Breathing Easier Brochure - Asma (CDC)

8/6/2019 Breathing Easier Brochure - Asma (CDC)

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Breathingeasier


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CDCNationalAsthmaControlProgramAmericaBreathingEasierWorkingtogether,wecanalleviatetheburdenofasthmaandkeepAmericabreathingeasier.


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ResearchbytheCentersforDiseaseControlandPrevention(CDC)showsthatmorethan32millionpeopleintheUnitedStateshavebeendiagnosedwithasthmaatsometime.Ofthe22millionU.S.residentswhocurrentlyhaveasthma,12millionhavehadanasthmaepisodeorattackoverthepastyear.CDCsNationalAsthmaControlProgramplaysacriticalroleinhelpingAmericabreatheeasierbylearningmoreaboutasthmaandhowtocontrolit.


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Fourthousandpeopledieeachyearfromasthma related causes,andasthmaisacontributingfactorinanother7,000deathseveryyear.Inasthma,somethingairpollution,allergens,exercise,stress,certainchemicalsintheworkplacecausestheairwaysofthelungstonarroworbecomeblocked,makingithardtobreathe.Forthemostpartwedontknowwhysomepeoplehaveasthmaandothersdonotalthoughweregettingclosereverydaybutthankstotheworkofmedicalresearchers,healthcareprofessionals,andpublichealthspecialists,weredoingmoretohelppeoplewiththediseasealleviatesomeoftheirburden.Buttheburdenofasthmafallsnotonlyonindividualswithasthma.Italsofallsonourschools,ourfamilies,ourneighborhoods,ourworkplaces,ourcities,andourstates.Itfallsonourhealthcaresystem.ItfallsonallAmericans,whetherornotwehaveasthma,becausewepayforthatburdenwithhigherhealthinsurancerates,withlostproductivity,andwithourtaxdollars.TheCDCNationalAsthmaControlProgramfundsstates,cities,andschoolprogramstohelpthemimprovesurveillanceofasthma,trainhealthprofessionals,educateindividualswithasthmaandtheirfamilies,andexplainasthmatothepublic.Tomaintainthatprogress,CDCanditsfederal,state,local,andnonprofitpartnersmustcontinuethevitalworkoftrackingasthma,enhancingthecapacityoffederal,state,andlocalpublichealthoffices;traininghealthpractitionersandeducators;implementingproveninterventions;fillingingapsinresearch;andincreasingtheAmericanpeoplesunderstandingofasthma.Aspartofajoint,coordinatedeffort,thesepeople,programsandpoliciescanalleviatetheburdenofasthmaandkeepAmericabreathingeasier.


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CONTENTS2

An Asthma Story

5 13 25P A R T O N E P A R T T W O P A R T T H R E E

Asthma: A Brief Public Health Evaluation,Introduction Response to Accomplishments,

ControlAsthma FutureDirections

31Acknowledgments


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MykidshaveasthmaandsodoI.Infact,themomscasewasfarworse.Unlikeher children, thisIllinoismotherhadnoregularsourceofmedicalcare.Sheregularly

wenttotheemergencyroomwhenthepanickystruggletobreatheoverwhelmed herduring bad asthma attacks.ThroughaCDCfunded asthmacontrolprogram,acaseworkereducatedtheyoungmotherabouthowmedicationscouldcontrolherasthma.Thecaseworkerdemonstratedhowaneasytocarry inhalercouldhelpherbreatheeasily,withoutanxiety,whenmedicationsfailedtopreventanattack.Thecaseworkeralsotalkedwithherabouthowtominimizedust,tobaccosmoke,andothercommonsubstancesathomethattriggerasthmaattacks.Inaddition,thecaseworkeremphasizedhowimportantitwastofindaprimarycaredoctor,onewhocouldlookafterherregularlyandbeavailablesoshewouldnothavetousetheemergencyroomsooften.Sixweekslater,themotherapproachedthecaseworkeratacommunityhealthfair.Shehadfoundaprimarydoctor,andshewasbeginningtogetherasthmaundercontrol.Thecase

workerwaspleasedatthewomanssuccess.Sheknewthatbygettingbetterregularmedicalcare,theyoungmotherwouldbebetterabletocareforherselfandherchildrenandwouldneedtheemergencyroomlessoften.


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partone


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A M E R I C A B R E AT H I N G E A S I E R

Asthma: A Brief IntroductionMorethan30millionpeopleintheUnitedStateshavebeendiagnosedwithasthmaduringtheirlifetime.Ofthe20millionU.S.residentswhocurrentlyhaveasthma,12millionhavehadanasthmaepisodeorattackoverthepastyear.

Thenumberofreportedcasesofasthmahasbeenontherisesince 1980theburdenofasthmaintheU.S.increasedgreatlythroughoutthe1980sand1990s.

Fourthousandpeopledieeachyearfromasthma related causes.Manyofthosedeathscouldbeavoidedwithpropertreatmentandcare.

W H A T I S A S T H M A ?Inpeoplewithasthma,somethingcausestheairwaysofthelungstonarroworbecomeblocked,makingithardtobreathe.

Normally,theairwaystothelungsarefullyopenwhenwebreathe,soairmovesinandoutfreely.Peoplewithasthmahavehighlysensitiveairwaysthatbecomeinflamedeasily.Theyhaveasthmaallthetime,buttheyhaveasthmaepisodesorattacksonlywhensomethingbotherstheirairways.Duringanepisode,theymaycoughandwheezeorbecomeshortofbreath.Sometimesanepisodeissosevere,theyneedemergencymedicalattentiontobreathenormallyagain.

Inanasthmaepisode: Theliningoftheairwaysswellsandbecomesmoreinflamed.

Mucusclogs

the

airways.

Musclestightenaroundtheairways. Thesechangesnarrowtheairwaysuntilbreathingbecomesdifficultandstressful,liketrying

tobreathethroughastrawstuffedwithcotton.


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Insomepeopleasingletriggercansetoffanasthmaattack,whileforothersseveraltriggersmustbepresentatthesametime.

W H A T C A U S E S A S T H M A ?Thecauseofasthmaislargelyunknown,althoughsometimeshavingasthmaislinkedtoaspecifictriggersuchashavinginhaledcertainchemicalsatwork.However,ifsomeoneinyourfamilyhasasthma,youaremorelikelytohaveit,sotheremaybeahereditarycomponenttothedisease.

Anasthmaepisodeoccurswhenapersonwithasthmainhalessubstancesintheairthattriggersymptomsathome,work,orschool.

Asthmatriggerslurkindoorsandout.Inmanypeoplewithasthma,thesamesubstances(calledallergens)thatcauseal

lergysymptomscantriggeranasthmaattack.Theseallergensmaybeinhaled,suchaspollen,tobaccosmoke,ordust,oreaten,suchasshellfish.Avoidingorlimitingexpo suretoknownallergenscanhelppreventasthmasymptoms.

Airpollutionisoneofthemostunderappreciatedcontributorstoasthmaepisodes.Childrenwithasthmaareparticularlyvulnerabletoozone,evenatlevelsbelowtheEnvironmentalProtectionAgencyscurrentstandard.Pollutionfromtruckandautoexhaustalsoraisestheriskofasthmasymptoms.

Inaddition,anasthmaattackcanbecausedinsomepeoplebystrenuousphysicalexercise,certainmedicines,andevenbadweathersuchasthunderstorms.Notwocasesofasthmaareexactlyalike.Somepeoplereacttojustafewofthesetriggers,sometomany.Somepeopleneedonlyasingletriggertosetoffanasthmaattack,whileforotherssev eraltriggersmustbepresentatthesametime.Peoplewithasthmamustlearnwhichfactorstriggertheirepisodes,andthentrytominimizetheirexposuretothem.

W H O I S A T G R E A T E S T R I S K O F A S T H M A ?Asthmaaffectspeopleofallraces,bothsexesandallages,anditaffectspeopleineveryregionoftheU.S.However,asthmaisseenmoreoftenamongchildren,womenandgirls,AfricanAmericans,PuertoRicans,peopleintheNortheast,thoselivingbelowthefederalpovertylevel,andthosewithparticularwork related exposures.


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E

a

y

Outdoorairpollution Mold

xerciseandotherctivitiesthatmakeoubreatheharder


Tobaccosmoke

PollenCommonasthmatriggersPetdanderandotherallergenslikedustmitesandpollen


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airflow

secondarystageofasthmaMucusclogstheairways.Musclestightenaroundtheairways.

Whathappensduringanasthmaattack?

a

irflow

healthylungsAirflowsunconstrictedthroughtheairways.Breathingisrelaxedandeffortless.

airflow

firststageofasthmaTheliningoftheairwaysswellsandbecomesmoreinflamed.

Thesechangesnarrowtheairwaysuntilbreathingbecomesdifficultandstressful,liketryingtobreathethroughastrawstuffedwithcotton.


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airflow

severestageofasthmaTheciliatedliningcellsaresodamagedthattheysloughoffintothelumenandbecomepartofthedebristhatobstructstheairway.


Children

Anyonecangetasthma,butchildrenareespeciallyvulnerable.Asthmaistwiceascommonamongchildrenasadults.Asthmaisoneofthemostcommonchronicchildhooddiseases.Nearlyfivemillionasthmasufferersareunderage18.

Asthmaisthethird ranking causeofhospitalizationforchildrenandoneoftheleadingcausesofschoolabsen teeism.Atotalof12.8millionschooldaysaremissedeachyearbecauseofasthma.

MinoritiesAfricanAmericanshavethehighestdeathrateofallgroups.

Hispanicsingeneralhavealowerasthmaprevalencethannon Hispanic blacksandwhites;however,PuertoRicanHispanicshavehigherprevalencethanotherHispanicsub groups.Inaddition,theprevalenceofasthmaamongPuertoRicansishigherthanamongnon Hispanic whitesandnon Hispanicblacksforbothadultsandchildren.

In2006,2.7millionHispanicshadasthma,comparedto3.4millionnon Hispanic blacksand15.6millionnon Hispanicwhites.

CommunitiesSometimes,whereyoulivecanalsoincreaseyourriskofex periencinganasthmaepisode.TheAsthmaandAllergyFoundationofAmerica(AAFA)notesthatfactorssuchasairpollution,pollencounts,andpublicsmokingbans;howmanyasthmamedicationseachpersonwithasthmauses;


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andthenumberoflocalasthmaspecialistsstronglyinfluencetheoccurrenceofanindividualasthmaepisode.

W H A T A R E T H E C O S T S O F A S T H M A ?Eachday,11Americansdiefromasthma.

Asthmadeathratesrosebetween1980and1996amongbothsexes,andmostageandethnicgroups,buthavedeclinedsince2000.Womenandgirlsaccountfornearly64%ofasthmadeathsoverall,althoughamongchildrenmoreboysdieeachyearthangirls.

Asthmaburdensournationandourhealthsysteminwaysotherthanliveslimitedandlost.

Asthmaleadstoalmost13millionoutpatientvisitstothedoctorandtwomilliontripstotheemergencyroomeachyear.

AccordingtoAAFA,theestimatedannualcostofasthmaisnearly$19.7billion,includingnearly$10billionindirecthealthcarecosts(mostlyforhospitalizations)and$8billionforindirectcostssuchaslostearningsduetoillnessordeath.

Asthmaisthefourthleadingcauseofworkabsenteeismanddiminishedworkpro ductivityforadults,resultinginnearly12millionmissedorlessproductiveworkdayseach

year.

A S T H M A C A N N O T B E C U R E D B U T I T C A N B E C O N T R O L L E DThecausesofasthmaandhowwecanpreventorcureitareunknownexceptinlimitedcasesofexposuretochemicalsatwork.

However,wecantreatandcontrolasthma.Individuals,doctors,communities,andpublichealthofficialscanalltakeactiontoreducethetollthatasthmatakesonoursociety.

CDCsNationalAsthmaControlProgramplaysacriticalroleinhelpingAmericabreatheeasierbyhelpingusalllearnmoreaboutasthmaandhowwecancontrolit.


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Numbers: 32.6millionpeopleintheUnitedStatesmorethan1in10Americanshavehadasthmaat

somepointintheirlives. 22.2millionpeople,1inevery14Americans,arecurrentlydiagnosedwithasthma. 12.2millionpeoplehadanasthmaattacklastyear. 4,000Americansdieeveryyearfromasthma related complications. Asthmacoststhenation$19.7billioneveryyear.

EverydayintheUnitedStates,duetoasthma: 30,000peoplehaveanasthmaattack. 5,000peoplevisittheemergencyroom. 1,000peopleareadmittedtothehospital. 11peopledie.

AsthmaFacts


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parttwo


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Public Health Response toControl AsthmaC D C C R E A T E S A N A T I O N A L A S T H M A C O N T R O L P R O G R A MAstheprevalenceofasthmaincreasedduringthe1980sand1990s,federalhealthagen ciesresponded.

TheNationalAsthmaEducationandPreventionProgram(NAEPP)oftheNationalInstitutesofHealthsNationalHeart,Lung,andBloodInstitutefirstissuedguidelinesfor thediagnosisandmanagement ofasthmain1991. These guidelinestranslatedadvancesinscientificandclinicalresearchintopracticaladviceforpeoplewithasthma,forthehealthcareproviderswholookafterthem,andforthecommunitieswheretheylive.

Theguidelinesincludedthebestscientificevidenceaboutcomprehensive,long termmanagementstrategiesdesignedtopreventandreverseairwayinflammationandtomanageasthmaattacks.Theysetupstandardmethodsfordoctorstogaugetheseverityofapatientsasthmaandmonitortreatmentprogress.Theguidelinesalsonotedthatpeoplewithasthmashould usea written actionplanwith treatment instructionsto controltheirillnessandhandleworseningasthma.Theyencouragedpartnershipsamongindividualswithasthma,families,andclinicians.Theyalsolaidoutcontrolmeasurestoavoidoreliminateenvironmentalfactorsthatbringonasthmasymptomsorattacks.

TheNAEPPguidelineswereupdatedin1997and2007toreflectnewresearchfind ings,buttheymarkedonlythebeginningofAmericasroadtobreathingeasier.Whilecaringforindividualpatientsisacrucialstep,theroaddoesnotendinadoctorsofficeorhospital.Decreasingtheburdenofasthmaalsodemandsacomprehensiveandco ordinatedpublichealthapproach.ThatswhereCDCanditspartnerscomein.

In1998agroupofCDCstaffandfederal,state,andotherscientistsrecognizedthatmoreneededtobeknownaboutasthmaifitwastobebettercontrolled.Fortheseprofessionals,thekeytoasthmacontrolwassurveillanceidentifyingandtrackingasthmacases.


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Theywantedtoknow:1. Howmanypeoplehaveasthma?Howmanycasesoccurovertime?2. Whatgroupssuffermostfromasthma?3. Howseverearethecases?4. Howwellareasthmacasescontrolled?5. Whatisthecostofasthma?

CDCcreatedtheNationalAsthmaControlProgramin1999tolaunchthispublichealth

approach

to

asthma.

A S T H M A C O N T R O L P R O G R A M G O A L S A N D H O W T H E P R O G R A M W O R K SLiketheHealthyPeople2010goals,theasthmacontrolprogramgoalsseektoreducethenumberofdeaths,hospitalizations, emergencydepartmentvisits,schooldays orworkdaysmissed,andlimitationsonactivityduetoasthma.

WHATISSURVEILLANCE?Surveillance,alsocalledtracking,isthestudyofthedistribu In 1999,CDCsnationwideBehavioralRiskFactorSurveil tionandoccurrenceofadiseaseinapopulationovertime.To lanceSystem(BRFSS)addedquestionsaboutasthmacontrolunderstandthosepatterns,researcherscanrecorddatasuchas andmedicationuse.Moredetailedasthmamanagementandthenumberofpeoplewithasthma,thenumberofpeoplewho controldataarecollectedin37statesthroughtheNationalgotohospitalsoremergencyroomsfortreatment,thenumber AsthmaSurvey,afollow up toBRFSS.ofpeoplethatdiefromthedisease,andotherinformation. CDCsNationalHealthInterviewSurvey(NHIS)collectsdata

Unlikemanyinfectiousdiseases,asthmaisnotusually onhowoftenasthmacausesdaysofrestrictedactivity,daysreportedtotheCDC,andthereisnolaboratorytesttodiagnose lostatworkorschool,physicianvisits,andhospitalizations.it.Thatmakesithardtoknowforsurehowmanyfirst time CDCalsohelpsstatesandlocalitiescollectandanalyzecasesofasthmaoccureachyear. datatobetterunderstandwhogetsasthma,howsevereitis,and

Tofillinthatgap,CDCusesseveralsurveystogather wherepeoplewithasthmalive,work,orgotoschool.Thisin asthmainformation.Infact,mostofwhatweknowabouthow formationisthenusedtoplanandevaluateasthmainterventions.asthmaaffectsAmericanscomesfromsurveys.


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Meetingthosegoalsmeansknowingthescaleoftheproblemandhavingprogramstohelpmanagetheproblem.CDCsasthmacontrolprogramhasthreeparts:surveil lance,interventions,andpartnerships.

Surveillance(ortracking)letsusknowhowmanypeoplehaveasthma,wheretheylive,andhowthosenumberschangewiththepassageoftime.CDCcon ductssurveillanceactivitiesatboththenationalleveland,incooperationwithpartners,thestatelevel.

Interventionsapplymethodsusedtopreventortreatasthma.CDCconductsinterventionsincooperationwithstateandcityhealthofficials,nongovernmen talorganizations,andothers.

PartnershipsincludealliancesCDCbuildswithstates,localities,nonprofitorganizations,andotherfederalagenciestoreducetheburdenofasthma.

NATIONALHEALTHYPEOPLE2010GOALSReduceasthmadeathsReducehospitalemergency

departmentvisitsReducenumberofschooldaysor

workdaysmissedduetoasthmaIncreasetheproportionof

peoplewithasthmawhoreceiveappropriatecare

Establishasthmasurveillancein15states

Together,theCDCasthmacontrolprogramanditsmanypartnersmakeupthepublichealthresponsetoasthmacontrol.Thatresponseisacomplexwebofactivitiesandpartnershipsatthenational,state,andlocallevels.CDCprovidescriticalsupport

throughfundingandtechnicalguidancetostatehealthdepartmentsandlocalentitiestoensurethatasthmacontrolandmanagementareavailabletothoseinneed.

CDCsNationalAsthmaControlProgramComponentsandPercentageofBudget

Interventions 18%

Surveillance 13%

Partnerships 69%


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F E D E R A L P A R T N E R S H I P STheNationalAsthmaControlProgramhasitshomeinCDCsNationalCenterforEnvironmentalHealth,DivisionofEnvironmentalHazardsandHealthEffects.CDCsNationalCenterforHealthStatistics(NCHS)andDivisionofAdolescentandSchoolHealth(DASH)alsopartnerintheprogram.

CDCcollaborateswithotherfederalagenciesaswelltoachieveitsasthmacontrolobjectives.CDCmeetswiththeFederalLiaisonGrouponAsthma,whichalsoincludestheEnvironmentalProtectionAgency(EPA),theNationalInstitutesofHealth:Na tionalHeart,LungandBloodInstituteandNationalInstituteofAllergyandInfectiousDiseases,andothers.CDCregularlycooperateswithotherfederalagenciesinvolvedinasthmacontrol,includingtheCentersforMedicareandMedicaidServices,theHealthResourcesandServicesAdministration,andtheDepartmentofHousingandUrbanDevelopment.CDCworkscloselywithEPAtorecommendguidancedocumentsandre vieweducationalmaterialsfortechnicalaccuracy.

Inaddition,CDCfundscollectionofsocial,environmental,andmedicaldataonasthmaamong10,000childrenbytheBureauofLaborStatisticsNationalLongitudinalSurveyofYouth.

S T A T E A N D L O C A L A S T H M A C O N T R O L A N D C D CPartnershipsbetweenCDCandstatehealthdepartments,cities,andotherlocalentities(suchasschoolsandnonprofitorganizations)areessentialforthesuccessofasthmacontrolintheU.S.Programsattheselevelsallowformoreefficientuseofspecialexpertise,increasedflexibility,andfasterstartsforprograms.

BuildingStateCapacityCDCgrantssupportasthmaprogramsin33states,Washington,D.C.,andPuertoRico.Thesegrantshelpstatehealthdepartmentsbuildtheirasthmaprograms,bolster


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surveillance,implementinterventions,andfosterpartnerships.Inturn,thisrobuststatecapacityenhancesthenationalpublichealthinfrastructureforaddressingasthma.UsingCDCgrants,22stateshavesuppliedtrainingandtoolkitstoteachhealth

careprovidersbetterwaystodiagnose,treat,andmanageasthma.Twenty three stateshavedevelopedsimilarmaterialstoeducateschoolpersonnelsotheycandomoretohelpstudentscontroltheirasthma.

BuildingLocalProgramsCITIES:

In

2001,

CDC

began

to

fund

inner city

collaborations

as

part

of

the

Controlling

AsthmainAmericanCitiesProject(CAACP)withthegoalofdevelopingcomprehen siveandintensivecommunityasthmacontrolplans.Sevenmetropolitanareaswere

NEW YORK

Congressprovided$5.2millionfortheNewYorkEmergencyDisasterReliefRelatedtoAsthmaprogramintheaftermathoftheterroristattackonSeptember11,2001.Surveillancebythecityandstatemonitorsnewonsetasthma,asthmahospitalizationsandemergencydepartmentvisits,andasthmasymptomssinceSeptember11.TheprogramtracksNewYorkstateresponsepersonnel,homeenvironmentsneartheWorldTradeCentersite,andhospitalizationsduetoairqualityissuessinceSeptember11,2006.TheNewYorkprogramalsodevelopedasthmaprogramsinschoolhealthcenters,preschoolsanddaycarecentersinlowerManhattan.Interventionsimprovedclinicalpracticeandcoordinationofasthmacarebetweenhospitals,schools,andprimarycareproviders.

1999 2000 2001 2002 2003 2004 2005 2006 2007

$0.8$2.4

$5.7$9.0

$10.9$12.8 $13.5 $13.0 $13.3

FUND

ING

TO

STATES

IN

MI

LLIONS

In 1999 four states

were funded.

Today, 33 states,

Washington, D.C.,

and Puerto Rico

receive funding

from CDC.

*


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fundedaspartofCAACP:Chicago,Minneapolis/St.Paul,NewYorkCity,Oakland,Philadelphia,Richmond,andSt.Louis.Theseprojectstranslatedexistingasthmareductionstrategiesintoservicesforchildrenlivingindifficultsocialandphysicalenvi ronments.BasedontheirexperienceinCAACP,projectstaffsalsocreatednewinterventionstailoredtolocalconditions.CAACPresultedinextensivepartnershipsinvolvingeverylevelofthehealthcaresystemfromdaycareproviderstodoctors.

Someprogramseducateddaycareprovidersandparentsaboutmanagingasthmainyoungchil dren.Othersintegratedasthmaself management trainingintoexistingsocialserviceorfaith based organizations.Oneprogramlinkedhigh riskchildren tospecialtyasthmaservicesthroughtheirschools,whileanotherworkedwithmanagedcareplanstoensurereimbursementforself managementtraining. SomeCAACPprogramstrainedcommunityphar maciststoeducatepeoplewithasthmaaboutusingasthmamedicationsproperly,whileotherstaughtdoctorsthelatestmedicalmanagementtechniquesandbetterwaystocommunicatethemtoparentsofkidswithasthma.

Anothersuccessfulprogramtaughtparentsofchildrenwithasthmahowtousediariestomakenoteofpeakairflow,triggers,symptoms,medica tions,andsideeffects.Thestudycoordinatorthenused theseasthma diaries todemonstratehowlong term controller medicinesworked betterthan rescue/quick relief drugs in preventingasthmasymptoms. Theevidencein theirowndiariespersuadedindividualswithasthmatoovercometheirrelianceonrescuedrugs.

CDCgrantedadditionalfundstoCAACPcities

WISCONSIN

Since2002,morethan850primarycareclinicianshavebeentrainedbyapartnershipoftheChildrensHealthAllianceofWisconsin,FightAsthmaMilwaukeeAllies,theMedicalCollegeofWisconsin,theWisconsinAcademyofPediatricsFoundation,theWisconsinAsthmaCoalition,andtheWisconsinMedicalSociety.AnallergistandnursetooktheAllergistOutreachAsthmaEducationProgramdirectlytoprimarycareclinicsforpediatricians,familypracticephysicians,nursepractitioners,nurses,respiratorytherapists,andotherclinicalstaff.Reviewsoftheprogramshowedsignificantimprovementsinseverityclassification,assessmentofdustasatrigger,andwritingacareplan.Physiciansandnursesalsoreportedimprovementsinteachingindividualswithasthmaandstaffteamwork.AdaptingtochangingneedsinWisconsin,theAllergistOutreachProgramhasevolvedintoshortregionaltrainingsessionsthatreachlargeraudiences.TheAmericanLungAssociationoftheUpperMidwesthastakentheAllergistOutreachProgramontheroadandnowconductsinclinicandregionaltrainingsessionsinMinnesota,NorthDakota,Ohio,SouthDakota,andWisconsin.


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FUNDED STATES

FUNDED CITIES

CDC Funded StatesandCities

TX

WA

ORSD

NE

MN

MI

IA

IL

MO

AR

MS AL GA

SC

TN

KY

IN OH

PA

AK

HI

NC

VA

WV DE

TRI

MEVT

AZ

COUT

WYID

NV

CA

NM

OK

WI

NY MA

NJ

PR

Washington, DC

Richmond

PhiladelphiaNew York

Chicago

Milwaukee

St. Louis

Minneapolis/St. Paul

Oakland

Los Angeles

San Diego

Albuquerque

Houston

FresnoCharlotte

Fort Lauderdale

in2003toimplementplansliketheseoverthenextfiveyears.TheCAACPprojectendedinJune2008, butdatacollection,evaluation,andoutcomestudiesareongoing. Meantime,localCAACPsiteshavefoundtheirownfundingsourcestosustainasthmacontrolwork.SCHOOLS:AspartofitsCoordinatedSchoolHealthProgram,CDCsDivisionofAdolescentandSchoolHealth (DASH)implements aschool based asthmamanagementprogramwith thegoalofincreasingthenumberofasthma friendly schoolsacrossthenation.Asthma friendlyschoolsprovideasafeandsupportivelearningenvironmentforstudentsandhavepoliciesandprogramsinplacetohelpstudentskeeptheirasthmaundergoodcontrol.

STATESURVEILLANCEStatesurveillanceistheindispensablelinkbetweenCDCs CDC funded stateasthmacontrolprogramsnowmeasureNationalAsthmaControlProgramandstatehealthdepartments. adultandchildprevalence,indicatorsofasthmacontrol,hospi

Before1998,citiesandstatesdidnotcollectasthmain talizations, anddeaths.Somestatesalsotrackasthmaintheformationuniformly.Sincethen,CDCfundingandguidancehave Medicaidpopulation,costsattributabletoasthma,orasthmahelpedstatehealthdepartmentsstandardizedetaileddata managementindicatorslikeasthmaactionplans,detailedmed collection,simplifyingcomparisonofdiseaseratesacross icationuse,schooldaysorworkdaysmissedduetoasthma,orjurisdictions. emergencydepartmentvisits.


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DASHcurrentlyfunds10urbanschooldistrictstoimplementcomprehensiveschoolasthmaprogramsaimedatreducingstudentasthmaepisodesandabsences.Theseschooldistrictsimplementpoliciesandprogramsrelatedtoimprovedschoolhealthservices,asthmaeducationforstudentsandstaff,andenvironmentalmanagement.

DASHfundedsixnationalnongovernmentalor ganizations(NGOs)from20002006todeveloptoolsandtrainingprogramstosupportteachers,schoolnurses,schooladministrators,pediatri cians,schoolboardmembers,communitymem bers,andparentsinbetterunderstandingasthmaandwhattheycandotoimproveasthmamanage mentinschools.TwooftheseNGOs,theAmericanLungAssociationandtheAmericanAssociationof

IOWA

AnewasthmamanagementtrainingcurriculumforchildcareprovidersandschoolsresultedfromIowasAsthmaControlProgram,acollaborationamongtheIowaDepartmentofPublicHealth,theAmericanLungAssociationofIowa(ALA),theIowaAsthmaCoalition(IAC),theChildCareResourceandReferral(CCR&R)Agency,theVisitingNurseServices(VNS),MercyHospital,BlankHospital,andGlaxoSmithKline. TheYoungandtheBreathless hasbeendeliveredtomorethan1,000childcareproviders,over200licensedchildcarecenters,andfourmajorschooldistrictssinceSeptember2003.Trainthetrainersessionshavebeenprovidedtonearly175nursesandnursingstudentsin88counties.ByMay2008,thisprogramhadtouched19,000childrenreceivingchildcareservicesorattendingschool.Childrenarenottheonlyoneswhobenefit.Althoughthetrainingisintendedtohelpchildcareproviderscareforchildrenwithasthma,80%oftheprovidersarewomenaged2240years.Giventhatasthmaprevalenceishighinwomenaged22 35years,theprogramalsoequippedproviderswithskillstomanagetheirownasthma.

ILLINOIS

TheIllinoisAsthmaProgramprovidespublicandprofessionaleducationforschoolpersonnelthroughasatelliteprogram,andimplementsanasthmamanagementprogramfor9th and10thgradestudentsinhighriskcommunities.Inonesmall,ruralcounty,theIllinoisAsthmaProgram,theIllinoisAsthmaPartnerships,andthelocalAsthmaCoalitionTeamhavehelpedplaceasthmaintheforefrontofthecommunitysmind,alongwithotherchronicdiseaseslikediabetes.Healthcareproviders,teachers,andcoacheshavetakenasthmaeducationprograms.Inaddition,schoolshavestarteddevelopingasthmapoliciesforallstudents,withspecialattentiontothoseplayingsports.


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SchoolAdministrators,arereceivingfundingtocontinueimplementationoftheirasthmatoolsandprogramsfrom2006 2011. DASHalsoprovidessurveillancetoolstohelpstatesandcitiestrackprogressin

improvedimplementationofasthmamanagementpoliciesandpracticesatthestate,district,andschoollevels,aswellasself reported asthmaprevalenceamongmiddleandhighschoolstudents.Experienceshowsthatsuccessfulschool based asthmaprogramsshareseveralcommonfactors: Theyestablishstronglinkswithasthmacareclinicianstoensure

continuedmedicalcare. Theyfocusonthegreatestneed,targetingforintervention

studentswhoarethemostaffectedbyasthmaatschool. Theybuildenthusiasticadministrativesupportwithintheschool,

includingthehiringofafull time schoolnurse,tocoordinateamulti pronged approachtocontrollingasthma.

NONGOVERNMENTALORGANIZATIONS:CDCalsoworkswithnonprofit andhealth careprofessionalorganizations,includingtheAmericanLungAssociation;theAl lergy andAsthma Foundation ofAmerica; theAmer

icanAcademyofAsthma,AllergyandImmunology;AllergyandAsthmaNetwork/MothersofAsthmatics;andtheAmericanThoracicSociety.Safeandeffectiveprogramsdevelopedbytwooftheseorganizationsarenowbeingimplementedby12CDCgranteesin

cludinglargehospitalsystems,urbanhospitals,cityhealth departments, school systems, and localchaptersofnationalasthmaorganizations.

PENNSYLVANIA

PennsylvaniasDepartmentofHealthestablishedthePennsylvania AsthmaPartnershiptooverseethestatesasthmaplan.Thestateusessurveillancedatatotargetasthmainterventionsinareasofthestatewithhighratesofasthma,butoneefforttoreducetheburdenofasthmacamestraightfromthegrassroots.Inonehighschool,studentsnoticedthatsmokedriftingoutofateachers loungeintotheschoolbandroomtriggeredasthmaattacksinastudent.Thestudentspersuadedtheschooladministrationtobansmokingwithinthebuilding,butthendecidedthatresponsewasinadequate.TheAsthmaPartnershipfundsantismokingcontractorsineverycountybecausetobaccosmokecanserveasatriggerforasthmaattacks.Withthehelpofthecountytobaccocontractor,thestudentsorganizedasuccessfulpetitiondrivethroughouttheircommunitytoencouragetheschooladministrationtoprohibittobaccouseanywhereonschoolgrounds.


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TheAllergyandAsthma FoundationofAmericasAsthmaCareTrainingforKids(ACTforKids)teacheschildrenhowtopreventandcontroltheirsymptoms.Childrenlearntorecognizeearlysymptoms andknowwhatappropriateactionstotakeiftheyappear.Parentslearntoencouragechildrentomakegooddecisionsincaringforthemselves.ACTforKidsincreasesasthmacontrolcompliancebehaviors,decreases emergencydepartmentvisits,anddecreasesthenumberofdayschildrenspendinthehospital.

In theAmericanLungAssociationsOpenAirwaysforSchools(OAS),childrendiscussbasicfactsaboutasthmaandpracticerelaxationexercisestocalmthemselvesduringanasthmaepisode.Theylearntoidentifywarningsignsofanasthmaattack,andthendevelopandpracticeaplanformanagingit.Childrenlearntoevaluatetheirsymptoms,usemedicationproperly,andpracticedecidingwhentocallformedicalhelp.Theylearnaboutenviron mentaltriggersandstayingphysicallyactive.OASboostsschoolperformanceandself management behaviorsandlowersthenumberofasthmaattacks.

RICHMOND

AninnovativeCAACPprograminRichmond,Virginia,workedwithoverweightschoolkidswithasthma.TheAsthmaFitprogramcombinedphysicalactivity,asthma,andnutritioneducation andlotsoffun! tohelpchildrenloseweightandreducetheirriskforasthmaattacks.

G E O R G I A

Lawsandpoliciesmustnotstandinthewayofthetreatmentofchildrenwithasthma.InJonesboro,a10yearoldstudentdiedofanasthmaattackwhilewaitingtoboardthebushomefromschool.Districtrulesatthetimeprohibitedstudentsfromcarryingorusingasthmamedicationbythemselvesatschool.Asaresultofthisavoidabletragedy,theAmericanLungAssociationinGeorgia,ChildrensHealthcareofAtlanta,andtheGeorgiaDepartmentofHumanResourcesworkedwithothercitizenstochangeGeorgiastatelawandlocalschoolpoliciestoallowpossessionandselfadministrationofprescribedasthmamedicationsunderthesupervisionofschoolpersonnel.


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CDCPARTNERS NationalCenterforChronicDiseasePreventionandHealthPromotionDivisionofAdolescentand

SchoolHealth NationalCenterforHealthStatisticsFEDERALPARTNERS CentersforMedicareandMedicaidServices EnvironmentalProtectionAgency(EPA) DepartmentofHousingandUrbanDevelopment FederalLiaisonGrouponAsthma(includesEPA,NationalInstitutesofHealth:NationalHeart,Lungand

BloodInstituteandNationalInstituteofAllergyandInfectiousDiseases,andothers), HealthResourcesandServicesAdministrationSTATES

CITIES

NGOsAllergyandAsthmaFoundationofAmericaAllergyandAsthmaNetwork/MothersofAsthmaticsAmericanAcademyofAsthma,Allergyand

Immunology

AmericanAssociationofSchoolAdministratorsAmericanLungAssociationAmericanThoracicSociety

CaliforniaColoradoConnecticutGeorgiaHawaiiIdahoIllinois

IndianaIowaMaineMarylandMassachusettsMichiganMinnesota

MississippiMissouriNewHampshireNewJerseyNewMexicoNewYorkNorthCarolina

OhioOklahomaOregonPennsylvaniaPuertoRicoRhodeIslandTexas

UtahVermontVirginiaWashingtonWashington,D.C.WestVirginiaWisconsin

AlbuquerqueCharlotteChicagoFortLauderdale

FresnoHoustonLosAngelesMilwaukee

Minneapolis/St.PaulNewYorkCityOaklandPhiladelphia

RichmondSanDiegoSt.Louis

CDCNationalAsthmaControlProgramPARTNERS


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partthree


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Evaluation, Accomplishments,FutureDirectionsE V A L U A T I O NEveryserviceprogrammustberigorouslyevaluatedtoseehowwellitperformsitsintendedpurpose.CDCstaffevaluatetheNationalAsthmaControlProgrambasedonfoursimplequestions:

Whatarewedoing?Arewedoingtherightthings?Arewedoingthingsright?Arewereducingtheburdenofasthma?Whatarewedoing?CDCisdevelopingaWeb based reportingsystemtohelpcat

aloguepartnersactivities.Thissystemwillprovidesummariesofstateeffortsandtrackstateactivitiesandprogressovertime.

Arewedoingtherightthings?CDCusesinformationgeneratedfromCAACPtoidentifybestpracticesandthemosteffectiveinterventions.CDCalsoworkswiththeTaskForceonCommunityPreventiveServicestoidentifycommunity based interven tionsthatareproventowork.

Arewedoingthingsright?CDCworkswithstategranteestodevelopconsistentstandardsandindicatorsthatwillhelpevaluatetheeffectivenessofsurveillance,interventions,andpartnerships.

Arewereducingtheburdenofasthma?TohelpanswerthisquestionCDCisrefiningcollectionoftherightkindofdatasuchasthepercentageofpeoplewithasthmawhoreceiveasthmacontroltrainingandservices.CAACPisalreadycollectinginformationatthelocallevelaboutasthmahospitalizationratesandschoolabsenteeism.


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A C C O M P L I S H M E N T SSinceCDCsNationalAsthmaControlProgrambegan10yearsago,muchhasbeenaccomplishedtoexpandandimproveasthmatreatment,management,andcontrolintheU.S.Theprogramhasfilledthecriticalneedforapublichealthresponsetoasthma,theveryapproachthathashelpedindividualsandcommunitiesmanageandcontrolthedisease.

BeforeCDCsNationalAsthmaControlProgrambegan,therewereinsufficientdatatoanswerquestionsaboutasthmasuchas:Whohasit?Whoisgettingasthma?Whoissufferingfromasthmaepisodes?Whereandamongwhomisasthmaontherise?Whoneedstogotothehospitalbecauseofanasthmaepisode?Whoneedsbettertreat mentfortheirasthma?Today,becauseofNationalAsthmaControlProgramtracking,morenationalandstate specific dataareavailabletohelpprofessionalsanswerthesequestionsandfocuseffortsandresourcesonthoseinneed.

ThroughCDCsupportandfunding,statehealthdepartmentshavebeenabletobuilduptheirasthmacontrolprograms.Thesestateprogramshaveimprovedthequalityofasthmacare,improvedasthmamanagementinschools,andfosteredpoliciestohelpreduceairpollution,allofwhichhelptoreduceasthmarates.

F U T U R E D I R E C T I O N SCDCsNationalAsthmaControlProgramhasestablishedapublichealthresponsetoasthmacontrol.Asaresult,anetworkofprofessionals,programs,anddatacollectionsystemsatthelocal,state,andnationallevelsareinplacetocontinuetoaddress,analyze,andcontrolasthmainthiscountry.

Asthmacasesarestillincreasing,andmanycommunitiesandindividualsareinneedofcareandtreatment.CDCsprogramisfocusedondeterminingwhyasthmaisontherise,whohasasthmaandwhy,whattriggersanasthmaepisode,andwhatinter ventionsandprogramsworkbest.


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Before1999Trackingtheprogressofasthmacontrol

Lackofpublichealthresponsetoasthmacontrol.LackofstateandlocalasthmacontrolprogramsintheU.S.Lackofdataneededtohelpreducetheburdenofasthma.Limitedasthmacontrolprogramsinschools.Limitedknowledgeaboutasthmacontrolprogramsandinterventionsthatwork.Lackofaconnectionbetweenasthmaandairpollution.Limitedunderstandingofasthmacontrolprogramsandtreatmentatthecommunityandindividuallevels.

Integratedandcoordinatedpublichealthresponsetoasthmacontrol.Networkofasthmacontrolprogramsandprofessionalsacrossthecountry.Asthmacontrolprogramsin33states,Washington,D.C.,andPuertoRico.Robustnationalandstate specific dataandsurveysystemstohelpunderstandasthmaandtomakesounddecisionsregardingasthmacontrol.Betterasthmamanagementinanumberofschoolsacrossthecountry.Effortsinitiatedtoevaluateandidentifybestpracticesatthecommunityandindividuallevels.Increasedunderstandingoftheassociationsbetweenasthmaandparticulatevehicleemissions,andtheconsequentneedforprotectivehealthpolicies.Somestateshavemandatedcontrolsonvehicleemissionstohelpimproveairquality.Increaseinasthmacontrolacrossthecountryand,inparticular,amongpopulationsandindividualsatrisk.

Now


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CDCplanstoseekanswerstowhyasthmaisontherise,whohasasthmaandwhytheyhaveit,whattriggersanasthmaepisode,andwhatinterventionsandprogramscontrolitbest.

Specificfuturedirectionsare: Identifyingnewcasesofasthmaandpotentialriskfactorsbydiagnosisandtrackingofpatientsinamanagedcaresystem. Analyzingracialandethnicdisparitiesinasthmatodevelopculturallyspecificinterventionsandreducethesedisparities. Understandingwhattriggersorexacerbatesasthmaepisodesinordertodevelopbetterpopulationlevelprevention

interventions,especiallyamongthepeopleatgreatestrisk. Addressingemergingneedssuchasincreasingairpollutionandman made ornaturaldisastersthatcouldleadto

increasesinasthma.Forexample:Airpollution,especiallyparticulatesintheairfromvehicleemissions,hasbeenlinkedtoasthmaratesandhospitalvisitsincertaincommunities.Understandingthisconnectioncanhelpneighborhoodsandcommunitiespasshealth protectivepolicies, suchasthosethatdecreasevehicleemissions.


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T H E B U R D E N O F A S T H M ATheburdenofasthmaistoooftenbornebythoseleastabletobearit.Achild.Afearfulyoungmother.Amanworriedaboutmissinganotherdayofwork.Anelderlywomanlivingalone.

InCalifornia,alittlegirlnamedJasminefacedthatburden.Withouthelp,shemighthavebeencrushedbyit.Concernedaboutherbreathingproblems,herparentswouldntlethertakepartinphysicaleducationorothervigorousactivitywithotherkidsherage.Theywouldntevenlethergotopreschooliftheweatherwascoldorrainy.

Butwiththehelpofanasthmacasemanager,Jasminesmomanddadlearnedhowtomanageherasthmausingmedicationsprescribedbyherdoctor.Theasthmaspe cialistsfoundthatexercisewaslesslikelytocausesymptomsthanothertriggersinthehousehold,whichweresooneliminated.Soonshewasrunningandplayinglikeotherkidsherage.

Today,Jasminehappilyattendsschool,asactiveastherestofherclass.Buttheburdenofasthmafallsnotonlyonindividualswithasthma.Italsofallson

ourschools,ourfamilies,ourneighborhoods,ourcities,andourstates.Itfallsonourhealthcaresystem.ItfallsonallAmericans,whetherornotwehaveasthma,becausewepayforthatburdenwithhigherhealthinsurancerates,withthelostproductivityofdaysmissedatwork,withfuturesdiminishedbydayshomefromschool,andwithourtaxdollars.

Wemaynotknowwhatcausesasthmaalthoughweregettingclosereverydaybutthankstotheworkofmedicalresearchersandpublichealthspecialists,weredoingmoretohelppeoplewithasthmaandalleviatetheburdenitcreates.

Tomaintainthatprogress,CDCanditsstate,local,andnonprofitpartnersmustcontinuethevitalworkofconductingsurveillanceactivities,buildingcapacity,traininghealthandeducationprofessionals,implementinginterventionsthatwork,andin creasingtheAmericanpeoplesawarenessandunderstandingofasthma.

Aspartofajoint,coordinatedeffort,thesepeople,programsandpoliciescanallevi atetheburdenofasthmaandkeepAmericabreathingeasier.


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AcknowledgmentsCDCwouldliketothanktheAmericanPublicHealthAssociationandZeigler/Dacusfortheirsupportindevelopingthisbook.

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Paperusedinthisdocumentismadewith100%post consumer fibers.FontsusedinthisdocumentareFilisophia,DinandDinCondensed.


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difficultbreathingis:fearlimitedactivitiesmissedwork/schoolexpensive


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easybreathingis:peacefulactivelivingproductivecosteffective


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U.S.DepartmentofHealthandHumanServicesCentersforDiseaseControlandPrevention4770BufordHwy.,MSF 57 Chamblee,GA30341 U.S.A.TEL: (404)639 3311 PUBLICINQUIRIES: 1 800 CDC INFO WEB:www.cdc.gov FORMOREINFORMATION: www.cdc.gov/asthma

Documents

Breathing Easier Brochure - Asma (CDC)