1. Barriers to care of asthma. Barbara P. Yawn, MD, MSc Director of Research Olmsted Medical Center Rochester, MN Astra Zeneca November 21, 2003

2. Recognition of its impact Rodney Dangerfield of chronic diseases Rodney Dangerfield of chronic diseases According to MEPS According to MEPS >66% of parents consider childs asthma somewhat or very severe <20% of primary care physicians say they ever see moderate asthma

3. Barriers Understanding role of allergic disease in continuum of respiratory track Understanding role of allergic disease in continuum of respiratory track AR asthma AR asthma allergy inflammation allergy inflammation allergic inflammation

4. Barriers Early identification of asthma in the young child and differentiation from COPD Early identification of asthma in the young child and differentiation from COPD Identification strategies for allergens – simple Identification strategies for allergens – simple TRIP – UP guidelines TRIP – UP guidelines

5. Barriers Good evidence base for Primary Care Good evidence base for Primary Care Medical therapy Medical therapy Staged but based on current control Staged but based on current control All ages All ages Co morbidities Co morbidities Sinusitis Sinusitis Allergies Allergies Co-therapyCo-therapy Single therapySingle therapy

6. Barriers Models for collaborative care Models for collaborative care More than referral More than referral Distance education Distance education Patients Patients Families Families Physicians & nurses Physicians & nurses Schools and work sites Schools and work sites

7. Barriers Models for monitoring for primary care Models for monitoring for primary care Frequency of visits Frequency of visits Methods of monitoring Methods of monitoring Symptoms Symptoms Control assessments Control assessments Assessment of progression Assessment of progression ?PFT ?PFT ??? ???