AsthmaJessica Phelan

2/27/2012

Defining Asthma

• A chronic lung disease that inflames and narrows the airways

• Mucous can cause the airway to become even smaller

• Chain reaction can result in asthma symptoms such as wheezing, chest tightness, shortness of breath, and coughing

• Most common chronic disorder in children

Asthma

Signs and Symptoms of Asthma

• Coughing• Wheezing• Chest tightness• Shortness of breath• Not everyone has these symptoms

Who is at risk for asthma?

• Affects people of all ages but most often starts during childhood

• Among children more boys have asthma than girls

• Among adults more women have the disease than men

• Some develop occupational asthma

Prevalence of Asthma in the U.S.

• 18.7 million adults in US• 7.0 million children have asthma• 53% of people with asthma had an asthma

attack in 2008• More children (57%) than adults (51%) had an

attack in 2008

US State InfoAdults with asthma in US, 2009

Mortality

• 3,388 deaths• 185 children and 3262 adults in 2007

Racial and Ethnic Disparities

• 11% of non-Hispanic blacks of all ages • 17% of non-Hispanic black children• From 2001 to 2009 asthma rates rose the

most among black children with an almost 50% increase

Identifying Asthma

• Lung Function Test• Medical History• Physical Exam

What Causes Asthma

• The exact cause of asthma is unknown• Possibly a combination of factors such:– Atopy– Parents who have asthma– Respiratory infections during childhood– genetics

The “Hygiene Hypothesis”

• A theory that researchers have for what causes asthma

• Western lifestyle's emphasis on hygiene has resulted in changes in our living conditions and an overall decline in infections in early childhood

Asthma Triggers

• Allergens• Irritants• Medicines• Sulfites• Infections• Physical Activity• Some conditions can make asthma harder to

manage

Economic Impact• 17.0 million visits to physician offices, hospital outpatient, and

emergency departments with asthma as primary diagnosis• Average length of stay for hospital inpatient care is 4.3 days• From 2002-2007 it cost the US about $3300/person with

asthma in medical expenses• 2 in 5 uninsured people with asthma could not afford their

prescription medicines• 1 in 9 insured people with asthma could not afford their

prescription medicines• In 2008 persons with asthma missed 10.5million school days

and 14.2 million work days due to their asthma

Treatment/Prevention

• There is no cure for asthma but the symptoms can be treated

• Although someone with asthma may feel fine the majority of the time they can still have a flare up at anytime

Medications

• Long-term control medicines reduce airway inflammation and prevent asthma symptoms. Most people with asthma take long term control medicine daily to prevent symptoms. Inhaled corticosteroids.

• Quick-relief (rescue) medications relieve asthma symptoms when they flare up. Inhaled short-acting beta2-agonists.

• It is important to treat symptoms as soon as they are noticed to help prevent symptoms from worsening or causing a sever asthma attack

Inhalers

Education

• People with asthma can prevent asthma attacks if they are taught to use inhaled corticosteroids correctly and to avoid asthma triggers.

• In 2008 less than half of people with asthma reported being taught how to avoid triggers

• Creating an asthma action plan with a doctor can help individuals better manage their asthma

Asthma Action Plan StagesGreen Zone: Doing WellNo cough, wheeze, chest tightness, or shortness of breath; can do all usual activities. Take prescribed long-term control medicine such as inhaled corticosteroids.Yellow Zone: Getting WorseCough, wheeze, chest tightness, or shortness of breath; waking at night; can do some, but not all, usual activities. Add quick-relief medicine.Red Zone: Medical Alert!Very short of breath; quick-relief medicines don't help; cannot do usual activities; symptoms no better after 24 hours in Yellow Zone. Get medical help NOW.

Asthma Action Plan Example

What can be done on the level of:

• Federal, State, and Local Health Officials• Health Care Providers• People with Asthma and Parents of Children

with Asthma• Schools and School Nurses• Employers and Insurers

Federal, State, and Local Health Officials

• Track asthma rates• Promote vaccinations• Promote improvements in indoor air quality

Health Care Providers

• Determine severity of asthma• Create and asthma action plan for patients• Prescribe inhaled corticosteroids for patients

with persistent asthma

Asthma self-management education by age, US, 2008

Source: National Health Interview Survey, 2008, asthma supplement

People with Asthma and Parents of Children with Asthma

• Receive ongoing appropriate medical care• Become empowered and develop self efficacy• Avoid asthma triggers• Use prescribed medications correctly

Schools and School Nurses

• Use student asthma action plans to guide use of medications

• Make students’ quick-relief inhalers readily available to them

• Take steps to fix indoor air quality problems

Employers and Insurers

• Promote healthy workplaces by reducing or eliminating known asthma triggers

• Eliminating co-payments for inhaled corticosteroids

• Provide reimbursement for educational sessions

Asthma Prevention Programs

• US Environmental Protection Agency offers a School Flag Program to raise awareness about air quality conditions by raising flags in front of schools during the week

Asthma Prevention Programs

• CDC’s National Asthma Control Program was created to reduce the number of deaths, hospitalizations, emergency department visits, school days or workdays missed, and limitations on activity due to asthma

Translational Research

• Inner-city Asthma Consortium– Funded by National Institute of Allergy and

Infectious Diseases– Asthma intervention tailored to children living in

inner-city areas– Evaluate safety and efficacy of immune-based

therapies designed to reduced asthma severity and prevent disease onset in inner-city children

Translational Research

• The CDC and the Task for on Community Preventive Services

• Guidelines for the Diagnosis and Management of Asthma

• Other areas of investigation are asthma and the elderly, complementary and alternative medicines use among people with asthma, influenza immunization rates among people with asthma, and asthma and sever psycholgoical distress

Surveillance Systems

• National Center for Health Statistics• Behavioral Risk Factor Surveillance System• Asthma Call-back Survey• CDC’s National Asthma Survey• National Health Interview Survey

Resources

• http://www.cdc.gov/VitalSigns/Asthma/index.html

• http://www.cdc.gov/nchs/fastats/asthma.htm• http://www.cdc.gov/asthma/NACP.htm• http://www.nhlbi.nih.gov/health/public/lung/

asthma/asthma_atglance.pdf• http://www.niehs.nih.gov/health/topics/cond

itions/asthma/• http://www.nhlbi.nih.gov/health/health-topic

s/topics/asthma/• http://www.cdc.gov/asthma/aag/2010/highli

ghts.html