Transcript Slide 1

Asthma
A Presentation on Asthma Management and Prevention
What is Asthma?
Chronic disease of the airways that may cause
Wheezing
Breathlessness
Chest tightness
Nighttime or early morning coughing
Episodes are usually associated with
widespread, but variable, airflow obstruction
within the lung that is often reversible either
spontaneously or with treatment.
Pathology of Asthma
Asthma
involves
inflammation of
the airways
Normal
Asthma
Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For Asthma
Created and funded by NIH/NHLBI, 1995
What is Epidemiology?
The study of the distribution and
determinants of diseases and
injuries in human populations.
Source: Mausner and Kramer, Mausner and Bahn Epidemiology- An Introductory Text, 1985.
Child and Adult Asthma Prevalence
United States, 1980-2007
Lifetime
• Child
14
Prevalence (%)
12
 Adult
10
8
6
Current
4
2
12-Month
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
20
06
0
Source: National Health Interview Survey; CDC National Center for Health Statistics
Year
Asthma Prevalence by Sex
United States, 1980-2007
•
14
12
Female
Lifetime
 Male
Prevalence (%)
10
8
12-Month
6
Current
4
2
Source: National Health Interview Survey; CDC National Center for Health Statistics
06
20
04
20
02
20
00
20
98
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
82
19
19
80
0
Year
12-Month Asthma Prevalence by Race
United States, 1980-1996
Prevalence (%)
12
10
8
Black
6
White
4
2
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
82
19
80
0
Source: National Health Interview Survey; CDC National Center for Health Statistics
Year
18
16
14
12
10
8
6
4
2
0
▲ Black NH
Lifetime
 White NH
 Hispanic
Current
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
Prevalence (%)
Asthma Prevalence by Race/Ethnicity
United States, 1997-2007
Source: National Health Interview Survey; National Center for Health Statistics
Year
Current Asthma Prevalence for Youth
by Race/Ethnicity, Ages 5-17, 2005-2007
10.1% Overall
14.2
9.1
10.2
10
Centers for Disease Control and Prevention. National Center for Health Statistics. Health
Data Interactive. www.cdc.gov/nchs/hdi.htm. [July 15, 2009].
American
Indian / Alaska
Native
Asian
Hispanic
NonHispanicWhite
7.1
Non-Hispanic
Black
16
14
12
10
8
6
4
2
0
Asthma Disparities Among U.S. Children
 Low-income populations, minorities, and children living in
inner cities experience more ED visits, hospitalizations,
and deaths due to asthma than the general population.1
 The burden of asthma falls disproportionately on nonHispanic black, American Indian/Alaskan Native and
some Hispanic (i.e., Puerto Rican) populations.2, 3
1Lieu
TA et al. Racial/Ethnic Variation in Asthma Status and Management Practices
Among Children in Managed Medicaid. Pediatrics 2002; 109:857–865.
2National Center for Health Statistics. Health data for all ages
http://www.cdc.gov/nchs/health_data_for_all_ages.htm.
3Asthma and Allergy Foundation of America and National Pharmaceutical Council.
Ethnic Disparities in the Burden and Treatment of Asthma. Reston, 2005.
Population Disparities in Asthma
Current asthma prevalence is higher
among
children than adults
boys than girls
women than men
Asthma morbidity and mortality is
higher among
African Americans than Caucasians
Source: MMWR 2007;56(No. SS-8):1-54
Asthma* Hospital Discharge Rates#
by Sex United States: 1980-2006
24
Rate per 10,000
22
20
18
Females
16
14
Males
12
10
80 982 984 986 988 990 992 994 996 998 000 002 004 006
9
1
1
1
1
1
1
1
1
1
1
2
2
2
2
Source: National Hospital Discharge Survey, CDC National Center for Health Statistics, * First-listed
diagnosis, # Age-adjusted to 2000 U.S. population
Year
Adult and Child Asthma Hospital Discharge
Rates
United States, 1996-2006
35
Rate per 10,000
30
25
Children
20
15
Adults
10
5
0
9
19
6
9
19
7
9
19
8
9
19
9
0
20
0
0
20
1
0
20
2
0
20
3
0
20
4
0
20
5
0
20
6
Source: National Hospital Discharge Survey, CDC National Center for Health Statistics ,* Firstlisted diagnosis, # Age-adjusted to 2000 U.S. population
Year
Asthma Hospital Discharge Rates
by Race
United States, 1980-2006
45
Rate per 10,000
40
35
30
Black
25
20
15
10
5
White
Other
0
80 982 984 986 988 990 992 994 996 998 000 002 004 006
9
1
1
1
1
1
1
1
1
1
1
2
2
2
2
Source: National Hospital Discharge Survey, CDC National Center for Health Statistics, * First-listed
diagnosis, # Age-adjusted to 2000 U.S. population
Year
Asthma Mortality Rates by Age
United States: 1979-2005
ICD-9
ICD-10
100
Rate per million
65 +
80
60
40
35-64
20
5-9
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
0
Source: Underlying Cause of Death; CDC National Center for Health Statistics
* Age-adjusted to 2000 U.S. population
Year
Asthma Mortality Rates by Race
United States: 1979-2005
ICD-9
ICD-10
Rate per million
60
50
40
Black
Other
30
20
10
White
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
0
Source: Underlying Cause of Death; CDC National Center for Health Statistics
* Age-adjusted to 2000 U.S. population
Year
Risk Factors for Developing Asthma
 Genetic characteristics
 Occupational exposures
 Environmental exposures
Risk Factors for Developing Asthma:
Genetic Characteristics
Atopy
The body’s predisposition to develop an antibody
called immunoglobulin E (IgE) in response to
exposure to environmental allergens
Can be measured in the blood
Includes allergic rhinitis, asthma, hay fever, and
eczema
Risk Factors for Developing Asthma:
Environmental Exposure
Clearing the Air:
Asthma and Indoor Air Exposures
http://www.iom.edu (Publications)
Institute of Medicine, 2000
Committee on the Assessment of Asthma and Indoor Air
Review of current evidence about indoor air exposures
and asthma
Clearing the Air:
Categories for Associations of Various
Elements
Sufficient evidence of a causal relationship
Sufficient evidence of an association
Limited or suggested evidence of an
association
Inadequate or insufficient evidence to
determine whether an association exists
Limited or suggestive evidence of no
association
Clearing the Air:
Indoor Air Exposures & Asthma Development
Biological Agents
 Sufficient evidence of causal
relationship
 House dust mite
 Sufficient evidence of association
 None found
 Limited or suggestive evidence of
association
 Cockroach (among pre-school aged
children)
 Respiratory syncytial virus (RSV)
Chemical Agents
 Sufficient evidence of causal
relationship
 None found
 Sufficient evidence of association
 Environmental Tobacco Smoke
(among pre-school aged children)
 Limited or suggestive evidence of
association
 None found
Clearing the Air:
Indoor Air Exposures & Asthma Exacerbation
Biological Agents
 Sufficient evidence of causal
relationship
 Cat
 Cockroach
 House dust mite
Chemical Agents
 Sufficient evidence of causal
relationship
 Environmental tobacco smoke
(among pre-school aged children)
 Sufficient evidence of
association
 NO2, NOX (high levels)
 Sufficient evidence of an association  Limited or suggestive evidence of
 Dog
association
 Fungus/Molds
 Rhinovirus
 Limited or suggestive evidence of
association
 Domestic birds
 Chlamydia and Mycoplasma pneumonia
 RSV
 Environmental Tobacco Smoke
(among school-aged, older children,
and adults)
 Formaldehyde
 Fragrances
Reducing Exposure to House Dust Mites
 Use bedding
encasements
 Wash bed linens weekly
 Avoid down fillings
 Limit stuffed animals to
those that can be washed
 Reduce humidity level
(between 30% and 50%
relative humidity per
EPR-3)
Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For
Asthma Created and funded by NIH/NHLBI, 1995
Reducing Exposure to
Environmental Tobacco Smoke
Evidence suggests an
association between
environmental tobacco smoke
exposure and exacerbations of
asthma among school-aged,
older children, and adults.
Evidence shows an association
between environmental tobacco
smoke exposure and asthma
development among pre-school
aged children.
Reducing Exposure to Cockroaches
Remove as many water and food sources as
possible to avoid cockroaches.
Reducing Exposure to Pets
People who are allergic to pets should not
have them in the house.
At a minimum, do not allow pets in the
bedroom.
Reducing Exposure to Mold
Eliminating mold and the moist conditions that permit
mold growth may help prevent asthma exacerbations.
Other Asthma Triggers
Air pollution
Trees, grass, and weed pollen
Clinical Management of Asthma
Expert Panel Report 3
National Asthma Education and Prevention Program
National Heart, Lung and Blood Institute, 2007
Source: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf
2007 NAEPP EPR-3
Treatment recommendations based
on:
Severity
Control
Responsiveness
Provide patient self-management
education at multiple points of care
Reduce exposure to inhaled indoor
allergens to control asthmamultifaceted approach
Source: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf
What is GIP?
 Guidelines Implementation Panel
Report for Expert Panel Report 3
 Recommendations and strategies
to implement EPR-3
 Six key messages
Source: http://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.pdf
GIP’s Six Key Messages
Inhaled
Corticosteroids
Asthma Control
Follow-up Visits
Asthma Action Plan
Asthma Severity
Source: http://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.pdf
Allergen and Irritant
Exposure Control
Diagnosing Asthma:
Medical History
Symptoms
Coughing
Wheezing
Shortness of breath
Chest tightness
Symptom Patterns
Severity
Family History
Diagnosing Asthma
Troublesome cough, particularly at night
Awakened by coughing
Coughing or wheezing after physical
activity
Breathing problems during particular
seasons
Coughing, wheezing, or chest tightness
after allergen exposure
Colds that last more than 10 days
Relief when medication is used
Diagnosing Asthma
Wheezing sounds during normal
breathing
Hyperexpansion of the thorax
Increased nasal secretions or nasal
polyps
Atopic dermatitis, eczema, or other
allergic skin conditions
Diagnosing Asthma:
Spirometry
Test lung function when diagnosing asthma
Medications to Treat Asthma
Medications
come in several
forms.
Two major
categories of
medications are:
Long-term control
Quick relief
Medications to Treat Asthma:
Long-Term Control
Taken daily over a long period of time
Used to reduce inflammation, relax airway
muscles, and improve symptoms and lung
function
Inhaled corticosteroids
Long-acting beta2-agonists
Leukotriene modifiers
Medications to Treat Asthma:
Quick-Relief
Used in acute
episodes
Generally shortacting
beta2agonists
Medications to Treat Asthma:
How to Use a Spray Inhaler
The health-care
provider should
evaluate inhaler
technique at each
visit.
Source: “What You and Your Family Can Do About Asthma” by the Global Initiative for
Asthma Created and funded by NIH/NHLBI
Medications to Treat Asthma:
Inhalers and Spacers
Spacers can help
patients who have
difficulty with inhaler
use and can reduce
potential for adverse
effects from
medication.
Medications to Treat Asthma:
Nebulizer
 Machine produces a
mist of the medication
 Used for small children
or for severe asthma
episodes
 No evidence that it is
more effective than an
inhaler used with a
spacer
Managing Asthma:
Asthma Management Goals
Achieve and maintain control of symptoms
Maintain normal activity levels, including
exercise
Maintain pulmonary function as close to
normal levels as possible
Prevent asthma exacerbations
Avoid adverse effects from asthma
medications
Prevent asthma mortality
Managing Asthma:
Asthma Action Plan
Develop with a physician
Tailor to meet individual needs
Educate patients and families about all aspects
of plan
Recognizing symptoms
Medication benefits and side effects
Proper use of inhalers and Peak Expiratory Flow
(PEF) meters
Managing Asthma:
Sample Asthma Action Plan
Describes medicines
to use and actions to
take
National Heart, Blood, and Lung Institute Expert Panel Report 3 (EPR 3): Guidelines for the
Diagnosis and Management of Asthma. NIH Publication no. 08-4051, 2007.
Managing Asthma:
Peak Expiratory Flow (PEF) Meters
 Allows patient to assess status of his/her asthma
 Persons who use peak flow meters should do so frequently
 Many physicians require for all severe patients
Managing Asthma:
Peak Flow Chart
People with
moderate or
severe asthma
should take
readings:
Every morning
Every evening
After an
exacerbation
Before inhaling
certain
medications
Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For
Asthma Created and funded by NIH/NHLBI
Managing Asthma:
Indications of a Severe Attack
Breathless at rest
Hunched forward
Speaks in words rather than complete
sentences
Agitated
Peak flow rate less than 60% of normal
Managing Asthma:
Things People with Asthma Can Do
Have an individual management plan containing
Your medications (controller and quick-relief)
Your asthma triggers
What to do when you are having an asthma attack
Educate yourself and others about
Asthma Action Plans
Environmental interventions
Seek help from asthma resources
Join an asthma support group
A Public Health Response to Asthma
A call to action for organizations and people with
an interest in asthma management to work as
partners in reducing the burden of asthma within
our nation’s communities.
A Public Health Response to Asthma:
Surveillance
Over time…
How much asthma does the population have?
How severe is asthma across the population?
How well controlled is asthma in the population?
What is the cost of asthma?
A Public Health Response to Asthma:
Uses of Surveillance Data
Basis for planning and
targeting intervention
activities
Evaluating
intervention activities
A Public Health Response
to Asthma Education
Education programs can be targeted to:
People with asthma
Parents of children with asthma
Medical care providers
School staff
Public
A Public Health Response to Asthma:
Coalition
Successful asthma campaigns need the
cooperation of committed partners.
A Public Health Response to Asthma:
Advocacy
Asthma needs to be addressed
comprehensively by multiple government and
non-government agencies.
A Public Health Response to Asthma:
Interventions
Medical management
Education
Environment
Schools
A Public Health Response to Asthma:
Medical Management Interventions
Ensure people with asthma
know about their disease and
are empowered to demand
appropriate management
A Public Health Response to Asthma:
Environmental Interventions
 Help people create and
maintain healthy home,
school, and work
environments.
 Environmental interventions
may consist of:
 Assessments to identify
asthma triggers
 Education on how to
remove asthma triggers
 Remediation to remove
asthma triggers
A Public Health Response to Asthma:
School Intervention Science-Based Guidance
 Management and support
systems
 Health and mental health
services
 Asthma education for
students, staff, and parents
 Healthy school environment
 Physical education and
activity
 School, family, and
community efforts
Source: www.cdc.gov/HealthyYouth/asthma/strategies
Key Aspects
Require team effort
Coordinate health, including mental and physical
health, education, environment, family, and
community efforts
Assess needs of school and prioritize (every
action step is not feasible to every school or
district)
Focus on students with frequent asthma
symptoms, health room visits, and absenteeism
Family/Community
Involvement
Physical
Education
1. Management &
Support Systems
6. School, Family,
& Community
Efforts
5. Physical
Education &
Activity
Nutrition
Services
Health
Services
2. Health &
Mental Health
Services
Counseling,
Psychological, and
Social Services
3. Asthma
Education
4. Healthy School
Environment
Health Promotion
For Staff
Healthy School
Environment
Health
Education
A Public Health Response to Asthma:
School
 A leading chronic disease cause of school absence
 Common disease addressed by school nurses
 Affects teachers, administrators, nurses, coaches,
students, bus drivers, after school program staff,
maintenance personnel
On average, 3 children in a classroom of 30
are likely to have asthma.*
*Epidemiology
2006.
and Statistics Unit. Trends in Asthma Morbidity and Mortality. NYC: ALA, July
A Public Health Response to
Asthma:
What can make asthma worse in the school?
 Mold and mildew
 Animals in classroom
 Carpeted classrooms
 Cockroaches
 Poor air quality
Asthma-Friendly School
DVD and Toolkit
Objectives
Personal stories to relate to
viewer
Aspects of an asthma-friendly
school
Six strategies for addressing
asthma in a coordinated school
health program
Potential impact of asthmafriendly schools
A Public Health Response to Asthma:
School Actions
 Establish policies and procedures to support children with
asthma.
 Keep students’ asthma action plans at the school.
 Make medications available
 During school hours
 Before physical activity and sports
 During before- and after-school programs
 On field trips or when away from campus
 Train school staff to recognize signs of an asthma attack
and to use appropriate medications.
A Public Health Response to Asthma:
Evaluation
The systematic investigation of the
structure, activities, or outcomes of
asthma control programs.
Are we doing the right thing?
Are we doing things right?
Benefits of Program Evaluation
Evaluations help asthma programs
 Manage resources and services effectively
 Understand reasons for current performance
 Build capacity
 Plan and implement new activities
 Demonstrate the value of their efforts
 Ensure accountability
Using Evaluation to Improve Programs
Highlight effective program components
Recognize achievements
Replicate successes
Assess and prioritize needs
Target program improvements
Advocate for the program
Framework for Program Evaluation
A Public Health Response to Asthma:
Summary
 Asthma is a complex disease that is not yet preventable or
curable.
 Asthma can be managed with medication, environmental
changes, and behavior modifications.
 By working together, we can ensure that people with asthma
enjoy a high quality of life.
Resources
 National Asthma Education and Prevention Program
 http://www.nhlbi.nih.gov/about/naepp/
 Asthma and Allergy Foundation of America
 http://www.aafa.org
 American Lung Association
 http://www.lungusa.org
 American Academy of Allergy, Asthma, and
Immunology
 http://www.aaaai.org
 Allergy and Asthma Network/Mothers of Asthmatics,
Inc.
 http://www.aanma.org
Resources
 American College of Allergy, Asthma, and
Immunology
 http://www.acaai.org
 American College of Chest Physicians
 http://www.chestnet.org
 American Thoracic Society
 http://www.thoracic.org
 The Centers for Disease Control and Prevention
 http://www.cdc.gov/asthma