrile.

Dr. Kumar said he has no disclosures.

SAN FRANCISCO – A new skin prick test detects type-1 hypersensitivity to nitrile, the synthetic rubber in the gloves increasingly used by hospitals.

With latex allergies not uncommon among health care workers, "most hospitals have been switching over to nitrile gloves," said allergist and immunologist Dr. Santhosh Kumar of Virginia Commonwealth University, Richmond.

Photo credit: Anton Gvozdikov/Fotolia.com

But nitrile gloves can cause reactions, too, a problem not often recognized in the medical community and one that may emerge as a significant issue with expanded use, he said.

Since hospitals have been making the switch, "We’ve seen more and more people present with contact sensitivity [to nitrile], with hives and rashes on their hands. Some have it all over their body. It starts off initially on the hands, and then it gradually progresses," Dr. Kumar said.

To detect nitrile hypersensitivity, "we came up with a new skin prick test," he said.

Dr. Kumar and his colleagues tried it out on three people who had reacted to nitrile gloves in the past.

They cut 5-cm-square pieces from blue and purple nitrile gloves, and soaked them in normal saline for 2 hours.

They then applied the pieces to the underside of the patients’ forearms, and pricked the skin through the patches with Greer DermaPIKs. The pieces were removed and rubbed over the pricked areas a few times.

Skin tests were read 15 minutes later and considered positive if the wheal was 3 mm larger than saline control pricks.

All three patients had positive tests with mean wheal diameters of 5.5 mm. The mean saline prick wheal diameter was 2.17 mm, the mean diameter of histamine pricks—also used as controls—was 5.17 mm.

Latex IgE was positive in the one patient who had previously reacted to latex gloves.

The test "is a simple and effective method to detect type-1 hypersensitivity reactions to nitrile products," Dr. Kumar and his colleagues concluded.

"If a patient is positive, we tell them to avoid nitrile gloves," he said. Vinyl gloves are option, though less elastic than latex and nitrile.

Dr. Kumar said he has no disclosures.

SAN FRANCISCO – A new skin prick test detects type-1 hypersensitivity to nitrile, the synthetic rubber in the gloves increasingly used by hospitals.

With latex allergies not uncommon among health care workers, "most hospitals have been switching over to nitrile gloves," said allergist and immunologist Dr. Santhosh Kumar of Virginia Commonwealth University, Richmond.

Photo credit: Anton Gvozdikov/Fotolia.com

But nitrile gloves can cause reactions, too, a problem not often recognized in the medical community and one that may emerge as a significant issue with expanded use, he said.

Since hospitals have been making the switch, "We’ve seen more and more people present with contact sensitivity [to nitrile], with hives and rashes on their hands. Some have it all over their body. It starts off initially on the hands, and then it gradually progresses," Dr. Kumar said.

To detect nitrile hypersensitivity, "we came up with a new skin prick test," he said.

Dr. Kumar and his colleagues tried it out on three people who had reacted to nitrile gloves in the past.

They cut 5-cm-square pieces from blue and purple nitrile gloves, and soaked them in normal saline for 2 hours.

They then applied the pieces to the underside of the patients’ forearms, and pricked the skin through the patches with Greer DermaPIKs. The pieces were removed and rubbed over the pricked areas a few times.

Skin tests were read 15 minutes later and considered positive if the wheal was 3 mm larger than saline control pricks.

All three patients had positive tests with mean wheal diameters of 5.5 mm. The mean saline prick wheal diameter was 2.17 mm, the mean diameter of histamine pricks—also used as controls—was 5.17 mm.

Latex IgE was positive in the one patient who had previously reacted to latex gloves.

The test "is a simple and effective method to detect type-1 hypersensitivity reactions to nitrile products," Dr. Kumar and his colleagues concluded.

"If a patient is positive, we tell them to avoid nitrile gloves," he said. Vinyl gloves are option, though less elastic than latex and nitrile.

Dr. Kumar said he has no disclosures.

SAN FRANCISCO – A new skin prick test detects type-1 hypersensitivity to nitrile, the synthetic rubber in the gloves increasingly used by hospitals.

With latex allergies not uncommon among health care workers, "most hospitals have been switching over to nitrile gloves," said allergist and immunologist Dr. Santhosh Kumar of Virginia Commonwealth University, Richmond.

Photo credit: Anton Gvozdikov/Fotolia.com

But nitrile gloves can cause reactions, too, a problem not often recognized in the medical community and one that may emerge as a significant issue with expanded use, he said.

Since hospitals have been making the switch, "We’ve seen more and more people present with contact sensitivity [to nitrile], with hives and rashes on their hands. Some have it all over their body. It starts off initially on the hands, and then it gradually progresses," Dr. Kumar said.

To detect nitrile hypersensitivity, "we came up with a new skin prick test," he said.

Dr. Kumar and his colleagues tried it out on three people who had reacted to nitrile gloves in the past.

They cut 5-cm-square pieces from blue and purple nitrile gloves, and soaked them in normal saline for 2 hours.

They then applied the pieces to the underside of the patients’ forearms, and pricked the skin through the patches with Greer DermaPIKs. The pieces were removed and rubbed over the pricked areas a few times.

Skin tests were read 15 minutes later and considered positive if the wheal was 3 mm larger than saline control pricks.

All three patients had positive tests with mean wheal diameters of 5.5 mm. The mean saline prick wheal diameter was 2.17 mm, the mean diameter of histamine pricks—also used as controls—was 5.17 mm.

Latex IgE was positive in the one patient who had previously reacted to latex gloves.

The test "is a simple and effective method to detect type-1 hypersensitivity reactions to nitrile products," Dr. Kumar and his colleagues concluded.

"If a patient is positive, we tell them to avoid nitrile gloves," he said. Vinyl gloves are option, though less elastic than latex and nitrile.

Dr. Kumar said he has no disclosures.

SAN FRANCISCO – A new skin prick test detects type-1 hypersensitivity to nitrile, the synthetic rubber in the gloves increasingly used by hospitals.

With latex allergies not uncommon among health care workers, "most hospitals have been switching over to nitrile gloves," said allergist and immunologist Dr. Santhosh Kumar of Virginia Commonwealth University, Richmond.

Photo credit: Anton Gvozdikov/Fotolia.com

But nitrile gloves can cause reactions, too, a problem not often recognized in the medical community and one that may emerge as a significant issue with expanded use, he said.

Since hospitals have been making the switch, "We’ve seen more and more people present with contact sensitivity [to nitrile], with hives and rashes on their hands. Some have it all over their body. It starts off initially on the hands, and then it gradually progresses," Dr. Kumar said.

To detect nitrile hypersensitivity, "we came up with a new skin prick test," he said.

Dr. Kumar and his colleagues tried it out on three people who had reacted to nitrile gloves in the past.

They cut 5-cm-square pieces from blue and purple nitrile gloves, and soaked them in normal saline for 2 hours.

They then applied the pieces to the underside of the patients’ forearms, and pricked the skin through the patches with Greer DermaPIKs. The pieces were removed and rubbed over the pricked areas a few times.

Skin tests were read 15 minutes later and considered positive if the wheal was 3 mm larger than saline control pricks.

All three patients had positive tests with mean wheal diameters of 5.5 mm. The mean saline prick wheal diameter was 2.17 mm, the mean diameter of histamine pricks—also used as controls—was 5.17 mm.

Latex IgE was positive in the one patient who had previously reacted to latex gloves.

The test "is a simple and effective method to detect type-1 hypersensitivity reactions to nitrile products," Dr. Kumar and his colleagues concluded.

"If a patient is positive, we tell them to avoid nitrile gloves," he said. Vinyl gloves are option, though less elastic than latex and nitrile.

Dr. Kumar said he has no disclosures.

SAN FRANCISCO – A new skin prick test detects type-1 hypersensitivity to nitrile, the synthetic rubber in the gloves increasingly used by hospitals.

With latex allergies not uncommon among health care workers, "most hospitals have been switching over to nitrile gloves," said allergist and immunologist Dr. Santhosh Kumar of Virginia Commonwealth University, Richmond.

Photo credit: Anton Gvozdikov/Fotolia.com

But nitrile gloves can cause reactions, too, a problem not often recognized in the medical community and one that may emerge as a significant issue with expanded use, he said.

Since hospitals have been making the switch, "We’ve seen more and more people present with contact sensitivity [to nitrile], with hives and rashes on their hands. Some have it all over their body. It starts off initially on the hands, and then it gradually progresses," Dr. Kumar said.

To detect nitrile hypersensitivity, "we came up with a new skin prick test," he said.

Dr. Kumar and his colleagues tried it out on three people who had reacted to nitrile gloves in the past.

They cut 5-cm-square pieces from blue and purple nitrile gloves, and soaked them in normal saline for 2 hours.

They then applied the pieces to the underside of the patients’ forearms, and pricked the skin through the patches with Greer DermaPIKs. The pieces were removed and rubbed over the pricked areas a few times.

Skin tests were read 15 minutes later and considered positive if the wheal was 3 mm larger than saline control pricks.

All three patients had positive tests with mean wheal diameters of 5.5 mm. The mean saline prick wheal diameter was 2.17 mm, the mean diameter of histamine pricks—also used as controls—was 5.17 mm.

Latex IgE was positive in the one patient who had previously reacted to latex gloves.

The test "is a simple and effective method to detect type-1 hypersensitivity reactions to nitrile products," Dr. Kumar and his colleagues concluded.

"If a patient is positive, we tell them to avoid nitrile gloves," he said. Vinyl gloves are option, though less elastic than latex and nitrile.

Dr. Kumar said he has no disclosures.

SAN FRANCISCO – A new skin prick test detects type-1 hypersensitivity to nitrile, the synthetic rubber in the gloves increasingly used by hospitals.

With latex allergies not uncommon among health care workers, "most hospitals have been switching over to nitrile gloves," said allergist and immunologist Dr. Santhosh Kumar of Virginia Commonwealth University, Richmond.

Photo credit: Anton Gvozdikov/Fotolia.com

But nitrile gloves can cause reactions, too, a problem not often recognized in the medical community and one that may emerge as a significant issue with expanded use, he said.

Since hospitals have been making the switch, "We’ve seen more and more people present with contact sensitivity [to nitrile], with hives and rashes on their hands. Some have it all over their body. It starts off initially on the hands, and then it gradually progresses," Dr. Kumar said.

To detect nitrile hypersensitivity, "we came up with a new skin prick test," he said.

Dr. Kumar and his colleagues tried it out on three people who had reacted to nitrile gloves in the past.

They cut 5-cm-square pieces from blue and purple nitrile gloves, and soaked them in normal saline for 2 hours.

They then applied the pieces to the underside of the patients’ forearms, and pricked the skin through the patches with Greer DermaPIKs. The pieces were removed and rubbed over the pricked areas a few times.

Skin tests were read 15 minutes later and considered positive if the wheal was 3 mm larger than saline control pricks.

All three patients had positive tests with mean wheal diameters of 5.5 mm. The mean saline prick wheal diameter was 2.17 mm, the mean diameter of histamine pricks—also used as controls—was 5.17 mm.

Latex IgE was positive in the one patient who had previously reacted to latex gloves.

The test "is a simple and effective method to detect type-1 hypersensitivity reactions to nitrile products," Dr. Kumar and his colleagues concluded.

"If a patient is positive, we tell them to avoid nitrile gloves," he said. Vinyl gloves are option, though less elastic than latex and nitrile.

Dr. Kumar said he has no disclosures.

SAN FRANCISCO – A new skin prick test detects type-1 hypersensitivity to nitrile, the synthetic rubber in the gloves increasingly used by hospitals.

With latex allergies not uncommon among health care workers, "most hospitals have been switching over to nitrile gloves," said allergist and immunologist Dr. Santhosh Kumar of Virginia Commonwealth University, Richmond.

Photo credit: Anton Gvozdikov/Fotolia.com

But nitrile gloves can cause reactions, too, a problem not often recognized in the medical community and one that may emerge as a significant issue with expanded use, he said.

Since hospitals have been making the switch, "We’ve seen more and more people present with contact sensitivity [to nitrile], with hives and rashes on their hands. Some have it all over their body. It starts off initially on the hands, and then it gradually progresses," Dr. Kumar said.

To detect nitrile hypersensitivity, "we came up with a new skin prick test," he said.

Dr. Kumar and his colleagues tried it out on three people who had reacted to nitrile gloves in the past.

They cut 5-cm-square pieces from blue and purple nitrile gloves, and soaked them in normal saline for 2 hours.

They then applied the pieces to the underside of the patients’ forearms, and pricked the skin through the patches with Greer DermaPIKs. The pieces were removed and rubbed over the pricked areas a few times.

Skin tests were read 15 minutes later and considered positive if the wheal was 3 mm larger than saline control pricks.

All three patients had positive tests with mean wheal diameters of 5.5 mm. The mean saline prick wheal diameter was 2.17 mm, the mean diameter of histamine pricks—also used as controls—was 5.17 mm.

Latex IgE was positive in the one patient who had previously reacted to latex gloves.

The test "is a simple and effective method to detect type-1 hypersensitivity reactions to nitrile products," Dr. Kumar and his colleagues concluded.

"If a patient is positive, we tell them to avoid nitrile gloves," he said. Vinyl gloves are option, though less elastic than latex and nitrile.

Dr. Kumar said he has no disclosures.

SAN FRANCISCO – A new skin prick test detects type-1 hypersensitivity to nitrile, the synthetic rubber in the gloves increasingly used by hospitals.

With latex allergies not uncommon among health care workers, "most hospitals have been switching over to nitrile gloves," said allergist and immunologist Dr. Santhosh Kumar of Virginia Commonwealth University, Richmond.

Photo credit: Anton Gvozdikov/Fotolia.com

But nitrile gloves can cause reactions, too, a problem not often recognized in the medical community and one that may emerge as a significant issue with expanded use, he said.

Since hospitals have been making the switch, "We’ve seen more and more people present with contact sensitivity [to nitrile], with hives and rashes on their hands. Some have it all over their body. It starts off initially on the hands, and then it gradually progresses," Dr. Kumar said.

To detect nitrile hypersensitivity, "we came up with a new skin prick test," he said.

Dr. Kumar and his colleagues tried it out on three people who had reacted to nitrile gloves in the past.

They cut 5-cm-square pieces from blue and purple nitrile gloves, and soaked them in normal saline for 2 hours.

They then applied the pieces to the underside of the patients’ forearms, and pricked the skin through the patches with Greer DermaPIKs. The pieces were removed and rubbed over the pricked areas a few times.

Skin tests were read 15 minutes later and considered positive if the wheal was 3 mm larger than saline control pricks.

All three patients had positive tests with mean wheal diameters of 5.5 mm. The mean saline prick wheal diameter was 2.17 mm, the mean diameter of histamine pricks—also used as controls—was 5.17 mm.

Latex IgE was positive in the one patient who had previously reacted to latex gloves.

The test "is a simple and effective method to detect type-1 hypersensitivity reactions to nitrile products," Dr. Kumar and his colleagues concluded.

"If a patient is positive, we tell them to avoid nitrile gloves," he said. Vinyl gloves are option, though less elastic than latex and nitrile.

Dr. Kumar said he has no disclosures.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.