‘Current asthma treatment is like prescribing Tylenol to people with high blood pressure’

“Inhaled asthma treatment should be prioritized over oral medications. Currently, however, only 40 percent of primary care providers in Korea prescribe inhaled steroids for asthma. It's like prescribing Tylenol instead of blood pressure medication to hypertensive patients.”

Dr. Yoo Kwang-ha, the president of Konkuk University Medical Center and a director at the Korean Academy of Tuberculosis and Respiratory Diseases, said so on Wednesday, emphasizing the seriousness of the current situation at a policy discussion at the National Assembly.

Hosted by Rep. Lee Ju-young of the splinter opposition New Reform Party and organized by the academy, the discussion was held to share the current status of asthma and chronic obstructive pulmonary disease (COPD) treatment and present policy directions for introducing related systems.

In the panel discussion, Professor Choi Joon-young of the Department of Respiratory Medicine at the Catholic University of Korea St. Mary's Incheon Hospital explained the current status of asthma and COPD treatment problems.

“Asthma is characterized by airway hyper-responsiveness, and inhaled steroids are the core drugs for asthma treatment. They are essential in controlling symptoms, improving lung function, and improving quality of life. However, oral medications are more commonly prescribed in primary care settings,” Professor Choi said. “Many factors make prescribing inhaled steroids challenging for physicians.”

The professor especially pointed to the need for patient education on inhaler use, which is difficult to provide given primary care organizations' limited time and resources.

“It's important for patients to use inhalers correctly, and education is essential. Inhaler use errors are up to 60 percent. Teaching patients how to use inhalers correctly reduces errors by more than 50 percent,” he said, reiterating the importance of education.

Training primary care providers on the correct use of inhalers is time-consuming, but there is a lack of support for this training, he said. Choi stressed the need for national incentives and support for training. He added that the government should introduce training fees or incentives to encourage doctors to actively prescribe inhalers.

Dr. Yoo also noted that asthma and COPD patients are underserved in primary care, saying, “Six out of 10 asthma patients do not receive inhaled steroid treatment. It means that inhaled treatments, which have become the standard of care for asthma, are underutilized in primary care settings.”

“Inhalers are a highly effective treatment with fewer side effects than oral medications, but there are significant time and training burdens for primary care providers to use them. In the current system, doctors are more likely to prescribe oral medications rather than inhalers,” he said. “Doctors must be motivated to prescribe inhalers.”

Yoo also emphasized the importance of COPD management.

“COPD primarily affects older adults, with an estimated 3 million people in Korea alone, but only 5 percent are properly diagnosed and treated,” Yoo said. “Most patients don't even know they have the disease; primary healthcare providers must actively diagnose and manage it.”

Dr. Yoo continued, “If the government does not provide adequate support to primary healthcare providers, asthma and COPD patients will not receive adequate treatment and end up in general or tertiary hospitals. The prevention and treatment of asthma and COPD are 'sensitive diseases' that can be managed outpatient, and if managed well in primary healthcare, hospitalization and mortality rates can be significantly reduced.”

In the second presentation, “Recommendations for Improving the Respiratory Disease Treatment Environment Based on Overseas Cases,” Profess Lee Jin-guk of the Department of Respiratory Medicine at the Catholic University of Korea Seoul St. Mary's Hospital introduced successful asthma management programs in other countries, including Finland and Australia, and argued that Korea should adopt the same system.

“Finland introduced an asthma management program in 1994, and after 10 years of implementation, the mortality and hospitalization rates of asthma patients were reduced by more than half,” Professor Lee said. “The core of the program is active management and medical staff education in primary health care centers, and Finland provides incentives to hospitals that treat asthma well, and medical staff education is very systematic along with patient education.”

He also introduced the example of Australia, which has implemented the “3 Plus Visit Plan,” which encourages asthma patients to visit a primary care provider for at least three visits, which has been shown to significantly improve symptom control and quality of life for asthma patients, noting that the system has the potential to be adopted in Korea,

“In the U.S., doctors in primary care centers are creating societies, conducting research, and contributing academically as well as clinically to better manage asthma and COPD patients,” Lee said. “In Korea, however, such academic activities are rare because primary care physicians are forced to focus on patient care. If conditions are created for primary care physicians to conduct research and academic activities, higher quality care will be possible,” emphasizing the need for institutional improvement.

‘Pulmonary function tests should be included in the national health checkup’

The panel discussion that followed featured Kwak Soon-heon, director of the Health Policy Division at the Ministry of Health and Welfare, Professor Park Yong-bum of the Department of Respiratory and Allergy Medicine at Hallym University Kangdong Sacred Heart Hospital, and Kang Dong-wook, an asthma patient.

“Pulmonary function tests are essential for the proper diagnosis and management of asthma and COPD,” Professor Park said, advocating for greater use of pulmonary function tests in primary healthcare centers. “However, the current rate of lung function testing in primary healthcare centers is very low. Including lung function testing in national health checkups, especially for high-risk groups, will enable early diagnosis and improve patients' treatment.”

Kang, who represented asthma patients, spoke from his own experience, explaining how difficult it is to access asthma care in primary healthcare centers.

“I work in the dusty Garak Market. I think regular pulmonary function tests are essential in a job that puts a lot of strain on the lungs,” Kang said. “At neighborhood clinics, they don't have pulmonary function testing equipment and often have a poor understanding of asthma treatment. They must create an environment where people can trust and receive treatment at local hospitals.”

Health and Welfare Ministry ‘may expand existing pilot projects after confirming its effects’

Regarding the proposal, Director Kwak said, “The idea of including lung function tests in the national health checkup has been discussed continuously, but many other conditions also wanted to be included in the checkup, so there must be an order of priority.”

He added that the Ministry of Health and Welfare is considering introducing lung function tests for high-risk groups, and it may be more realistic to start with a pilot project first instead of including it in the national checkup.

“The issue of including asthma and COPD in the chronic disease management system is still being discussed, and in fact, research and preparation for this has already begun. A pilot project for this will be launched soon,” Kwak said. “However, we will proceed in stages based on the experience of the existing primary care chronic disease management pilot project.”

Rep. Lee Ju-young said in her opening remarks, “I am pleased to emphasize the importance of chronic respiratory disease management through today's discussion. Respiratory diseases span a wide spectrum, from children to the elderly, and have a significant impact on patients' ability to lead their daily lives. As a doctor and a mother, I know firsthand the challenges patients face when these conditions are not properly managed. The heartache I felt when my children suffered from asthma is still fresh in my mind.”

Lee emphasized that asthma and COPD now deserve to be recognized as nationally managed conditions, hoping the policy debate will begin immediately.