Professional Documents
Culture Documents
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
12
Adult
Prevalence (%)
10 8 6 4 2 0
Current 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
Source: National Health Interview Survey; CDC National Center for Health Statistics
Year
Female Male
Lifetime
12-Month Current
Source: National Health Interview Survey; CDC National Center for Health Statistics
10 8 6 4 2 0
19 80 19 82 19 84 19 86 19 88 19 90 19 92 19 94 19 96
Black White
Year
Source: National Health Interview Survey; CDC National Center for Health Statistics
Prevalence (%)
Lifetime
Current
19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07
19 9
Year
Source: National Health Interview Survey; National Center for Health Statistics
10.1% Overall
10 7.1 10.2
NonHispanicWhite
Asian
Centers for Disease Control and Prevention. National Center for Health Statistics. Health Data Interactive. www.cdc.gov/nchs/hdi.htm. [July 15, 2009].
Non-Hispanic Black
Hispanic
Lieu TA et al. Racial/Ethnic Variation in Asthma Status and Management Practices Among Children in Managed Medicaid. Pediatrics 2002; 109:857865. 2 National Center for Health Statistics. Health data for all ages http://www.cdc.gov/nchs/health_data_for_all_ages.htm. 3 Asthma and Allergy Foundation of America and National Pharmaceutical Council. Ethnic Disparities in the Burden and Treatment of Asthma. Reston, 2005.
1
20 18 16 14 12 10
0 2 4 8 0 2 4 6 8 0 2 4 6 6 98 198 198 198 198 199 199 199 199 199 200 200 200 200 1
Females
Males
Year
Source: National Hospital Discharge Survey, CDC National Center for Health Statistics, * First-listed diagnosis, # Age-adjusted to 2000 U.S. population
Adult and Child Asthma Hospital Discharge Rates United States, 1996-2006
35 30
25 20 15 10 5 0
9 19 6 7 8 1 2 3 5 6 9 0 4 99 199 199 200 200 200 200 200 200 200 1
Children
Adults
Year
Source: National Hospital Discharge Survey, CDC National Center for Health Statistics ,* First-listed diagnosis, # Age-adjusted to 2000 U.S. population
35 30 25 20 15 10 5 0
0 2 4 6 8 0 2 4 6 8 0 2 4 6 9 8 19 8 19 8 19 8 19 8 19 9 19 9 19 9 199 19 9 20 0 200 20 0 200 1
Black
White Other
Year
Source: National Hospital Discharge Survey, CDC National Center for Health Statistics, * First-listed diagnosis, # Age-adjusted to 2000 U.S. population
ICD-10
Female
Male
Year
ICD-10
65 +
35-64
Year
ICD-10
Black Other
White
Year
Chemical Agents
Sufficient evidence of causal relationship
None found
Chemical Agents
Sufficient evidence of causal relationship
Environmental tobacco smoke (among pre-school aged children)
Source: What You and Your Family Can Do About Asthma by the Global Initiative For Asthma Created and funded by NIH/NHLBI, 1995
Evidence shows an association between environmental tobacco smoke exposure and asthma development among pre-school aged children.
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.
Eliminating mold and the moist conditions that permit mold growth may help prevent asthma exacerbations.
Source: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf
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
Source: http://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.pdf
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
Source: What You and Your Family Can Do About Asthma by the Global Initiative for Asthma Created and funded by NIH/NHLBI
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.
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
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
1. Management & Support Systems 6. School, Family, & Community Efforts 2. Health & Mental Health Services
Health Services
Physical Education
3. Asthma Education
Health Education
Epidemiology and Statistics Unit. Trends in Asthma Morbidity and Mortality. NYC: ALA, July 2006.
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?
Assess and prioritize needs Target program improvements Advocate for the program
Resources
National Asthma Education and Prevention Program
http://www.nhlbi.nih.gov/about/naepp/
Resources
American College of Allergy, Asthma, and Immunology
http://www.acaai.org