A Presentation on Asthma Management and Prevention
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1 A Presentation on Asthma Management and Prevention Asthma: A Presentation on Asthma Management and Prevention
2 What is Asthma? Chronic disease of the airways that may cause WheezingBreathlessnessChest tightnessNighttime or early morning coughingEpisodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment.Asthma is a disease that affects the lungs. It causes repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. If someone has asthma, he or she has it all the time, but asthma attacks will occur only when something bothers the lungs. We know that if someone in the family of a person with asthma has asthma, other family members are more likely to have it too. In most cases, we don’t know what causes asthma, and we don’t know how to cure it; however, it can be controlled.Asthma can be controlled by knowing the warning signs of an attack, staying away from things that trigger an attack, and following the advice from a healthcare provider.2
3 Pathology of Asthma Asthma involves inflammation of the airways Normal This drawing from the National Heart, Lung and Blood Institute compares the normal airway on the left to the airway of a person with asthma. During an asthma episode, the airways become extremely narrow due to muscle constriction, swelling of the inner lining, and mucus production, causing very limited airflow. During severe episodes, the airways may become extremely narrow, compromising airflow and leading to unexpected fatalities.Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For Asthma Created and funded by NIH/NHLBI, 19953
4 Asthma Prevalence in the United States June 2014National Center for Environmental HealthDivision of Environmental Hazards and Health Effects
5 IntroductionAsthma:affects 25.7 million people, including 7.0 million children under 18;is a significant health and economic burden to patients, their families, and society:In 2010, 1.8 million people visited an ED for asthma-related care and 439,000 people were hospitalized because of asthmaAsthma affects 25.7 million people (2010) , including 7.0 million children under age 18 (2010); therefore, it is a significant health and economic burden to patients, their families, and society.In 2010, almost 1.8 million people visited an ED for asthma-related care and 439,000 people were hospitalized because of asthma.
6 IntroductionAsthma prevalence is an estimate of the percentage of the U.S. population with asthma. Prevalence estimates help us understand the burden of asthma on the nation.Asthma “period prevalence” is the percentage of the U.S. population that had asthma in the previous 12 months.“Current” asthma prevalence is the percentage of the U.S. population who had been diagnosed with asthma and had asthma at the time of the survey.Asthma “period prevalence” was the original prevalence measure ( ). The survey was redesigned in 1997 and this measure was replaced by lifetime prevalence (not presented in slides) and asthma episode or attack in the past 12 months. In 2001, another measure was added to assess current asthma prevalence.To describe the burden of asthma in the United States, we present two types of prevalence estimates.Asthma “period prevalence” was the original measure ( ) of U.S. asthma prevalence and estimated the percentage of the population that had asthma in the previous 12 months.Beginning in 2001, current asthma prevalence was measured by the question, ‘‘Do you still have asthma?’’ for those with an asthma diagnosis and was introduced to identify all persons with asthma.
7 Asthma Period Prevalence and Current Asthma Prevalence: United States, 1980-2010 Asthma prevalence increased from 3.1% in 1980 to 5.5% in 1996 and 7.3% in 2001 to 8.4% in 2010.The percentage of the U.S. population with asthma increased from 3.1% in 1980 to 5.5% in 1996 and 7.3% in 2001 to 8.4% in 2010.
8 Current Asthma Prevalence: United States, 2001-2010 PercentTotal number of personsOne in 12 people (about 26 million, or 8% of the population) had asthma in 2010, compared with 1 in 14 (about 20 million, or 7%) in 2001.YearOne in 12 people (about 26 million, or 8% of the U.S. population) had asthma in 2010,compared with 1 in 14 (about 20 million, or 7%) in 2001.
9 Blacks are more likely to have asthma than both Whites and Hispanics. Current Asthma Prevalence by Race and Ethnicity: United States,Blacks are more likely to have asthma than both Whites and Hispanics.Blacks are more likely to have asthma than both Whites and Hispanics.
10 Current Asthma Prevalence by Age Group, Sex, Race and Ethnicity, Poverty Status, Geographic Region, and Urbanicity: United States, Average AnnualSome people are more likely to have asthma than others.Current asthma occur more in children (9.5%) than in adults (7.7%) and females (9.2%) than males (7.0%). (yellow bars)Regarding race and ethnicity, asthma prevalence was higher among black persons (11.2%) and was lower among Asian (5.2%) and Hispanic persons (6.5%) compared with white persons (7.7%). Among Hispanics, Puerto Ricans (16.1%) were more likely to have asthma compared with Mexican persons (5.4%).Current asthma prevalence increased with decreasing annual household income.As far as geographic region, current asthma prevalence was higher in the Northeast (8.8%) than in the South (7.6%) or in the West (8.0%), and was higher in the Midwest (8.7%) than in the South (7.6%). Prevalence rate did not differ between metropolitan and nonmetropolitan areas.Children, females, Blacks, and Puerto Ricans are more likely to have asthma.People with lower annual household income were more likely to have asthma.Residents of the Northeast and Midwest were more likely to have asthma.Living in or not in a city did not affect the chances of having asthma.
11 Child and Adult Current Asthma Prevalence by Age and Sex: United States, 2006-2010 Among children, current asthma prevalence was higher among male children aged 0 to 4 years (7.7%) and aged 5 to 14 years (12.4%) compared with female children in the same age group (4.7% and 8.8%, respectively). Asthma prevalence was similar for male and female children aged years.Among children aged 0-14, boys were more likely than girls to have asthma.Boys and girls aged years had asthma at the same rate..Among adults women were more likely than men to have asthma.
12 From 2001 to 2010 both children and adults had fewer asthma attacks. Asthma Attack Prevalence among Children and Adults with Current Asthma: United States,Children aged 0-17 yearsAdults aged 18 and overBoth children and adults, showed a decrease in asthma attacks.In 2001, 61.7% of children and 53.8% of adults with asthma had at least one asthma attack in the previous 12 months compared with 58.3% and 49.1% in 2010, respectively.From 2001 to 2010 both children and adults had fewer asthma attacks.For children, asthma attacks declined from at least one asthma attack in the previous 12 months for 61.7% of children with asthma in 2001 to 58.3% in 2010.For adults, asthma attacks declined from at least one asthma attack in the previous 12 months for 53.8% of adults with asthma in 2001, to 49.1% in 2010.
13 Asthma Attack Prevalence among Persons with Current Asthma by Age Group, Sex, Race and Ethnicity, Poverty Status, and Geographic Region: Unites States, Average AnnualChildren with asthma were more likely to have had at least one asthma attack during the previous 12 months (56.5%) than adults (49.1%).Asthma attacks occurred more often in females (52.7%) than males (49.2%) and, among those with a family income less than 100% of the federal poverty threshold (55.1%) than persons with income between 250% and less than 450% of the poverty threshold (47.9%), and among those living in South and West, than those living in Northeast.Asthma attack prevalence did not differ by race or ethnicity.From 2008 to 2010 asthma attacks occurred more often in children and women, among families whose income was below 100% of the federal poverty threshold, and in the South and West.Race or ethnicity did not significantly affect asthma attack prevalence.
14 Technical NotesAsthma Period Prevalence and Current Asthma Prevalence: Estimates of asthma prevalence indicate the percentage of the population with asthma at a given point in time and represent the burden on the U.S. population. Asthma prevalence data are self-reported by respondents to the National Health Interview Survey (NHIS). Asthma period prevalence was the original measure ( ) of U.S. asthma prevalence and estimated the percentage of the population that had asthma in the previous 12 months. From , a redesign of the NHIS questions resulted in a break in the trend data as the new questions were not fully comparable to the previous questions. Beginning in 2001, current asthma prevalence (measured by the question, ‘‘Do you still have asthma?’’ for those with an asthma diagnosis) was introduced to identify all persons with asthma. Current asthma prevalence estimates from 2001 onward are point prevalence (previous 12 months) estimates and therefore are not directly comparable with asthma period prevalence estimates from 1980 to 1996 Behavioral Risk Factor Surveillance System (BRFSS): State asthma prevalence rates on the map come from the BRFSS. The BRFSS is a state-based, random-digit-dialed telephone survey of the noninstitutionalized civilian population 18 years of age and older. It monitors the prevalence of the major behavioral risks among adults associated with premature illness and death. Information from the survey is used to improve the health of the American people. More information about BRFSS can be found at:
17 What is Epidemiology?The study of the distribution and determinants of diseases and injuries in human populations.Asthma is a highly prevalent disease that affects the quality of life of many people in the United States. Surveillance of a disease requires that public health workers have the ability to accurately identify cases, access needed data, and use adequate resources so as to collect, assess, report, and use the data.Source: Boss, Leslie; Kreutzer, Richard. The Public Health Surveillance of Asthma. Journal of Asthma, 38 (1), 83–89, 2001.Asthma is one of the most common chronic illnesses in the United States. It is therefore a significant burden to public health. In the United States, approximately 23 million people have asthma, including 6.5 million children under age 18.Without proper management, asthma can result in frequent emergency department (ED) visits, hospitalizations, and premature deaths. In 2006, almost 2 million people visited an ED because of asthma, and almost half a million of those visitors were hospitalized.Source: Mausner and Kramer, Mausner and Bahn Epidemiology- An Introductory Text, 1985.17
18 Risk Factors for Developing Asthma Genetic characteristicsOccupational exposuresEnvironmental exposuresRisk Factors for Developing Asthma18
19 Risk Factors for Developing Asthma: Genetic Characteristics AtopyThe body’s predisposition to develop an antibody called immunoglobulin E (IgE) in response to exposure to environmental allergensCan be measured in the bloodIncludes allergic rhinitis, asthma, hay fever, and eczemaRisk Factors for Developing Asthma: Genetic Characteristics19
20 Risk Factors for Developing Asthma: Environmental Exposure Clearing the Air:Asthma and Indoor Air Exposures(Publications)Institute of Medicine, 2000Committee on the Assessment of Asthma and Indoor AirReview of current evidence about indoor air exposures and asthmaRisk Factors for Developing Asthma: Environmental Exposure20
21 Clearing the Air: Categories for Associations of Various Elements Sufficient evidence of a causal relationshipSufficient evidence of an associationLimited or suggested evidence of an associationInadequate or insufficient evidence to determine whether an association existsLimited or suggestive evidence of no associationClearing the Air: Categories for Associations of Various Elements21
22 Clearing the Air: Indoor Air Exposures & Asthma Development Biological AgentsSufficient evidence of causal relationshipHouse dust miteSufficient evidence of associationNone foundLimited or suggestive evidence of associationCockroach (among pre-school aged children)Respiratory syncytial virus (RSV)Chemical AgentsSufficient evidence of causal relationshipNone foundSufficient evidence of associationEnvironmental Tobacco Smoke (among pre-school aged children)Limited or suggestive evidence of associationClearing the Air: Indoor Air Exposures & Asthma Development22
23 Clearing the Air: Indoor Air Exposures & Asthma Exacerbation Biological AgentsSufficient evidence of causal relationshipCatCockroachHouse dust miteSufficient evidence of an associationDogFungus/MoldsRhinovirusLimited or suggestive evidence of associationDomestic birdsChlamydia and Mycoplasma pneumoniaRSVChemical AgentsSufficient evidence of causal relationshipEnvironmental tobacco smoke (among pre-school aged children)Sufficient evidence of associationNO2, NOX (high levels)Limited or suggestive evidence of associationEnvironmental Tobacco Smoke (among school-aged, older children, and adults)FormaldehydeFragrancesClearing the Air: Indoor Air Exposures & Asthma Exacerbation23
24 Reducing Exposure to House Dust Mites Use bedding encasementsWash bed linens weeklyAvoid down fillingsLimit stuffed animals to those that can be washedReduce humidity level (between 30% and 50% relative humidity per EPR-3)Reducing Exposure to House Dust MitesSource: “What You and Your Family Can Do About Asthma” by the Global Initiative For Asthma Created and funded by NIH/NHLBI, 1995
25 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.Reducing Exposure to Environmental Tobacco SmokeEvidence shows an association between environmental tobacco smoke exposure and asthma development among pre-school aged children.25
26 Reducing Exposure to Cockroaches Remove as many water and food sources as possible to avoid cockroaches.
27 Reducing Exposure to Pets People who are allergic to pets should not have them in the house.At a minimum, do not allow pets in the bedroom.Reducing Exposure to Pets
28 Reducing Exposure to Mold Eliminating mold and the moist conditions that permit mold growth may help prevent asthma exacerbations.
29 Other Asthma Triggers Air pollution Trees, grass, and weed pollen
30 Clinical Management of Asthma Expert Panel Report 3National Asthma Education and Prevention ProgramNational Heart, Lung and Blood Institute, 2007An expert panel commissioned by the National Asthma Education and Prevention Program (NAEPP) Coordinating Committee (CC) developed the 2007 EPR 3 Guidelines on Asthma. The National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health coordinated the effort.Source:30
31 2007 NAEPP EPR-3 Treatment recommendations based on: SeverityControlResponsivenessProvide patient self-management education at multiple points of careReduce exposure to inhaled indoor allergens to control asthma-multifaceted approachThe expert panel used the 1997 guidelines and the 2004 update as the framework to organize the literature review, and the final guidelines report for four essential components of asthma care: assessment and monitoring, patient education, control of factors contributing to asthma severity, and pharmacologic treatment.Here are a few highlights.Source:31
32 What is GIP?Guidelines Implementation Panel Report for Expert Panel Report 3Recommendations and strategies to implement EPR-3Six key messagesThe Guidelines Implementation Panel (GIP) Report presents recommendations and strategies for overcoming barriers to the acceptance and use of the updated NHLBI clinical practice guidelines for asthma. At the heart of the GIP Report are six key messages to address the issues that are likely to significantly affect asthma care processes and outcomes if the broader asthma community were to focus its attention and resources on them. The GIP Report is a call to action by the full range of guideline end-users, including medical professionals, office support staff, educators, administrators, policy makers, purchasers, and payors of healthcare services in both the private and public sectors.Source:32
33 GIP’s Six Key Messages Inhaled Corticosteroids Asthma Action Plan Asthma SeverityAsthma ControlFollow-up VisitsAllergen and Irritant Exposure ControlInhaled CorticosteroidsInhaled corticosteroids are the most effective medications for long-term management of persistent asthma, and they should be used by patients and clinicians as recommended in the guidelines for controlling asthma.Message: Asthma Action PlanAll people who have asthma should receive a written asthma action plan to guide their self-management efforts.Message: Asthma SeverityMessage: All patients should have an initial severity assessment based on measures of current impairment and future risk to determine type and level of initial therapy needed.Message: Asthma ControlMessage: At planned follow-up visits, asthma patients should review the level of control with their health care providers on the basis of multiple measures of current impairment and future risk; this review can guide clinician decisions to either maintain or adjust therapy.Message: Follow-up Visits Patients who have asthma should be scheduled for planned follow-up visits at periodic intervals to assess their asthma control and to modify treatment if needed.Message: Allergen and Irritant Exposure Control Clinicians should review each patient’s sensitivity to allergens and irritants and provide a multipronged strategy to reduce exposure—i.e., avoid exposures that make the patient’s asthma worse.Source:33
34 Diagnosing Asthma: Medical History SymptomsCoughingWheezingShortness of breathChest tightnessSymptom PatternsSeverityFamily HistoryDiagnosing Asthma: Medical History34
35 Diagnosing Asthma Troublesome cough, particularly at night Awakened by coughingCoughing or wheezing after physical activityBreathing problems during particular seasonsCoughing, wheezing, or chest tightness after allergen exposureColds that last more than 10 daysRelief when medication is usedDiagnosing Asthma35
36 Diagnosing Asthma Wheezing sounds during normal breathing Hyperexpansion of the thoraxIncreased nasal secretions or nasal polypsAtopic dermatitis, eczema, or other allergic skin conditionsDiagnosing Asthma
37 Diagnosing Asthma: Spirometry Test lung function when diagnosing asthmaDiagnosing Asthma: Spirometry37
38 Medications to Treat Asthma Medications come in several forms.Two major categories of medications are:Long-term controlQuick reliefMedications to Treat Asthma
39 Medications to Treat Asthma: Long-Term Control Taken daily over a long period of timeUsed to reduce inflammation, relax airway muscles, and improve symptoms and lung functionInhaled corticosteroidsLong-acting beta2-agonistsLeukotriene modifiersMedications to Treat Asthma: Long-Term Control
40 Medications to Treat Asthma: Quick-Relief Used in acute episodesGenerally short-acting beta2agonistsMedications to Treat Asthma: Quick-Relief
41 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: How to Use a Spray InhalerSource: “What You and Your Family Can Do About Asthma” by the Global Initiative for Asthma Created and funded by NIH/NHLBI
42 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: Inhalers and Spacers42
43 Medications to Treat Asthma: Nebulizer Machine produces a mist of the medicationUsed for small children or for severe asthma episodesNo evidence that it is more effective than an inhaler used with a spacerMedications to Treat Asthma: Nebulizer
44 Managing Asthma: Asthma Management Goals Achieve and maintain control of symptomsMaintain normal activity levels, including exerciseMaintain pulmonary function as close to normal levels as possiblePrevent asthma exacerbationsAvoid adverse effects from asthma medicationsPrevent asthma mortalityManaging Asthma: Asthma Management Goals
45 Managing Asthma: Asthma Action Plan Develop with a physicianTailor to meet individual needsEducate patients and families about all aspects of planRecognizing symptomsMedication benefits and side effectsProper use of inhalers and Peak Expiratory Flow (PEF) metersManaging Asthma: Asthma Action Plan
46 Managing Asthma: Sample Asthma Action Plan Describes medicines to use and actions to takeThe Asthma Action Plan summarizes the doctor’s instructions for self-management of asthma. The plan contains places in which the doctor can fill in directions for medication, peak flow numbers, asthma triggers, and actions to take in case of an asthma attack or an emergency. The written Asthma Action Plan specifies details for patients’ daily management (medications and environmental control strategies) and outlines steps to take to recognize and handle an asthma attack. A written Asthma Action Plan is recommended for all patients.National Heart, Blood, and Lung Institute Expert Panel Report 3 (EPR 3): Guidelines for the Diagnosis and Management of Asthma. NIH Publication no , 2007.46
47 Managing Asthma: Peak Expiratory Flow (PEF) Meters Allows patient to assess status of his/her asthmaPersons who use peak flow meters should do so frequentlyMany physicians require for all severe patients
48 Managing Asthma: Peak Flow Chart People with moderate or severe asthma should take readings:Every morningEvery eveningAfter an exacerbationBefore inhaling certain medicationsManaging Asthma: Peak Flow ChartSource: “What You and Your Family Can Do About Asthma” by the Global Initiative For Asthma Created and funded by NIH/NHLBI
49 Managing Asthma: Indications of a Severe Attack Breathless at restHunched forwardSpeaks in words rather than complete sentencesAgitatedPeak flow rate less than 60% of normalManaging Asthma: Indications of a Severe Attack
50 Managing Asthma: Things People with Asthma Can Do Have an individual management plan containingYour medications (controller and quick-relief)Your asthma triggersWhat to do when you are having an asthma attackEducate yourself and others aboutAsthma Action PlansEnvironmental interventionsSeek help from asthma resourcesJoin an asthma support groupManaging Asthma: Things People with Asthma Can Do
51 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
52 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: Surveillance
53 A Public Health Response to Asthma: Uses of Surveillance Data Basis for planning and targeting intervention activitiesEvaluating intervention activitiesA Public Health Response to Asthma: Uses of Surveillance Data
54 A Public Health Response to Asthma Education Education programs can be targeted to:People with asthmaParents of children with asthmaMedical care providersSchool staffPublicA Public Health Response to Asthma Education
55 A Public Health Response to Asthma: Coalition Successful asthma campaigns need the cooperation of committed partners.A Public Health Response to Asthma: Coalition
56 A Public Health Response to Asthma: Advocacy Asthma needs to be addressed comprehensively by multiple government and non-government agencies.
57 A Public Health Response to Asthma: Interventions Medical managementEducationEnvironmentSchoolsA Public Health Response to Asthma: Interventions
58 A Public Health Response to Asthma: Medical Management Interventions Ensure people with asthma know about their disease and are empowered to demand appropriate managementA Public Health Response to Asthma: Medical Management Interventions58
59 A Public Health Response to Asthma: Environmental Interventions Help people create and maintain healthy home, school, and work environments.Environmental interventions may consist of:Assessments to identify asthma triggersEducation on how to remove asthma triggersRemediation to remove asthma triggersA Public Health Response to Asthma: Environmental Interventions59
60 A Public Health Response to Asthma: School Intervention Science-Based Guidance Management and support systemsHealth and mental health servicesAsthma education for students, staff, and parentsHealthy school environmentPhysical education and activitySchool, family, and community effortsThe six strategies for addressing asthma within a coordinated school health program are [read bullets].If you open the Strategies document, you will see that each one is accompanied by action steps.The strategies and action steps are based on research evidence and on expert opinion and evidence from exemplary practice in school asthma management, health education, and public health.The publication can be downloaded for free at this Web site.Source:60
61 Key Aspects Require team effort Coordinate health, including mental and physical health, education, environment, family, and community effortsAssess needs of school and prioritize (every action step is not feasible to every school or district)Focus on students with frequent asthma symptoms, health room visits, and absenteeismThe beginning of the Strategies document provides some overall guidance for programs, specifying that a team effort is required with school nurses, administrators, classroom teachers, PE teachers, and others working together to ensure that students with asthma can participate safely in school.Every action step is not going to be feasible for every school or district. For example, not every school can provide a full-time nurse.Schools should establish priorities on the basis on their needs, and they should focus first on students with frequent symptoms, health room visits, and/or absenteeism. These students will need the school and school district’s support the most.61
62 Coordinated School Health Program Health ServicesFamily/Community InvolvementStrategies for Addressing Asthma1. Management & Support Systems6. School, Family, & Community Efforts2. Health & Mental Health ServicesCounseling,Psychological, andSocial ServicesPhysicalEducation5. Physical Education & Activity3. Asthma EducationHealthEducationNutritionServices4. Healthy School EnvironmentThis graphic shows how the six strategies for addressing asthma fit within the eight components of a coordinated school health program.A successful school asthma program is a team effort—it involves school nurses, administrators, classroom and physical education teachers, building maintenance staff, families, and students.Healthy SchoolEnvironmentHealth PromotionFor Staff62
63 A Public Health Response to Asthma: School A leading chronic disease cause of school absenceCommon disease addressed by school nursesAffects teachers, administrators, nurses, coaches, students, bus drivers, after school program staff, maintenance personnelA Public Health Response to Asthma: School
64 On average, 3 children in a classroom of 30 On average, a typical classroom of 30 students is likely to have 3 with asthma.*According to the 2004 National Health Interview Survey, parents reported that 9.6% (5.1 million) of their school-aged children (ages 5-17) had been told by a doctor that they have asthma (“lifetime asthma”) and still had asthma (“current asthma”).are likely to have asthma.**Epidemiology and Statistics Unit. Trends in Asthma Morbidity and Mortality. NYC: ALA, July 2006.64
65 A Public Health Response to Asthma: What can make asthma worse in the school? Mold and mildewAnimals in classroomCarpeted classroomsCockroachesPoor air qualityPoor air quality can include fumes and vapors and the presence of tobacco smoke.
66 Asthma-Friendly School DVD and Toolkit ObjectivesPersonal stories to relate to viewerAspects of an asthma-friendly schoolSix strategies for addressing asthma in a coordinated school health programPotential impact of asthma-friendly schoolsThe DVD was developed to help lay people understand what asthma-friendly schools are and to help asthma advocates market asthma-friendly schools; CDC developed a video called Creating an Asthma-Friendly School.The purpose of the video is to show the face of an asthma-friendly school.The video has a broad target audience—pretty much all the people whom asthma health advocates may want to convince that asthma is an important issue for them to address. This target audience includes teachers, school board members, school business leaders, school administrators, school health councils, school nurses, community members, and community asthma coalitions.66
67 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.Make medications availableDuring school hoursBefore physical activity and sportsDuring before- and after-school programsOn field trips or when away from campusTrain school staff to recognize signs of an asthma attack and to use appropriate medications.A Public Health Response to Asthma: School Actions
68 A Public Health Response to Asthma: Evaluation The systematic investigation of the structure, activities, or outcomes of asthma control programs.Are we doing the right thing?Are we doing things right?We have all heard the word evaluation.A whole range of things can be evaluated, from how well our partnerships work, how effective our administrative systems and policy development activities are, to how well our specific interventions work to improve the lives of persons with asthma.What is evaluation?Evaluation is the systematic investigation of the structure, activities, or outcomes of the asthma control programs.Note that evaluation is “systematic,” meaning that the process is disciplined, structured, and objective.The core of the word is “value”, and evaluation cannot be done without judgments and context.Evaluation answers how and why questions and provides a full understanding of what is happening in a specific program and why.The process helps to identify program strengths and builds on them.It is not a fault-finding process, but it does help identify areas that can be improved or things that can be done better.Even the best programs can improve. Through this process, we learn to become better at what we do!Program staff who are new to this process will build assessment skills and capacity as they conduct evaluations. There are no prerequisites for beginning an evaluation. Novices should draw on resources like this presentation and other materials to guide them along the way.68
69 Benefits of Program Evaluation Evaluations help asthma programsManage resources and services effectivelyUnderstand reasons for current performanceBuild capacityPlan and implement new activitiesDemonstrate the value of their effortsEnsure accountabilityThere are several basic uses and reasons to evaluate your program so that youManage resources and services effectively—Evaluation provides information for better decision-making. For example, it may offer data concerning the practicality of a new approach to contact investigations, or it may examine case management practices in detail to make sure that staff members are following protocols.Understand reasons for current performance—Evaluation provides us with a means to understand why we achieved our successes, or why we did not meet our objectives. Evaluation requires that we examine factors objectively, both inside and outside our program, to assess our performance. Understanding these factors allows us to make better decisions, implement change where appropriate, and improve upon what we have accomplished.Build capacity—We can also use evaluation for self-directed change, such as to increase funding, develop skills, and/or to build the infrastructure needed for a successful program. For example, evaluating an intervention in a community of recent immigrants might reveal a need to translate informational materials into a new language to enhance the program’s capacity to serve this emergent group. Evaluation also builds on itself—as we learn and gain experiences in conducting evaluations, we also build evaluation capacity for our program and increase program capacity for self-directed improvements.Plan and implement new initiatives—Evaluation helps us assess where we are in program development and accomplishments, and it helps us identify information we need to plan for our next steps. It tells us what we are lacking and where we need to focus our efforts. It provides us with information we need to strategize, plan, and implement initiatives that enhance the effectiveness of our asthma control program.Evaluation helps demonstrate the value of our efforts—It documents what each of us does and systematically shows how each has added value toward accomplishing our goals. This information can help decision-makers at all levels understand the benefits and consequences of what they are doing. At crucial times, findings from evaluation help us advocate for the cause and leverage support.Finally, evaluation can strengthen accountability—Evaluation is part of good management. It allows us to demonstrate that we are responsible stewards of the program’s funding and resources.69
70 Using Evaluation to Improve Programs Highlight effective program componentsRecognize achievementsReplicate successesAssess and prioritize needsTarget program improvementsAdvocate for the programEvaluation is an important tool to help us improve asthma control programs.Evaluation helps highlight effective program components.Many important things require our attention. Evaluation helps us prioritize needs and identify areas that require the most attention and can make the most impact.Evaluation is also a great tool for targeting program improvements.In a world where evidenced-based decision-making is important, evaluation results can be used to demonstrate program need and its value in advocacy efforts.70
72 A Public Health Response to Asthma: Summary Asthma is a complex disease that is not yet preventable or curable.Asthma can be managed with medication, environmental changes, and behavior modifications.By working together, we can ensure that people with asthma enjoy a high quality of life.A Public Health Response to Asthma: Summary
73 Resources National Asthma Education and Prevention Program Asthma and Allergy Foundation of AmericaAmerican Lung AssociationAmerican Academy of Allergy, Asthma, and ImmunologyAllergy and Asthma Network/Mothers of Asthmatics, Inc.Resources
74 Resources American College of Allergy, Asthma, and Immunology American College of Chest PhysiciansAmerican Thoracic SocietyThe Centers for Disease Control and PreventionResources