ALA’s Asthma ProgramsReducing the Burden of Illness and Death

Katherine PruittDirector, Best Practices

CDC Teleconference May 2003

About the Lung Association

• Founded in 1904 to combat tuberculosis

• Current mission is to prevent lung disease and promote lung health

• Grass-roots association of 75 state and local constituents, with numerous additional small branch offices

Visionary Lung Health Goals

• Tobacco-related lung disease will be eliminated in future generations

• Asthma will no longer be a burden to patients and their families, nor will it cause illness and death

• The air we breathe will not cause or worsen lung disease

• ALA will monitor lung health status and be the champion for those affected by lung disease

Asthma Results Indicators

• By 2007, states will have asthma public health infrastructures and 50% of states will meet minimum CDC guidelines for funding

• By 2007, 75% of children will attend schools that have adopted a comprehensive asthma management program

• By 2010, there will be a 50% reduction in hospitalization and emergency room visits

• By 2007, there will be a 50% increase in people with asthma getting influenza vaccine

How Will We Get There?

• Advocacy

• Education

• Research

Focus on Advocacy• Public Health Infrastructure

• Schools

• Access to Health Care

• Air Quality

Public Health Infrastructure

• State Health Program

• Healthy People 2010

• Comprehensive Program Infrastructure

Asthma in Schools

• Asthma Medication in Schools

• School Nurses

• Comprehensive School Legislation

Access to Health Care

• Prescription Asthma Medications

• Emergency Services

• Specialty Care

Air Quality

• Indoor Air Quality in Schools

• Environmental Tobacco Smoke

• High Air Pollution Days

Focus on Education

• Early Childhood Asthma Programs

• Open Airways For Schools

• IAQ Tools for Schools

• Asthma-Friendly Schools Initiative

• Master Home Environmentalist

• Asthma Certification Program

Early Childhood Asthma Programs

• Co-sponsor, with Sesame Workshop, of Sesame Street A is for Asthma, a bilingual asthma management video for preschoolers

• Counting on You, developed by ALA of Wisconsin, includes a concise manual and training materials for daycare and preschool providers

Open Airways For Schools

• School-based asthma education program, developed and tested at Columbia University

• Teaches children, aged 8-11, how to detect asthma warning signs and environmental factors that can trigger an asthma attack

Open Airways For Schools

• Six 40-minute group sessions for children with asthma held during the school day

• Written materials for parents

• Homework assignments with parents

OAS Learning Objectives

• Recognize asthma symptoms

• Initiate management steps

• Communicate with parents and teachers

• Recognize when medical care is needed

• Increased self-management skills, self-efficacy and influence on parent’s management decisions.

• Improved quality of life and social support from peers

• Improved academic performance

• Reduced frequency of days with symptoms of asthma

OAS Outcomes

OAS School Study Outcomes

OAS Implementation• Trained volunteers, including school nurses,

parents, health care students, and community groups teach the program

• Funding for implementation from CDC and EPA

• Since 1995, program has been implemented in over 30,000 schools reaching more than 400,000 children

Indoor Air Quality Tools for Schools

• Partnership with EPA’s Indoor Environments Division since 1997

• Open Airways For Schools teaches children to take control of their asthma

• However, children cannot control asthma triggers resulting from indoor air pollution

The US Government Accounting Office estimates that 28,100 schools housing some 15.5 million students, have less than adequate heating, ventilation and air conditioning systems. 15,000 schools, housing about 8.4 million students, characterized their air quality as unsatisfactory.

Condition of America’s Schools

IAQ TfS ComponentsBasicsBasicsAn overview of IAQAn overview of IAQ

• How this Kit is organized• Who is the IAQ Coordinator• Who are the team members• Why IAQ is important• Understanding problems and solutions

IAQ Management PlanIAQ Management PlanA flexible format forA flexible format for actionaction• How the IAQ Management Plan works• 10 steps to activate the Plan• 19 steps for implementing the Plan• IAQ Management Plan checklist & log• Communication do’s and don’tsResolving IAQ ProblemsResolving IAQ Problems

• Identifying & reacting to emergencies• The Problem Solving Wheel• Problem Solving checklist• Crisis communication

How to identify and fix IAQ problemsHow to identify and fix IAQ problemsAppendicesAppendicesAdditional supporting information• Hiring outside help if needed• Developing IAQ policies• Information on specific pollutants• Resources for additional information

IAQ Checklists

Teachers

Administrative Staff

Health Officer

Ventilation

Building Maintenance

Food Service

Waste Management

Renovation and Repairs

IAQ TfS Implementation• About 60 local Lung Associations actively

promoting IAQ Tools for Schools• Since 2000, involved in successful

implementation in over 600 schools• Cleveland, Dallas and Denver Public

Schools are implementing OAS and TfS• LA Unified and Boston have adopted a

district wide resolutions calling for the adoption of both programs

Asthma-Friendly Schools Initiative

• Use a coordinated community approach to the school asthma management program

• Provide appropriate school health services

• Provide asthma education and awareness

• Provide a healthy school environment

• Provide students with asthma with appropriate daily physical activity

AFSI Community-based Approach

• Involve parents and students

• Involve community healthcare providers

• Involve community asthma programs

• Involve school and community social support systems

• Facilitate linkages with students’ medical home

AFSI School Health Services

• Provide a fill time registered school nurse• Identify and track all students with asthma• Use Asthma Action Plans• Assure access to medications• Use standard emergency protocols• Assure access to a consulting physician• Provide intensive case management as

needed

AFSI Asthma Education

• Educate all school personnel, including bus drivers

• Educate students with asthma

• Educate parents

• Provide asthma awareness education to all students

AFSI Healthy School Environment

• Assure smoke-free buildings and grounds

• Provide smoking cessation services for students and staff

• Proactively maintain indoor air quality

• Use Integrated Pest Management

• Manage exposure to high levels of outdoor air pollution

Appropriate Daily Physical Activity

• Encourage full participation when students are well

• Assure ready access to pre-medication as prescribed

• Provide modified activity as needed• Provide individualized health plan

describing implementation steps for students Asthma Action Plan

Asthma-Friendly Schools Toolkit

• Targets local Lung Associations and asthma coalitions

• Customizable

• Helps develop comprehensive asthma management plan for schools

• Includes strategies for implementation of plans

Asthma-Friendly Schools Toolkit• Asthma-Friendly Schools Website

– All forms available for download

• Asthma Incident Report (AIR) database– Free to school nurses for case

management/tracking of student’s asthma

• CD-ROM– Contains copy of database, Toolkit, and Forms

• Binder

Asthma-Friendly Schools Toolkit

• Asthma-Friendly Schools Website– All forms available for download

• Asthma Incident Report (AIR) database– Free to school nurses for case

management/tracking of student’s asthma

• CD-ROM– Contains copy of database, Toolkit, and Forms

• Notebook

Coming Soon

• Toolkit to be completed summer of 2003• Available to all local lung associations and other

agencies upon request• Validation of the Toolkit

– Four mini-grants to local Lung Associations

– Implement an Asthma-Friendly Schools Program

– Evaluate the program, toolkit, and implementation process

Master Home Environmentalist• Home assessment program developed by the

ALA of Washington

• Intensively trained volunteers conduct home walk-through with checklist

• Focus primarily on mitigation of asthma triggers

• Evaluation results include long-term behavior change and anecdotal health improvements

Asthma Educator Certification Program

• ALA a lead organization in developing the new nationwide asthma educator certification program

• National Asthma Educator Certification Board started offering certification exam this year

• Local Lung Associations conducting exam prep training courses

Focus on Research

• Asthma Clinical Research Centers

• “Career Ladder” grant support program for young

lung health researchers

• Locally-supported clinical, behavioral and

intervention research

Asthma Clinical Research Centers

• Network conducts large clinical trials that have direct impact on patient care and asthma treatment

• Largest clinical network outside of the pharmaceutical industry

First Published ALA-ACRC Study

Objective:

“Does the flu vaccine make asthma better, worse or have no effect?”

Asthma and Flu Shot Findings

“The inactivated influenza vaccine is safe to administer to adults and children with asthma, including those with severe asthma. Given the morbidity of influenza, all those with asthma should receive the vaccine annually.”

N Engl J Med 2001;345:1529-36

Ongoing ACRC Investigations• Genetic Basis of Asthma

– Are genes a cause of asthma; do they modify asthma or do they affect a patient’s response to asthma medication?

• Monitoring Lung Function After Flu Vaccine– Are changes in lung function following the flu vaccine better calculated

through a device called an airwatch spirometer, which measures FEV1?

• Diet and Influenza Vaccine– What is the link between diet and asthma severity?

• Corticosteroids and the Flu Vaccine– What are the long-term effect of corticosteriods on the immune system’s

response to the flu vaccine?

• Risk Stratification– What are specific patient characteristics associated with increased risk of

asthma exacerbations?

ALA Working With Partners

• State and local health, environmental, social service and education agencies

• Health care providers

• Schools

• Academic institutions

• Environmental organizations

• Community groups

Lung disease is the third leading cause of death in America. Over the last decade, the death rate from lung disease has been growing faster than the rate from almost any other

leading killer.

Since 1904, the American Lung Association has been fighting lung disease through education, community service, advocacy,

and research. We are working to help those who suffer from lung disease today, and to stop the spread of lung disease

tomorrow.

To succeed, we need your support. Contact your local Lung Association to find out how you can join the fight.