An Associate Professor of Medicine and Epidemiology at Harvard Medical School, and an emergency physician at the Massachusetts General Hospital in Boston. He also founded and directs the Emergency Medicine Network (EMNet), a research collaboration involving almost 200 medical centers, and is past president of the American College of Epidemiology.
Dr. Camargo is a member of the National Institutes of Health, National Asthma Education and Prevention Program’s Third Expert Panel on the Management of Asthma, responsible for the Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. He also serves on the Department of Health and Human Services Dietary Guidelines Advisory Committee and the National Institute of Allergy and Infections Diseases’ Food Allergy Clinical Guidelines Expert Panel.
Dr Camargo’s research focuses on respiratory/allergy disorders in several cohorts (such as the Nurses’ Health Study) and EMNet has completed numerous studies focusing on respiratory/allergy emergencies and other public health issues. Dr Camargo has more than 350 publications.
Dr. Camargo received his MD from the University of California at San Francisco; MPH from the University of California at Berkeley; and PhD from the Harvard School of Public Health.
Dr. Camargo’s statement:
- As you’ve just heard, this country’s asthma epidemic places a heavy burden on millions of Americans – not only those with asthma … but also on those who live and work with someone with asthma.
- The current situation definitely qualifies as an “epidemic” … Over the last 20-30 years, the prevalence of asthma has climbed from 3% of Americans to almost 10%, a 3-fold increase. In other words, 1 in 10 Americans now has asthma. Actually, other recent studies have shown prevalence rates as high as 20 to 25% in some Hispanic and African-American communities …
- While asthma may quiet-down for some children during the teenage years, it usually returns during adult life. So, with these rising numbers of kids with asthma, you can see that the asthma problem is not going away anytime soon. Unless we change course, more and more Americans will suffer from asthma. This burden could be greatly reduced if more people knew the signs of poor asthma control and took a more preventive approach to this serious, but very controllable, disease.
- The burden also could be decreased if people followed the federally-funded NIH asthma guidelines. This requires that they not only know them but that they also do not experience barriers to their implementation – the kind of barriers that Nancy outlined in her comments.
- As you heard in my introduction, I’m an epidemiologist who works on public health issues. I’m also a physician who works in a large emergency department in Boston. So, let’s focus now on the emergency department, a critical part of the healthcare “safety net”.
- Each year, there are almost 2 million emergency department visits nationwide because of asthma. Anyone working in emergency medicine could tell you that far too many of these asthma patients use the emergency department as their primary method of asthma care. Most of these patients actually have insurance, most have doctors … but when you can’t breathe, the emergency department is a “safe harbor” – always open, and always ready to treat.
- Unfortunately, even after these emergency visits, many patients underestimate their asthma – and mistakenly think they have it under control. People often minimize their symptoms with their regular doctor, which leads to under-treatment … and then more serious asthma attacks, including those desperate (and preventable) visits to the hospital.
- If there’s one thing that I want to make clear today, it is this: Treating asthma in the hospital emergency department is NOT a good long-term strategy. I know that may seem obvious to many here but it still amazes me how many patients find it “perfectly normal” to get asthma treatment in the emergency department several times per year … each and every year. In urban settings, the typical emergency department patient with asthma reports at least 2 asthma-related ED visits in the last year.
- In the emergency department – and throughout the health care system – we need to not only prescribe quick-relief inhalers like albuterol, but we ALSO need to put much more emphasis on patient education and daily preventive medicines. These two steps can prevent emergency asthma care in the first place.
- Moreover, we recently demonstrated that EDs that follow the NIH asthma guidelines are less likely to admit their patients than patients in EDs that do not follow the guidelines. The cost savings would be quite large.
- Nancy Sander opened this session with a call for better asthma control and a consistent message from the government about the value of the NIH asthma guidelines. What does this mean for people with asthma? Although it’s unrealistic to stop every exacerbation, we’d like them to be rare. When they do happen, for example because of catching a cold ,we want people to calmly manage the situation with their action plan and thereby avoid the emergency department, inpatient ward, ICU or worse …. This is a very realistic goal when healthcare providers and patients are encouraged to follow the NIH guidelines.
- With the right approach to asthma, based on the NIH guidelines and with unfettered access to guideline-approved treatments, asthma really can be controlled and people really can live active, healthier lives …
Thanks for your support in reaching this goal.