 Volume 14: Issue 1 June 1999 |
 Combating
the Growing Problem of Asthma, a chronic lung disease in which the airways become inflamed, is a growing health problem in the United States, especially among children and members of minority groups. Over the past 20 years, the number of reported cases of asthma has nearly tripled. Today, almost 15 million Americans suffer from asthma—5 million are children and young adults under 18 years old. The prevalence of asthma is 5.7 percent in the population as a whole but is 7.5 percent, or one-third higher, in the under-18 age group, and data indicate that the prevalence is increasing in all age groups. Minority and low-income populations appear to be especially vulnerable. Although the prevalence of asthma is only slightly higher in nonwhites than in whites, African Americans and Hispanics are two to six times more likely than whites to die from asthma. The rate of asthma fatalities among African American children is four times higher than their white counterparts; the rate is six times higher among young adults. Causes and Effects Several factors may be responsible for the increase in the number of asthma cases and the differences in death rates, but the exact causes are not known. Changing demographics, however, may account for at least some of the increase. Today there are more children in the United States than there were during the peak year of the post-World War II baby boom, and the prevalence of asthma is higher in children and young adults than it is in the adult population. Despite the increasing prevalence of asthma, effective methods are available now to manage this potentially life-threatening disease. Asthma, like diabetes and other chronic conditions, cannot be cured, but it can be controlled. Effective management can prevent asthma attacks and reduce the risk of serious or fatal complications. Managing asthma and preventing its complications depend on avoiding exposure to asthma triggers, taking proper medications to prevent or treat asthma attacks, and continuously monitoring the disease. At the heart of asthma management and prevention are the patient and the health care provider. Health care providers in particular can teach asthma self-management to patients. They also can take an active role in disseminating information to schools, community centers, and similar organizations that reach children, minorities, and other populations at increased risk of asthma. Earlier this year, the Federal Task Force on Environmental Health Risks and Safety Risks to Children released its report Asthma and the Environment. The report contains recommendations for asthma research, surveillance, risk reduction, and management. To learn more about asthma prevalence and risk, the National Institute of Environmental Health Sciences (NIEHS) and the Department of Housing and Urban Development are sponsoring the National Allergen Survey. Results will determine the extent of the general population’s exposure to household allergens and differences in exposure based on factors such as region, ethnicity, socioeconomic status, and housing type. NIEHS also is teaming with the National Institute of Allergy and Infectious Diseases (NIAID) on the second Inner-City Asthma Study. This study is testing the effectiveness of two educational interventions—one aimed at primary care physicians and the other at families—in reducing the severity of asthma in children. In addition, NIEHS, NIAID, and the U.S. Environmental Protection Agency (EPA) are collaborating to determine the effect of exposure to indoor and outdoor particulates and pollutants on inner-city children. To collect additional data about asthma, State-based asthma surveillance systems are currently being developed with support from the Centers for Disease Control and Prevention (CDC). A 1996 CDC/Council of State and Territorial Epidemiologists survey indicated that most States lack the funding and data necessary to develop such programs on their own. EPA recently ordered 22 States to reduce their levels of ozone, which is among the environmental triggers for asthma. The new regulations are expected to reduce ozone levels by 28 percent in 4 years. EPA also is working with the American Psychological Association and the National Center for Safety and Child Care to educate the public about environmental tobacco smoke, another asthma trigger. Prevention and Education The National Asthma Education and Prevention Program (NAEPP), operated by the National Heart, Lung, and Blood Institute (NHLBI), uses a variety of methods to encourage the recognition of asthma symptoms by patients, families, and the public and to ensure the appropriate diagnosis by health professionals. NAEPP also promotes effective partnerships among patients, physicians, and other health providers to develop effective asthma treatment programs. Studies have shown that programs like NAEPP are most successful when they promote asthma-related behavior changes, increase patient understanding of the disease, and encourage patient-provider cooperation in the management of asthma. Such programs reduce asthma-related hospitalizations and emergency room visits and decrease the need for medications. For example, in the original Inner-City Asthma Study (by NIAID and NIEHS), which ended in 1996, a trained social worker taught patients and family members how to identify asthma triggers, improve their access to health services, and manage environmental exposures. These interventions resulted in significant reductions in symptoms and fewer visits to health care providers for treatment. NAEPP’s second Expert Panel Report, released in 1997, contains updated guidelines for health care providers to use in diagnosing and managing asthma. Included are ways to reduce exposure to environmental risk factors and proven methods for teaching asthma self-management and prevention to patients. NHLBI also created the Asthma Management Model System—an electronic information tool designed to facilitate long-term asthma management. The Web address is http://www.nhlbisupport.com/asthma/index.html. The site contains links to searchable databases and other asthma resources. That asthma is of rising public health import is reflected in Healthy People. Healthy People 2000 contained only three asthma objectives, scattered in different chapters. Healthy People 2010, currently in draft form, has an entire chapter on respiratory diseases, which contains more than 10 objectives on asthma alone. Healthy People 2010 will be launched at the "Partnerships for Health in the New Millennium" conference on January 24-28, 2000, in Washington, D.C.
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Asthma Facts
Select Asthma Resources www.healthfinder.gov National Asthma Education and Prevention Program National Institute of Allergy and Infectious Diseases National Institute of Environmental Health Sciences National Center for Environmental Health U.S. Environmental Protection Agency Allergy and Asthma Network Mothers of Asthmatics Inc. American Academy of Allergy, Asthma, and Immunology American Association for Respiratory Care American Lung Association Asthma and Allergy Foundation of America Return to Prevention Report Index Go to Spotlight | In the Literature | Activities | Meetings | Etcetera |