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Asthma Speaker Kit

Asthma Speaker Kit

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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

Source: Mausner and Kramer. Mausner and Bahn Epidemiology. .What is Epidemiology? The study of the distribution and determinants of diseases and injuries in human populations. 1985.An Introductory Text.

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 .

CDC National Center for Health Statistics .Asthma Prevalence by Sex United States. 1980-2007 14 12 Prevalence (%) 10 8 6 4 2 0 Year 19 80 19 82 19 88 19 90 20 00 19 84 19 86 19 92 19 94 19 96 19 98 20 02 20 04 20 06 •  Female Male Lifetime 12-Month Current Source: National Health Interview Survey.

1980-1996 12 Prevalence (%) 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 .12-Month Asthma Prevalence by Race United States.

National Center for Health Statistics .Asthma Prevalence by Race/Ethnicity United States. 1997-2007 18 16 14 12 10 8 6 4 2 0 7 19 9 Prevalence (%) Lifetime ▲ Black NH  White NH  Hispanic Current 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 19 9 8 Year Source: National Health Interview Survey.

.

[July 15.Current Asthma Prevalence for Youth by Race/Ethnicity. Health Data Interactive. 2005-2007 16 14 12 10 8 6 4 2 0 14. 2009].2 NonHispanicWhite Asian Centers for Disease Control and Prevention.1% Overall 10 7. Ages 5-17. National Center for Health Statistics.2 9.gov/nchs/hdi. www.cdc.1 10.htm. American Indian / Alaska Native Non-Hispanic Black Hispanic .1 10.

and deaths due to asthma than the general population. 2005. and children living in inner cities experience more ED visits.Asthma Disparities Among U.2. 1 . Reston. Pediatrics 2002. 3 Lieu TA et al.gov/nchs/health_data_for_all_ages.cdc. minorities.S..htm. Racial/Ethnic Variation in Asthma Status and Management Practices Among Children in Managed Medicaid. 109:857–865. Ethnic Disparities in the Burden and Treatment of Asthma. Children  Low-income populations. Health data for all ages http://www. hospitalizations. American Indian/Alaskan Native and some Hispanic (i. 3 Asthma and Allergy Foundation of America and National Pharmaceutical Council. 2 National Center for Health Statistics.1  The burden of asthma falls disproportionately on nonHispanic black.e. Puerto Rican) populations.

56(No. SS-8):1-54 .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.

S. * First-listed diagnosis. CDC National Center for Health Statistics. population . # Age-adjusted to 2000 U.Asthma* Hospital Discharge Rates# by Sex United States: 1980-2006 24 22 Rate per 10.000 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.

000 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. population . 1996-2006 35 30 Rate per 10.Adult and Child Asthma Hospital Discharge Rates United States. # Age-adjusted to 2000 U.S.

# Age-adjusted to 2000 U. 1980-2006 45 40 Rate per 10. CDC National Center for Health Statistics.S.Asthma Hospital Discharge Rates by Race United States. * First-listed diagnosis.000 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. population .

population ICD-10 Female Male Year .S. National Center for Health Statistics * Age-adjusted to 2000 U. United States: 1979-2005 ICD-9 30 Rate per million 25 20 15 10 5 0 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 Source: Underlying Cause of Death.Asthma Mortality Rates by Sex.

Asthma Mortality Rates by Age United States: 1979-2005 ICD-9 100 Rate per million 80 60 40 20 0 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 Source: Underlying Cause of Death. population ICD-10 65 + 35-64 Year .S. CDC National Center for Health Statistics * Age-adjusted to 2000 U.

Asthma Mortality Rates by Race United States: 1979-2005 ICD-9 60 Rate per million 50 40 30 20 10 0 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 Source: Underlying Cause of Death. population ICD-10 Black Other White Year .S. CDC National Center for Health Statistics * Age-adjusted to 2000 U.

Risk Factors for Developing Asthma  Genetic characteristics  Occupational exposures  Environmental exposures .

and eczema . hay fever. asthma.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.

iom.Risk Factors for Developing Asthma: Environmental Exposure Clearing the Air: Asthma and Indoor Air Exposures http://www.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

Chemical Agents
 Sufficient evidence of causal relationship
 None found

 Sufficient evidence of association
 None found

 Sufficient evidence of association
 Environmental Tobacco Smoke (among pre-school aged children)

 Limited or suggestive evidence of association
 Cockroach (among pre-school aged children)  Respiratory syncytial virus (RSV)

 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  Dog of association
 Fungus/Molds  Rhinovirus  Environmental Tobacco Smoke (among school-aged, older children, and adults)  Formaldehyde  Fragrances

 Limited or suggestive evidence of association
 Domestic birds  Chlamydia and Mycoplasma pneumonia  RSV

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 EPR3)

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.

. At a minimum. do not allow pets in the bedroom.Reducing Exposure to Pets People who are allergic to pets should not have them in the house.

Reducing Exposure to Mold Eliminating mold and the moist conditions that permit mold growth may help prevent asthma exacerbations. .

grass.Other Asthma Triggers Air pollution Trees. and weed pollen .

gov/guidelines/asthma/asthgdln. Lung and Blood Institute.Clinical Management of Asthma Expert Panel Report 3 National Asthma Education and Prevention Program National Heart. 2007 Source: http://www.pdf .nih.nhlbi.

gov/guidelines/asthma/asthgdln.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.nih.pdf .nhlbi.

nih.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.gov/guidelines/asthma/gip_rpt.

gov/guidelines/asthma/gip_rpt.nih.GIP’s Six Key Messages  Inhaled Corticosteroids  Asthma Action Plan  Asthma Severity  Allergen and Irritant Exposure Control  Asthma Control  Follow-up Visits Source: http://www.nhlbi.pdf .

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. or other allergic skin conditions . eczema.

Diagnosing Asthma: Spirometry Test lung function when diagnosing asthma .

 Two major categories of medications are: Long-term control Quick relief .Medications to Treat Asthma  Medications come in several forms.

relax airway muscles. and improve symptoms and lung function Inhaled corticosteroids Long-acting beta2-agonists Leukotriene modifiers .Medications to Treat Asthma: Long-Term Control  Taken daily over a long period of time  Used to reduce inflammation.

Medications to Treat Asthma: Quick-Relief  Used in acute episodes  Generally shortacting beta2agonists .

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: How to Use a Spray Inhaler The health-care provider should evaluate inhaler technique at each visit.

.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 .

Blood. NIH Publication no.Managing Asthma: Sample Asthma Action Plan Describes medicines to use and actions to take National Heart. and Lung Institute Expert Panel Report 3 (EPR 3): Guidelines for the Diagnosis and Management of Asthma. 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 .

school.  Environmental interventions may consist of:  Assessments to identify asthma triggers  Education on how to remove asthma triggers  Remediation to remove asthma triggers . and work environments.A Public Health Response to Asthma: Environmental Interventions  Help people create and maintain healthy home.

and parents  Healthy school environment  Physical education and activity  School.gov/HealthyYouth/asthma/strategies . and community efforts Source: www.cdc. family.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 absenteeism . education. including mental and physical health. environment.Key Aspects  Require team effort  Coordinate health. family. health room visits. 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 & Mental Health Services Health Services Physical Education Counseling.Family/Community Involvement 1. Family. Asthma Education Health Education Healthy School Environment Health Promotion For Staff . School. and Social Services 5. Physical Education & Activity Nutrition Services 4. & Community Efforts 2. Healthy School Environment 3. Management & Support Systems 6. Psychological.

after school program staff.A Public Health Response to Asthma: School  A leading chronic disease cause of school absence  Common disease addressed by school nurses  Affects teachers. administrators. coaches. students. maintenance personnel . bus drivers. nurses.

Trends in Asthma Morbidity and Mortality. NYC: ALA. . 3 children in a classroom of 30 are likely to have asthma.* * Epidemiology and Statistics Unit.On average. July 2006.

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 .

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.  Make medications available  During school hours  Before physical activity and sports  During before.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. .

 Are we doing the right thing?  Are we doing things right? . activities.A Public Health Response to Asthma: Evaluation The systematic investigation of the structure. or outcomes of asthma control programs.

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 .

 Asthma can be managed with medication. we can ensure that people with asthma enjoy a high quality of life.A Public Health Response to Asthma: Summary  Asthma is a complex disease that is not yet preventable or curable. and behavior modifications. .  By working together. environmental changes.

 http://www.gov/about/naepp/  Asthma and Allergy Foundation of America  http://www.org  American Lung Association  http://www.org  Allergy and Asthma Network/Mothers of Asthmatics.nhlbi. Inc.lungusa.org  American Academy of Allergy.aaaai.org .Resources  National Asthma Education and Prevention Program  http://www.aanma. Asthma.nih. and Immunology  http://www.aafa.

org  American College of Chest Physicians  http://www.cdc.org  American Thoracic Society  http://www.org  The Centers for Disease Control and Prevention  http://www.chestnet. and Immunology  http://www. Asthma.acaai.Resources  American College of Allergy.thoracic.gov/asthma .

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