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Asthma
Asthma
Asthma
Asthma
Asthma
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Asthma
Asthma
Asthma Prevalence in the United States
Asthma Prevalence in the United States
Sources
Sources
Sources (continued)
Sources (continued)
Risk Factors for Developing Asthma
Risk Factors for Developing Asthma
Risk Factors for Developing Asthma
Risk Factors for Developing Asthma
Risk Factors for Developing Asthma
Risk Factors for Developing Asthma
Reducing Exposure to House Dust Mites
Reducing Exposure to House Dust Mites
Reducing Exposure to House Dust Mites
Reducing Exposure to House Dust Mites
Reducing Exposure to Environmental Tobacco Smoke
Reducing Exposure to Environmental Tobacco Smoke
Reducing Exposure to Cockroaches
Reducing Exposure to Cockroaches
Reducing Exposure to Mold
Reducing Exposure to Mold
Reducing Exposure to Mold
Reducing Exposure to Mold
Other Asthma Triggers
Other Asthma Triggers
Other Asthma Triggers
Other Asthma Triggers
Other Asthma Triggers
Other Asthma Triggers
Other Asthma Triggers
Other Asthma Triggers
Other Asthma Triggers
Other Asthma Triggers
Clinical Management of Asthma
Clinical Management of Asthma
What is GIP
What is GIP
Diagnosing Asthma: Medical History
Diagnosing Asthma: Medical History
Diagnosing Asthma: Spirometry
Diagnosing Asthma: Spirometry
Medications to Treat Asthma
Medications to Treat Asthma
Medications to Treat Asthma: Quick-Relief
Medications to Treat Asthma: Quick-Relief
Medications to Treat Asthma: How to Use a Spray Inhaler
Medications to Treat Asthma: How to Use a Spray Inhaler
Medications to Treat Asthma: Inhalers and Spacers
Medications to Treat Asthma: Inhalers and Spacers
Medications to Treat Asthma: Nebulizer
Medications to Treat Asthma: Nebulizer
Managing Asthma: Sample Asthma Action Plan
Managing Asthma: Sample Asthma Action Plan
Managing Asthma: Sample Asthma Action Plan
Managing Asthma: Sample Asthma Action Plan
Managing Asthma: Peak Flow Chart
Managing Asthma: Peak Flow Chart
A Public Health Response to Asthma
A Public Health Response to Asthma
A Public Health Response to Asthma: Surveillance
A Public Health Response to Asthma: Surveillance
A Public Health Response to Asthma: Uses of Surveillance Data
A Public Health Response to Asthma: Uses of Surveillance Data
A Public Health Response to Asthma Education
A Public Health Response to Asthma Education
A Public Health Response to Asthma: Coalition
A Public Health Response to Asthma: Coalition
A Public Health Response to Asthma: Advocacy
A Public Health Response to Asthma: Advocacy
A Public Health Response to Asthma: Interventions
A Public Health Response to Asthma: Interventions
A Public Health Response to Asthma: Interventions
A Public Health Response to Asthma: Interventions
A Public Health Response to Asthma: Interventions
A Public Health Response to Asthma: Interventions
A Public Health Response to Asthma: Interventions
A Public Health Response to Asthma: Interventions
A Public Health Response to Asthma: Interventions
A Public Health Response to Asthma: Interventions
A Public Health Response to Asthma: Medical Management Interventions
A Public Health Response to Asthma: Medical Management Interventions
A Public Health Response to Asthma: Medical Management Interventions
A Public Health Response to Asthma: Medical Management Interventions
A Public Health Response to Asthma: Environmental Interventions
A Public Health Response to Asthma: Environmental Interventions
A Public Health Response to Asthma: School Intervention Science-Based
A Public Health Response to Asthma: School Intervention Science-Based
Strategies for Addressing Asthma
Strategies for Addressing Asthma
A Public Health Response to Asthma: School
A Public Health Response to Asthma: School
A Public Health Response to Asthma: What can make asthma worse in the
A Public Health Response to Asthma: What can make asthma worse in the
A Public Health Response to Asthma: What can make asthma worse in the
A Public Health Response to Asthma: What can make asthma worse in the
A Public Health Response to Asthma: What can make asthma worse in the
A Public Health Response to Asthma: What can make asthma worse in the
Asthma-Friendly School DVD and Toolkit
Asthma-Friendly School DVD and Toolkit
Asthma-Friendly School DVD and Toolkit
Asthma-Friendly School DVD and Toolkit
A Public Health Response to Asthma: Evaluation
A Public Health Response to Asthma: Evaluation
Framework for Program Evaluation
Framework for Program Evaluation
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Asthma

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1Asthma. A Presentation on Asthma 32Recommendations and strategies to
Management and Prevention. implement EPR-3 Six key messages. Source:
2What is Asthma? Chronic disease of the http://www.nhlbi.nih.gov/guidelines/asthma
airways that may cause Wheezing gip_rpt.pdf.
Breathlessness Chest tightness Nighttime 33GIP’s Six Key Messages. Inhaled
or early morning coughing Episodes are Corticosteroids Asthma Action Plan Asthma
usually associated with widespread, but Severity. Asthma Control Follow-up Visits
variable, airflow obstruction within the Allergen and Irritant Exposure Control.
lung that is often reversible either Source:
spontaneously or with treatment. http://www.nhlbi.nih.gov/guidelines/asthma
3Pathology of Asthma. Asthma involves gip_rpt.pdf.
inflammation of the airways. Asthma. 34Diagnosing Asthma: Medical History.
Normal. Source: “What You and Your Family Symptoms Coughing Wheezing Shortness of
Can Do About Asthma” by the Global breath Chest tightness Symptom Patterns
Initiative For Asthma Created and funded Severity Family History.
by NIH/NHLBI, 1995. 35Diagnosing Asthma. Troublesome cough,
4Asthma Prevalence in the United particularly at night Awakened by coughing
States. June 2014. National Center for Coughing or wheezing after physical
Environmental Health Division of activity Breathing problems during
Environmental Hazards and Health Effects. particular seasons Coughing, wheezing, or
5Introduction. Asthma: affects 25.7 chest tightness after allergen exposure
million people, including 7.0 million Colds that last more than 10 days Relief
children under 18; is a significant health when medication is used.
and economic burden to patients, their 36Diagnosing Asthma. Wheezing sounds
families, and society: In 2010, 1.8 during normal breathing Hyperexpansion of
million people visited an ED for the thorax Increased nasal secretions or
asthma-related care and 439,000 people nasal polyps Atopic dermatitis, eczema, or
were hospitalized because of asthma. other allergic skin conditions.
6Introduction. Asthma prevalence is an 37Diagnosing Asthma: Spirometry. Test
estimate of the percentage of the U.S. lung function when diagnosing asthma.
population with asthma. Prevalence 38Medications to Treat Asthma.
estimates help us understand the burden of Medications come in several forms. Two
asthma on the nation. Asthma “period major categories of medications are:
prevalence” is the percentage of the U.S. Long-term control Quick relief.
population that had asthma in the previous 39Medications to Treat Asthma: Long-Term
12 months. “Current” asthma prevalence is Control. Taken daily over a long period of
the percentage of the U.S. population who time Used to reduce inflammation, relax
had been diagnosed with asthma and had airway muscles, and improve symptoms and
asthma at the time of the survey. Asthma lung function Inhaled corticosteroids
“period prevalence” was the original Long-acting beta2-agonists Leukotriene
prevalence measure (1980-1996). The survey modifiers.
was redesigned in 1997 and this measure 40Medications to Treat Asthma:
was replaced by lifetime prevalence (not Quick-Relief. Used in acute episodes
presented in slides) and asthma episode or Generally short-acting beta2agonists.
attack in the past 12 months. In 2001, 41Medications to Treat Asthma: How to
another measure was added to assess Use a Spray Inhaler. The health-care
current asthma prevalence. provider should evaluate inhaler technique
7Asthma Period Prevalence and Current at each visit. Source: “What You and Your
Asthma Prevalence: United States, Family Can Do About Asthma” by the Global
1980-2010. Current asthma prevalence, Initiative for Asthma Created and funded
2001-2010. Asthma period prevalence, by NIH/NHLBI.
1980-1996. The percentage of the U.S. 42Medications to Treat Asthma: Inhalers
population with asthma increased from 3.1% and Spacers. Spacers can help patients who
in 1980 to 5.5% in 1996 and 7.3% in 2001 have difficulty with inhaler use and can
to 8.4% in 2010. reduce potential for adverse effects from
8Current Asthma Prevalence: United medication.
States, 2001-2010. Year. Percent. Total 43Medications to Treat Asthma:
number of persons. One in 12 people (about Nebulizer. Machine produces a mist of the
26 million, or 8% of the U.S. population) medication Used for small children or for
had asthma in 2010, compared with 1 in 14 severe asthma episodes No evidence that it
(about 20 million, or 7%) in 2001. is more effective than an inhaler used
9Current Asthma Prevalence by Race and with a spacer.
Ethnicity: United States, 2001-2010. 44Managing Asthma: Asthma Management
Blacks are more likely to have asthma than Goals. Achieve and maintain control of
both Whites and Hispanics. symptoms Maintain normal activity levels,
10Current Asthma Prevalence by Age including exercise Maintain pulmonary
Group, Sex, Race and Ethnicity, Poverty function as close to normal levels as
Status, Geographic Region, and Urbanicity: possible Prevent asthma exacerbations
United States, Average Annual 2008-2010. Avoid adverse effects from asthma
Children, females, Blacks, and Puerto medications Prevent asthma mortality.
Ricans are more likely to have asthma. 45Managing Asthma: Asthma Action Plan.
People with lower annual household income Develop with a physician Tailor to meet
were more likely to have asthma. Residents individual needs Educate patients and
of the Northeast and Midwest were more families about all aspects of plan
likely to have asthma. Living in or not in Recognizing symptoms Medication benefits
a city did not affect the chances of and side effects Proper use of inhalers
having asthma. and Peak Expiratory Flow (PEF) meters.
11Child and Adult Current Asthma 46Managing Asthma: Sample Asthma Action
Prevalence by Age and Sex: United States, Plan. Describes medicines to use and
2006-2010. Among children aged 0-14, boys actions to take. National Heart, Blood,
were more likely than girls to have and Lung Institute Expert Panel Report 3
asthma. Boys and girls aged 15-17 years (EPR 3): Guidelines for the Diagnosis and
had asthma at the same rate.. Among adults Management of Asthma. NIH Publication no.
women were more likely than men to have 08-4051, 2007.
asthma. 47Managing Asthma: Peak Expiratory Flow
12Asthma Attack Prevalence among (PEF) Meters. Allows patient to assess
Children and Adults with Current Asthma: status of his/her asthma Persons who use
United States, 2001-2010. Children aged peak flow meters should do so frequently
0-17 years. Adults aged 18 and over. From Many physicians require for all severe
2001 to 2010 both children and adults had patients.
fewer asthma attacks. For children, asthma 48Managing Asthma: Peak Flow Chart.
attacks declined from at least one asthma People with moderate or severe asthma
attack in the previous 12 months for 61.7% should take readings: Every morning Every
of children with asthma in 2001 to 58.3% evening After an exacerbation Before
in 2010. For adults, asthma attacks inhaling certain medications. Source:
declined from at least one asthma attack “What You and Your Family Can Do About
in the previous 12 months for 53.8% of Asthma” by the Global Initiative For
adults with asthma in 2001, to 49.1% in Asthma Created and funded by NIH/NHLBI.
2010. 49Managing Asthma: Indications of a
13Asthma Attack Prevalence among Persons Severe Attack. Breathless at rest Hunched
with Current Asthma by Age Group, Sex, forward Speaks in words rather than
Race and Ethnicity, Poverty Status, and complete sentences Agitated Peak flow rate
Geographic Region: Unites States, Average less than 60% of normal.
Annual 2008-2010. From 2008 to 2010 asthma 50Managing Asthma: Things People with
attacks occurred more often in children Asthma Can Do. Have an individual
and women, among families whose income was management plan containing Your
below 100% of the federal poverty medications (controller and quick-relief)
threshold, and in the South and West. Race Your asthma triggers What to do when you
or ethnicity did not significantly affect are having an asthma attack Educate
asthma attack prevalence. yourself and others about Asthma Action
14Technical Notes. Asthma Period Plans Environmental interventions Seek
Prevalence and Current Asthma Prevalence: help from asthma resources Join an asthma
Estimates of asthma prevalence indicate support group.
the percentage of the population with 51A Public Health Response to Asthma. A
asthma at a given point in time and call to action for organizations and
represent the burden on the U.S. people with an interest in asthma
population. Asthma prevalence data are management to work as partners in reducing
self-reported by respondents to the the burden of asthma within our nation’s
National Health Interview Survey (NHIS). communities.
Asthma period prevalence was the original 52A Public Health Response to Asthma:
measure (1980-1996) of U.S. asthma Surveillance. Over time… How much asthma
prevalence and estimated the percentage of does the population have? How severe is
the population that had asthma in the asthma across the population? How well
previous 12 months. From 1997-2000, a controlled is asthma in the population?
redesign of the NHIS questions resulted in What is the cost of asthma?
a break in the trend data as the new 53A Public Health Response to Asthma:
questions were not fully comparable to the Uses of Surveillance Data. Basis for
previous questions. Beginning in 2001, planning and targeting intervention
current asthma prevalence (measured by the activities Evaluating intervention
question, ‘‘Do you still have asthma?’’ activities.
for those with an asthma diagnosis) was 54A Public Health Response to Asthma
introduced to identify all persons with Education. Education programs can be
asthma. Current asthma prevalence targeted to: People with asthma Parents of
estimates from 2001 onward are point children with asthma Medical care
prevalence (previous 12 months) estimates providers School staff Public.
and therefore are not directly comparable 55A Public Health Response to Asthma:
with asthma period prevalence estimates Coalition. Successful asthma campaigns
from 1980 to 1996 Behavioral Risk Factor need the cooperation of committed
Surveillance System (BRFSS): State asthma partners.
prevalence rates on the map come from the 56A Public Health Response to Asthma:
BRFSS. The BRFSS is a state-based, Advocacy. Asthma needs to be addressed
random-digit-dialed telephone survey of comprehensively by multiple government and
the noninstitutionalized civilian non-government agencies.
population 18 years of age and older. It 57A Public Health Response to Asthma:
monitors the prevalence of the major Interventions. Medical management
behavioral risks among adults associated Education Environment Schools.
with premature illness and death. 58A Public Health Response to Asthma:
Information from the survey is used to Medical Management Interventions. Ensure
improve the health of the American people. people with asthma know about their
More information about BRFSS can be found disease and are empowered to demand
at: http://www.cdc.gov/brfss/. appropriate management.
15Sources. . 59A Public Health Response to Asthma:
16Sources (continued). . Environmental Interventions. Help people
17What is Epidemiology? The study of the create and maintain healthy home, school,
distribution and determinants of diseases and work environments. Environmental
and injuries in human populations. Source: interventions may consist of: Assessments
Mausner and Kramer, Mausner and Bahn to identify asthma triggers Education on
Epidemiology- An Introductory Text, 1985. how to remove asthma triggers Remediation
18Risk Factors for Developing Asthma. to remove asthma triggers.
Genetic characteristics Occupational 60A Public Health Response to Asthma:
exposures Environmental exposures. School Intervention Science-Based
19Risk Factors for Developing Asthma: Guidance. Management and support systems
Genetic Characteristics. Atopy The body’s Health and mental health services Asthma
predisposition to develop an antibody education for students, staff, and parents
called immunoglobulin E (IgE) in response Healthy school environment Physical
to exposure to environmental allergens Can education and activity School, family, and
be measured in the blood Includes allergic community efforts. Source:
rhinitis, asthma, hay fever, and eczema. www.cdc.gov/HealthyYouth/asthma/strategies
20Risk Factors for Developing Asthma: 61Key Aspects. Require team effort
Environmental Exposure. Clearing the Air: Coordinate health, including mental and
Asthma and Indoor Air Exposures physical health, education, environment,
http://www.iom.edu (Publications) family, and community efforts Assess needs
Institute of Medicine, 2000 Committee on of school and prioritize (every action
the Assessment of Asthma and Indoor Air step is not feasible to every school or
Review of current evidence about indoor district) Focus on students with frequent
air exposures and asthma. asthma symptoms, health room visits, and
21Clearing the Air: Categories for absenteeism.
Associations of Various Elements. 62Strategies for Addressing Asthma. 1.
Sufficient evidence of a causal Management & Support Systems. 6.
relationship Sufficient evidence of an School, Family, & Community Efforts.
association Limited or suggested evidence 2. Health & Mental Health Services. 5.
of an association Inadequate or Physical Education & Activity. 3.
insufficient evidence to determine whether Asthma Education. 4. Healthy School
an association exists Limited or Environment.
suggestive evidence of no association. 63A Public Health Response to Asthma:
22Clearing the Air: Indoor Air Exposures School. A leading chronic disease cause of
& Asthma Development. Biological school absence Common disease addressed by
Agents Sufficient evidence of causal school nurses Affects teachers,
relationship House dust mite Sufficient administrators, nurses, coaches, students,
evidence of association None found Limited bus drivers, after school program staff,
or suggestive evidence of association maintenance personnel.
Cockroach (among pre-school aged children) 64On average, 3 children in a classroom
Respiratory syncytial virus (RSV). of 30. are likely to have asthma.*.
Chemical Agents Sufficient evidence of *Epidemiology and Statistics Unit. Trends
causal relationship None found Sufficient in Asthma Morbidity and Mortality. NYC:
evidence of association Environmental ALA, July 2006.
Tobacco Smoke (among pre-school aged 65A Public Health Response to Asthma:
children) Limited or suggestive evidence What can make asthma worse in the school?
of association None found. Mold and mildew Animals in classroom
23Clearing the Air: Indoor Air Exposures Carpeted classrooms Cockroaches Poor air
& Asthma Exacerbation. Biological quality.
Agents Sufficient evidence of causal 66Asthma-Friendly School DVD and
relationship Cat Cockroach House dust mite Toolkit. Objectives Personal stories to
Sufficient evidence of an association Dog relate to viewer Aspects of an
Fungus/Molds Rhinovirus Limited or asthma-friendly school Six strategies for
suggestive evidence of association addressing asthma in a coordinated school
Domestic birds Chlamydia and Mycoplasma health program Potential impact of
pneumonia RSV. Chemical Agents Sufficient asthma-friendly schools.
evidence of causal relationship 67A Public Health Response to Asthma:
Environmental tobacco smoke (among School Actions. Establish policies and
pre-school aged children) Sufficient procedures to support children with
evidence of association NO2, NOX (high asthma. Keep students’ asthma action plans
levels) Limited or suggestive evidence of at the school. Make medications available
association Environmental Tobacco Smoke During school hours Before physical
(among school-aged, older children, and activity and sports During before- and
adults) Formaldehyde Fragrances. after-school programs On field trips or
24Reducing Exposure to House Dust Mites. when away from campus Train school staff
Use bedding encasements Wash bed linens to recognize signs of an asthma attack and
weekly Avoid down fillings Limit stuffed to use appropriate medications.
animals to those that can be washed Reduce 68A Public Health Response to Asthma:
humidity level (between 30% and 50% Evaluation. The systematic investigation
relative humidity per EPR-3). Source: of the structure, activities, or outcomes
“What You and Your Family Can Do About of asthma control programs. Are we doing
Asthma” by the Global Initiative For the right thing? Are we doing things
Asthma Created and funded by NIH/NHLBI, right?
1995. 69Benefits of Program Evaluation.
25Reducing Exposure to Environmental Evaluations help asthma programs Manage
Tobacco Smoke. Evidence suggests an resources and services effectively
association between environmental tobacco Understand reasons for current performance
smoke exposure and exacerbations of asthma Build capacity Plan and implement new
among school-aged, older children, and activities Demonstrate the value of their
adults. Evidence shows an association efforts Ensure accountability.
between environmental tobacco smoke 70Using Evaluation to Improve Programs.
exposure and asthma development among Highlight effective program components
pre-school aged children. Recognize achievements Replicate successes
26Reducing Exposure to Cockroaches. Assess and prioritize needs Target program
Remove as many water and food sources as improvements Advocate for the program.
possible to avoid cockroaches. 71Framework for Program Evaluation.
27Reducing Exposure to Pets. People who 72A Public Health Response to Asthma:
are allergic to pets should not have them Summary. Asthma is a complex disease that
in the house. At a minimum, do not allow is not yet preventable or curable. Asthma
pets in the bedroom. can be managed with medication,
28Reducing Exposure to Mold. Eliminating environmental changes, and behavior
mold and the moist conditions that permit modifications. By working together, we can
mold growth may help prevent asthma ensure that people with asthma enjoy a
exacerbations. high quality of life.
29Other Asthma Triggers. Air pollution 73Resources. National Asthma Education
Trees, grass, and weed pollen. and Prevention Program
30Clinical Management of Asthma. Expert http://www.nhlbi.nih.gov/about/naepp/
Panel Report 3 National Asthma Education Asthma and Allergy Foundation of America
and Prevention Program National Heart, http://www.aafa.org American Lung
Lung and Blood Institute, 2007. Source: Association http://www.lungusa.org
http://www.nhlbi.nih.gov/guidelines/asthma American Academy of Allergy, Asthma, and
asthgdln.pdf. Immunology http://www.aaaai.org Allergy
312007 NAEPP EPR-3. Treatment and Asthma Network/Mothers of Asthmatics,
recommendations based on: Severity Control Inc. http://www.aanma.org.
Responsiveness Provide patient 74Resources. American College of
self-management education at multiple Allergy, Asthma, and Immunology
points of care Reduce exposure to inhaled http://www.acaai.org American College of
indoor allergens to control Chest Physicians http://www.chestnet.org
asthma-multifaceted approach. Source: American Thoracic Society
http://www.nhlbi.nih.gov/guidelines/asthma http://www.thoracic.org The Centers for
asthgdln.pdf. Disease Control and Prevention
32What is GIP? Guidelines Implementation http://www.cdc.gov/asthma.
Panel Report for Expert Panel Report 3
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