Reducing the Burden of Disease

Asthma

California: Controlling Asthma Through Comprehensive State-Based Plans

Public Health Problem
Nearly 3 million Californians (8.8%) suffer from active asthma. Lifetime asthma prevalence increased 66% between 1984 and 2001. In 2000, more than 37,000 Californians were hospitalized and 555 died because of asthma. California's age-adjusted mortality rate for asthma (16.8) is above the national average (15.4).

Evidence That Prevention Works
Asthma is controlled through a two-pronged approach: (1) preventing and managing symptoms with medicine and (2) preventing and managing environmental factors that trigger asthma. Effective asthma control can improve quality of life, reduce medical costs, and reduce the number of asthma-related emergency department visits, hospitalizations, school and work days missed, days of restricted activity, and deaths each year.

Program Example
The California Department of Health Services and a diverse advisory committee consisting of California asthma professionals, coalitions, local public health agencies, educational agencies/schools, and health care plans have developed and are implementing the state's integrated asthma control plan. The plan's major components include surveillance and evaluation, public education, asthma treatment and management, secondary prevention of asthma, and policy. California will support and expand its asthma partnerships, currently consisting of more than 350 partners, and provide technical assistance to local coalitions and public health departments in monitoring and reducing the asthma burden.

Implications
This plan will help improve the coordination and effectiveness of asthma control activities in the state, resulting in improved health for those with asthma and a decrease in asthma-related medical costs.

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Illinois: Controlling Asthma Through Education

Public Health Problem
In 1999, more than 710,000 adults in Illinois reported that they had asthma, and 26.3 of every 10,000 children under 15 years of age discharged from the hospital had a diagnosis of asthma. That same year, 256 Illinois residents died of asthma.

Evidence That Prevention Works
Asthma is controlled through a two-pronged approach: (1) preventing and managing symptoms with medicine and (2) preventing and managing environmental factors that trigger asthma. Effective asthma control can improve quality of life, reduce medical costs, and reduce the number of asthma-related emergency department visits, hospitalizations, school and work days missed, days of restricted activity, and deaths each year.

Program Example
The American Lung Association of Metropolitan Chicago (ALAMC) is implementing the American Lung Association's "Open Airways for Schools (OAS)" intervention in seven Latino communities in Chicago. ALAMC is working collaboratively with community-based organizations to identify and train community members to recruit schools and implement OAS. These partners are working toward implementing OAS in more than 40 schools.

Implications
The "Open Airways for Schools (OAS)" intervention has been shown, along with other positive outcomes, to increase children's self-management skills and self-efficacy as well as children's influence on parental asthma management decision making. Results also showed a decrease in the annual frequency and average duration of self-reported asthma attacks. During one evaluation of the intervention, the number of symptom days decreased by 43% in one year in the intervention group.

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Michigan: Implementing a School-Based Asthma Education Program

Public Health Problem
Eighteen percent of all students attending Detroit public schools have diagnosed asthma. According to the Kids Count in Michigan 2000 Data Book, asthma is the leading cause of serious illness among children and the primary cause of hospitalization for children in Michigan. Low-income African American, Hispanic, and male children are at greatest risk. Nationally, asthma causes more school absences than any other chronic childhood disease.

Evidence That Prevention Works
When children with asthma, their parents, and the school staff receive education on asthma management, the children experience fewer asthma episodes. Also, staff, students, and parents are more aware of asthma triggers and are more likely to take steps to reduce the triggers in the home and school environment, and parents are more likely to adhere to the medical regimen outlined by the physician.

Program Example
Detroit public schools implemented a 3-year Asthma Education Program in 33 elementary schools targeting 2nd–5th graders diagnosed as having asthma. The objectives of the program were to educate students, parents, and school staff about asthma management and to control exposure to factors that trigger asthma attacks. A unique component of Detroit's program was the use of student educators to teach the lessons under the supervision of the district school nurses. These student educators were 11th and 12th graders enrolled in an allied health curriculum. Between January and May 2002, a total of 290 students received asthma management education.

Implications
As a result of this program, students, staff, and parents in Michigan are able to recognize asthma triggers and to take the necessary steps to reduce or eliminate these triggers at school and at home. In addition, students with asthma better understand that they must take responsibility for managing their asthma by adhering to the written asthma plans developed by their primary care providers.

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New York: Controlling Asthma Through Education

Public Health Problem
Asthma affects more than 1 million adults and 250,000 children in New York. The state's age-adjusted mortality rate for asthma (18.0) is above the national average (15.4). In 2000, New Yorkers were hospitalized a total of 39,600 times because of asthma. Nationally, people miss 14 million days of school and experience 100 million days of restricted activity because of asthma each year.

Evidence That Prevention Works
Asthma is controlled through a two-pronged approach: (1) preventing and managing symptoms with medicine and (2) preventing and managing environmental factors that trigger asthma. Effective asthma control can improve quality of life, reduce medical costs, and reduce the number of asthma-related emergency department visits, hospitalizations, school and work days missed, days of restricted activity, and deaths each year.

Program Example
In collaboration with several community health centers, the Bronx-Lebanon Hospital Center is implementing the Asthma and Allergy Foundation of America's "Asthma Care Training (ACT) for Kids" intervention for children aged 8 to 12 years who have persistent asthma. Approximately 160 children and their parents are expected to complete the ACT program in 2003.

Implications
The ACT intervention has been shown, along with other positive outcomes, to (1) increase knowledge of asthma triggers, (2) increase self-reported asthma control compliance behaviors, (3) reduce the number of emergency room visits and days of hospitalization for children with asthma, and (4) reduce medical costs.

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Texas: Controlling Asthma Through Individualized Plans

Public Health Problem
It is estimated that more than 1 million Texans have asthma. There were 249 deaths in Texas due to asthma in 1999. Nationally, there are between 400,000 and 500,000 hospitalizations, 14 million school days missed, and 100 million days of restricted activity due to asthma each year.

Evidence That Prevention Works
Asthma is controlled through a two-pronged approach: (1) preventing and managing symptoms with medicine and (2) preventing and managing environmental factors that trigger asthma. Effective asthma control can improve quality of life, reduce medical costs, and reduce the number of asthma-related emergency department visits, hospitalizations, school and work days missed, days of restricted activity, and deaths each year.

Program Example
The University of Texas Health Science Center-San Antonio and CHRISTUS Santa Rosa Children's Hospital are implementing CDC's inner-city asthma intervention. The intervention targets high-risk, urban families who often require intensive interventions to improve asthma outcomes and is designed to enhance medical care provided by primary care physicians and specialists. Through group and tailored individual sessions, an asthma counselor (a master's-level social worker) helps families learn to effectively manage their children's asthma.

Implications
The program puts into practice the findings of the National Institutes of Health's National Cooperative Inner-City Asthma Study, which has been shown to decrease the number of days children suffer from asthma symptoms. By learning to control asthma in individual patients, families will be better able to prevent visits to the emergency department, hospitalizations, and deaths due to asthma.

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Virginia: Controlling Asthma in American Cities

Public Health Problem
In Virginia, 13.7% of African Americans and 10.4% of whites have asthma. In 1999, more than 11,000 people were hospitalized and 108 died because of asthma. Children were hospitalized at rates nearly twice those of adults. In addition, national figures show that 14 million days of school are missed and 100 million days of restricted activity are due to asthma each year.

Evidence That Prevention Works
Asthma is controlled through a two-pronged approach: (1) preventing and managing symptoms with medicine, and (2) preventing and managing environmental factors that trigger asthma. Effective asthma control can improve quality of life, reduce medical costs, and reduce the number of asthma-related emergency department visits, hospitalizations, school and work days missed, days of restricted activity, and deaths each year.

Program Example
A collaborative called "Controlling Asthma in the Richmond Metro Area" (CARMA) is working to improve asthma management among urban children up to 18 years of age. To help achieve this goal, the collaborative is developing relationships among school systems, Head Start, local physician groups, medical organizations, and social organizations. The collaborative is designing and, in some cases, pilot-testing interventions aimed at improving the asthma management skills of preschool and elementary school personnel, families, and physicians and developing ways to provide families of children with asthma with support, education, and medical referrals. Because some studies indicate that obesity might be a risk factor for developing asthma, the project is focusing on interventions that can reduce the risk of childhood obesity as a strategy for preventing asthma and asthma symptoms.

Implications
This project is expected to help improve community and individual capacity to control asthma, thereby improving the health of those with asthma and decreasing asthma-related medical costs.

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