Breath of Fresh Air

Manufacturers in the asthma market are breathing easy this spring, keeping their end-users out of the emergency room with new medications and easy-to-use devices. “There’s no end in sight” for growth in this market, says Darren Friedman, owner of Breathe Right Pharmacy.

“All your demographics point to growth,” says Craig Bright, president of Med Quip, a new player attracted by the “fairly wide-open market.”

Industry experts offer various explanations for this growth. “We’re giving more to each patient,” Friedman says.

But Rob Lee, director of marketing for Pari Respiratory, says the two forces driving the asthma market are “an aging population, predisposed to asthma and other respiratory ailments, and age indication for pediatrics.” Younger patients are being diagnosed more quickly, he says, and the U.S. Food and Drug Administration has cleared age-indication down to 2 years old, thus expanding the market’s patient base.

According to Rich Kocinski, vice president and general manager of Sunrise Medical’s DiVilbiss Respiratory Group, half of the patient base for the asthma market typically is pediatrics under 10 years old, and half is patients over the age of 55.

“With a disease state growing at 6 to 8 percent a year, it’s a good, attractive market for us and the dealers. You ultimately have a patient base that’s going to be served,” Kocinski says.

Manufacturers describe the asthma market as solid and strong, especially when it comes to asthma medication. “The market is growing at 12 to 18 percent, depending on whose numbers you use,” according to John Snobarger, vice president of sales for Ferraris Medical. “There has been enormous growth in the number of people getting asthma and asthma-related symptoms, and drugs [in this market] continue to grow.”

The combining of two asthma drugs into one daily dose and one dispenser is a trend helping to fuel that growth. According to Richard Bulich, president of Pharmaceutical Buyers, Inc., or PBI, the asthma market during the past two years has seen “a resurgence of combinations of two drugs that synergize each other. This has opened the market to people who can now use the drugs with fewer side effects.”

“Patients want one simple, easy-to-use device,” Lee says, noting that the combined-medication inhalers have been especially effective for pediatrics. “This is not a rescue medication. It is preventive, and doctors like it because it prevents emergency room visits and 2 a.m. calls. It keeps health care costs down.”

The drug combinations — more readily available at better prices during the past year — provide a patient with “half the amount of each of two separate medicines, and more than twice the effectiveness,” according to Bulich.

These innovations have driven treatment times down, according to Kocinski. Five years ago, treatment time was roughly 15 minutes, he says; now, it’s five to seven minutes.

The Problem of Innovation

But there hasn’t been enough product innovation in this market, according to Friedman. Delivery systems and devices have been especially neglected, because of reimbursement, he says.

“The money is just dwindling in the industry,” Friedman says. “Some manufacturers are changing the design — the ‘look’ of devices — but the bottom line is that they all have the same guts.”

The industry’s preoccupation with reimbursement forced leading manufacturers to steer clear of innovation, experts say. “Work by pharmaceutical companies around asthma products tapered off, because the industry was so absorbed by health care reform,” Kocinski says. “Everybody kind of hit a wall and it took a couple of years to get through that reaction.” This led to less innovation on both the drug and equipment sides, he says. “But we’re starting to swing out of that tunnel now. We’re seeing indications of change.”

The focus of this change is new devices that are “making people’s taking of medications handier, with powdered material,” Lee says.

The body absorbs dry powders more quickly, and the powders’ effects last longer, Snobarger says. “We’re trying to make [delivery of molecules] easier and more convenient in ways that improve absorption,” he says. “If you can make a delivery device that is cost effective and easy to use, then you’ll get better compliance. [Most] chamber devices on the U.S. market are very large, and patients won’t carry them. [Patients] don’t want to be seen with them.”

Patients prefer a smaller delivery device, Snobarger says. “The efficacy is the same, at half or one-third of the price. So patients say, ‘Give me the little one.’”

When it comes to product development, leading manufacturers are keeping the demographics of the market’s patient population in mind. “The bulk of mild-to-moderate asthmatics can and do handle their condition with over-the-counter metered-dose inhalers,” Kocinski says. “But it’s tough to use MDIs on kids.” They require coordination that the older and younger populations — which make up most of the asthma market’s patient base — don’t have, he says.

Kocinski sees nebulizers as a “second line of defense — something to fall back on — which keeps people out of the emergency room.” Nine out of 10 asthmatic patients who go to the emergency room are going to receive treatment from a nebulizer, he says, so “if they can do it at home, they can spare the cost and burden on the health care system and spare themselves having to go.”

Electric devices for monitoring and gathering data on asthma patients at home also have changed, according to Snobarger. Physicians are looking at more than one value, and new devices “make it easier to monitor those values,” he says.

According to Snobarger, new pocket-sized devices on the market this spring can store up to 45 days of patient data — including values for peak expiratory flow and measurements of forced expiratory volume by second — “giving the patient much more data about lung function and giving doctors more information about what’s going on at home.”

Overall, industry players are pleased with the strength of the asthma market, but most are unwilling to predict the future.

“From a technological standpoint, both with equipment and medications, we’ve done well. But reimbursement remains a big issue,” Bulich says. “Medicare and government payers continue to ratchet down reimbursement. I’m neither optimistic nor pessimistic; the future is still very questionable.”

“Everybody is … waiting to see what will happen with reimbursement,” Friedman says. “They’re not putting a lot of dollars toward marketing or huge internal changes. We’re still proactive and trying to grow, but for the most part, it’s a wait-and-see game.”

Experts Interviewed:

Craig Bright, president, Med Quip, Van Nuys, Calif.; Richard Bulich, president, Pharmaceutical Buyers, Inc., Boulder, Colo.; Darren Friedman, owner, Breathe Right Pharmacy, Newbury Park, Calif.; Rich Kocinski, vice president and general manager, Sunrise Medical/DiVilbiss Respiratory Group, Longmont, Colo.; Rob Lee, director of marketing, Pari Respiratory, Monterey, Calif.; John Snobarger, vice president of sales, Ferraris Medical, Louisville, Colo.

The Impact of Asthma

“Everywhere else in the world, asthma deaths are going down,” says Rob Lee, product manager for Pari Respiratory. “The U.S. is the only industrialized nation where those numbers aren’t going down.”

According to Allergy and Asthma Network Mothers of Asthmatics, a national nonprofit network of families living with allergies and asthma, the cost of asthma in 2000 was $8.1 billion.

The AANMA Web site, www.aanma.org, says asthma is the most common cause of missed school days for children, and that asthma accounts for approximately three million missed workdays for adults annually.

“This impact attracts health care dollars,” Lee says.