Asthma is a chronic lung disease characterized by inflammation of the airways. Common symptoms include wheezing, coughing, chest tightness, and shortness of breath. Risk factors for developing asthma include genetic characteristics like atopy and environmental exposures such as tobacco smoke, dust mites, and cockroaches. Diagnosis involves assessing symptoms and lung function through spirometry testing. Treatment focuses on long-term control medications like inhaled corticosteroids and quick-relief medications for acute episodes. Proper use of inhalers and peak flow meters is important for effective management along with developing an asthma action plan.

1. AsthmaAsthma
PATIL

2. What is Asthma?
Chronic disease of the airways that may cause
Wheezing
Breathlessness
Chest tightness
Nighttime or early morning coughing
Episodes are usually associated with
widespread, but variable, airflow obstruction
within the lung that is often reversible either
spontaneously or with treatment.

3. Pathology of Asthma
Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For Asthma
Created and funded by NIH/NHLBI, 1995
Normal Asthma
Asthma
involves
inflammation of
the airways

4. Introduction
Asthma:
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
asthma

5. Introduction
Asthma 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 (1980-1996).
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.

6. Current asthma prevalence, 2001-
2010
Asthma period prevalence, 1980-1996
Asthma Period Prevalence and Current Asthma Prevalence:
United States, 1980-2010
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.

7. Total number of persons Percent
Current Asthma Prevalence: United States, 2001-2010
One 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.
Year

8. Current Asthma Prevalence by Race and Ethnicity:
United States, 2001-2010
Blacks are more likely to have asthma than both Whites and Hispanics.

9. Asthma is a syndrome characterized by
airflow obstruction that varies markedly,
both spontaneously and with treatment

10. Asthmatics harbora special type of
inflammation in the airways that makes
themmore responsive than nonasthmatics
to a wide range of triggers, leading to
excessive narrowing with consequent
reduced airflow and symptomatic
wheezing and dyspnea.

11. special type of
inflammation in the
airways that makes
them more
responsive than
nonasthmatics to a
wide range of
triggers, leading to
excessive narrowing
with consequent
reduced airflow and
symptomatic

12. Current Asthma Prevalence by Age Group, Sex, Race and Ethnicity,
Poverty Status, Geographic Region, and Urbanicity: United States,
Average Annual 2008-2010
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.

13. Child and Adult Current Asthma Prevalence by Age and Sex:
United States, 2006-2010
Among children aged 0-14, boys were more likely than girls to have asthma.
Boys and girls aged 15-17 years had asthma at the same rate..
Among adults women were more likely than men to have asthma.

14. Children aged 0-17 years
Adults aged 18 and over
Asthma Attack Prevalence among Children and Adults with
Current Asthma: United States, 2001-2010
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.

15. Asthma Attack Prevalence among Persons with Current Asthma by Age
Group, Sex, Race and Ethnicity, Poverty Status, and Geographic Region:
Unites States, Average Annual 2008-2010
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.

16. Technical Notes
Asthma 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 (1980-1996) of U.S. asthma
prevalence and estimated the percentage of the population that had asthma in the previous 12
months. From 1997-2000, 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: http://www.cdc.gov/brfss/.

17. Sources

18. Sources (continued)

19. What is Epidemiology?
The study of the distribution and
determinants of diseases and
injuries in human populations.
Source: Mausner and Kramer, Mausner and Bahn Epidemiology- An Introductory Text, 1985.

20. Risk Factors for Developing Asthma
 Genetic characteristics
 Occupational exposures
 Environmental exposures

21. Risk Factors for Developing Asthma:
Genetic Characteristics
Atopy
The body’s predisposition to develop an antibody
called immunoglobulin E (IgE) in response to
exposure to environmental allergens
Can be measured in the blood
Includes allergic rhinitis, asthma, hay fever, and
eczema

22. Risk Factors for Developing Asthma:
Environmental Exposure
Clearing the Air:
Asthma and Indoor Air Exposures
http://www.iom.edu (Publications)
Institute of Medicine, 2000
Committee on the Assessment of Asthma and Indoor Air
Review of current evidence about indoor air exposures
and asthma

23. Clearing the Air:
Categories for Associations of Various
Elements
Sufficient evidence of a causal relationship
Sufficient evidence of an association
Limited or suggested evidence of an
association
Inadequate or insufficient evidence to
determine whether an association exists
Limited or suggestive evidence of no
association

24. Clearing the Air:
Indoor Air Exposures & Asthma Development
Biological Agents
 Sufficient evidence of causal
relationship
 House dust mite
 Sufficient evidence of association
 None found
 Limited or suggestive evidence of
association
 Cockroach (among pre-school aged
children)
 Respiratory syncytial virus (RSV)
Chemical Agents
 Sufficient evidence of causal
relationship
 None found
 Sufficient evidence of association
 Environmental Tobacco Smoke
(among pre-school aged children)
 Limited or suggestive evidence of
association
 None found

25. Clearing the Air:
Indoor Air Exposures & Asthma Exacerbation
Biological Agents
 Sufficient evidence of causal
relationship
 Cat
 Cockroach
 House dust mite
 Sufficient evidence of an association
 Dog
 Fungus/Molds
 Rhinovirus
 Limited or suggestive evidence of
association
 Domestic birds
 Chlamydia and Mycoplasma pneumonia
 RSV
Chemical Agents
 Sufficient evidence of causal
relationship
 Environmental tobacco smoke
(among pre-school aged children)
 Sufficient evidence of
association
 NO2, NOX (high levels)
 Limited or suggestive evidence of
association
 Environmental Tobacco Smoke
(among school-aged, older children,
and adults)
 Formaldehyde
 Fragrances

26. Reducing Exposure to House Dust Mites
 Use bedding
encasements
 Wash bed linens weekly
 Avoid down fillings
 Limit stuffed animals to
those that can be washed
 Reduce humidity level
(between 30% and 50%
relative humidity per
EPR-3)
Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For
Asthma Created and funded by NIH/NHLBI, 1995

27. 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.
Evidence shows an association
between environmental tobacco
smoke exposure and asthma
development among pre-school
aged children.

28. Reducing Exposure to Cockroaches
Remove as many water and food sources as
possible to avoid cockroaches.

29. 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.

30. Reducing Exposure to Mold
Eliminating mold and the moist conditions that permit
mold growth may help prevent asthma exacerbations.

31. Other Asthma Triggers
Air pollution
Trees, grass, and weed pollen

32. Clinical Management of Asthma
Expert Panel Report 3
National Asthma Education and Prevention Program
National Heart, Lung and Blood Institute, 2007
Source: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf

33. 2007 NAEPP EPR-3
Treatment recommendations based
on:
Severity
Control
Responsiveness
Provide patient self-management
education at multiple points of care
Reduce exposure to inhaled indoor
allergens to control asthma-
multifaceted approach
Source: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf

34. What is GIP?
 Guidelines Implementation Panel
Report for Expert Panel Report 3
 Recommendations and strategies
to implement EPR-3
 Six key messages
Source: http://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.pdf

35. GIP’s Six Key Messages
Inhaled
Corticosteroids
Asthma Action Plan
Asthma Severity
Asthma Control
Follow-up Visits
Allergen and Irritant
Exposure Control
Source: http://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.pdf

36. Diagnosing Asthma:
Medical History
Symptoms
Coughing
Wheezing
Shortness of breath
Chest tightness
Symptom Patterns
Severity
Family History

37. Diagnosing Asthma
Troublesome cough, particularly at night
Awakened by coughing
Coughing or wheezing after physical
activity
Breathing problems during particular
seasons
Coughing, wheezing, or chest tightness
after allergen exposure
Colds that last more than 10 days
Relief when medication is used

38. Diagnosing Asthma
Wheezing sounds during normal
breathing
Hyperexpansion of the thorax
Increased nasal secretions or nasal
polyps
Atopic dermatitis, eczema, or other
allergic skin conditions

39. Diagnosing Asthma:
Spirometry
Test lung function when diagnosing asthma

40. Medications to Treat Asthma
Medications
come in several
forms.
Two major
categories of
medications are:
Long-term control
Quick relief

41. Medications to Treat Asthma:
Long-Term Control
Taken daily over a long period of time
Used to reduce inflammation, relax airway
muscles, and improve symptoms and lung
function
Inhaled corticosteroids
Long-acting beta2-agonists
Leukotriene modifiers

42. Medications to Treat Asthma:
Quick-Relief
Used in acute
episodes
Generally short-
acting
beta2agonists

43. Medications to Treat Asthma:
How to Use a Spray Inhaler
The health-care
provider should
evaluate inhaler
technique at each
visit.
Source: “What You and Your Family Can Do About Asthma” by the Global Initiative for
Asthma Created and funded by NIH/NHLBI

44. 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.

45. Medications to Treat Asthma:
Nebulizer
 Machine produces a
mist of the medication
 Used for small children
or for severe asthma
episodes
 No evidence that it is
more effective than an
inhaler used with a
spacer

46. Managing Asthma:
Asthma Management Goals
Achieve and maintain control of symptoms
Maintain normal activity levels, including
exercise
Maintain pulmonary function as close to
normal levels as possible
Prevent asthma exacerbations
Avoid adverse effects from asthma
medications
Prevent asthma mortality

47. Managing Asthma:
Asthma Action Plan
Develop with a physician
Tailor to meet individual needs
Educate patients and families about all aspects
of plan
Recognizing symptoms
Medication benefits and side effects
Proper use of inhalers and Peak Expiratory Flow
(PEF) meters

48. Managing Asthma:
Sample Asthma Action Plan
Describes medicines
to use and actions to
take
National Heart, Blood, and Lung Institute Expert Panel Report 3 (EPR 3): Guidelines for the
Diagnosis and Management of Asthma. NIH Publication no. 08-4051, 2007.

49. Managing Asthma:
Peak Expiratory Flow (PEF) Meters
 Allows patient to assess status of his/her asthma
 Persons who use peak flow meters should do so frequently
 Many physicians require for all severe patients

50. Managing Asthma:
Peak Flow Chart
People with
moderate or
severe asthma
should take
readings:
Every morning
Every evening
After an
exacerbation
Before inhaling
certain
medications
Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For
Asthma Created and funded by NIH/NHLBI

51. Managing Asthma:
Indications of a Severe Attack
Breathless at rest
Hunched forward
Speaks in words rather than complete
sentences
Agitated
Peak flow rate less than 60% of normal

52. Managing Asthma:
Things People with Asthma Can Do
Have an individual management plan containing
Your medications (controller and quick-relief)
Your asthma triggers
What to do when you are having an asthma attack
Educate yourself and others about
Asthma Action Plans
Environmental interventions
Seek help from asthma resources
Join an asthma support group

53. 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.

54. 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?

55. A Public Health Response to Asthma:
Uses of Surveillance Data
Basis for planning and
targeting intervention
activities
Evaluating
intervention activities

56. A Public Health Response
to Asthma Education
Education programs can be targeted to:
People with asthma
Parents of children with asthma
Medical care providers
School staff
Public

57. A Public Health Response to Asthma:
Coalition
Successful asthma campaigns need the
cooperation of committed partners.

58. A Public Health Response to Asthma:
Advocacy
Asthma needs to be addressed
comprehensively by multiple government and
non-government agencies.

59. A Public Health Response to Asthma:
Interventions
Medical management
Education
Environment
Schools

60. A Public Health Response to Asthma:
Medical Management Interventions
Ensure people with asthma
know about their disease and
are empowered to demand
appropriate management

61. 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 triggers
 Education on how to
remove asthma triggers
 Remediation to remove
asthma triggers

62. A Public Health Response to Asthma:
School Intervention Science-Based Guidance
 Management and support
systems
 Health and mental health
services
 Asthma education for
students, staff, and parents
 Healthy school environment
 Physical education and
activity
 School, family, and
community efforts
Source: www.cdc.gov/HealthyYouth/asthma/strategies

63. Key Aspects
Require team effort
Coordinate health, including mental and physical
health, education, environment, family, and
community efforts
Assess 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 absenteeism

64. 1. Management &
Support Systems
Family/Community
Involvement
Physical
Education
Nutrition
Services
Healthy School
Environment
Health Promotion
For Staff
Health
Education
Health
Services
Counseling,
Psychological, and
Social Services
4. Healthy School
Environment
2. Health &
Mental Health
Services
3. Asthma
Education
6. School, Family,
& Community
Efforts
5. Physical
Education &
Activity

65. A Public Health Response to Asthma:
School
 A leading chronic disease cause of school absence
 Common disease addressed by school nurses
 Affects teachers, administrators, nurses, coaches,
students, bus drivers, after school program staff,
maintenance personnel

66. are likely to have asthma.*
On average, 3 children in a classroom of 30
*
Epidemiology and Statistics Unit. Trends in Asthma Morbidity and Mortality. NYC: ALA, July
2006.

67. A Public Health Response to
Asthma:
What can make asthma worse in the school?
 Mold and mildew
 Animals in classroom
 Carpeted classrooms
 Cockroaches
 Poor air quality

68. Asthma-Friendly School
DVD and Toolkit
Objectives
Personal stories to relate to
viewer
Aspects of an asthma-friendly
school
Six strategies for addressing
asthma in a coordinated school
health program
Potential impact of asthma-
friendly schools

69. 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 available
 During school hours
 Before physical activity and sports
 During before- and after-school programs
 On field trips or when away from campus
 Train school staff to recognize signs of an asthma attack
and to use appropriate medications.

70. 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?

71. Benefits of Program Evaluation
Evaluations help asthma programs
 Manage resources and services effectively
 Understand reasons for current performance
 Build capacity
 Plan and implement new activities
 Demonstrate the value of their efforts
 Ensure accountability

72. Using Evaluation to Improve Programs
Highlight effective program components
Recognize achievements
Replicate successes
Assess and prioritize needs
Target program improvements
Advocate for the program

73. Framework for Program Evaluation

74. 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.

75. Resources
 National Asthma Education and Prevention Program
 http://www.nhlbi.nih.gov/about/naepp/
 Asthma and Allergy Foundation of America
 http://www.aafa.org
 American Lung Association
 http://www.lungusa.org
 American Academy of Allergy, Asthma, and
Immunology
 http://www.aaaai.org
 Allergy and Asthma Network/Mothers of Asthmatics,
Inc.
 http://www.aanma.org

76. Resources
 American College of Allergy, Asthma, and
Immunology
 http://www.acaai.org
 American College of Chest Physicians
 http://www.chestnet.org
 American Thoracic Society
 http://www.thoracic.org
 The Centers for Disease Control and Prevention
 http://www.cdc.gov/asthma