A Presentation on Asthma
Management and Prevention

What Is Asthma?
A chronic disease of the airways that may cause
Wheezing
Breathlessness
Chest tightness
Nighttime or early morning coughing

Pathology of Asthma

Epidemiology
The study of the distribution and determinants of diseases and injuries in human populations

Asthma Prevalence* by Age
United States: 1980–1996

Asthma Prevalence* by Sex
United States: 1982–1996

Asthma Prevalence* by Race
United States: 1982–1996

Asthma Prevalence* by Race
Ages 5-34, United States: 1980–1996

Asthma* Hospital Discharge Rates#
by Sex, United States: 1980–1998

Asthma* Hospital Discharge Rates#
by Race, United States: 1980–1998

Asthma* Hospital Discharge Rates
by Race, Ages 5-34, United States: 1980–1998

Age-Adjusted* Asthma Mortality Rates
by Sex, United States: 1979–1998

Slide 13

Slide 14

Costs of Asthma
United States, 1980–1998
Projection for the Year 2000


Risk Factors
for Development of Asthma
Genetic characteristics
Environmental exposures
Contributing factors

Risk Factors for Development of 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

Risk Factors for Development of Asthma:
Environmental
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 regarding indoor air exposures and asthma


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

Clearing the Air
Indoor Air Exposures and Asthma Development
Biological Agents
Sufficient evidence of a causal relationship
    House dust mite
Sufficient evidence of an association
    None found
Limited or suggestive evidence of an association
Cockroach (in preschool-aged children)
Respiratory syncytial virus (RSV)
Chemical Agents
Sufficient evidence of a causal relationship
None found
Sufficient evidence of an association
Environmental tobacco           smoke (in preschool-aged children)
Limited or suggestive evidence of an association
None found

Clearing the Air
Indoor Air Exposures and Asthma Exacerbation
Biological Agents
Sufficient evidence of a causal relationship
Cat
Cockroach
House dust mite
Sufficient evidence of an association
Dog
Fungi/Molds
Rhinovirus
Limited or Suggestive Evidence of an Association
Domestic birds
Chlamydia and Mycoplasma   pneumoniae
RSV
Chemical Agents
Sufficient evidence of a causal relationship
Environmental tobacco smoke (in preschool-aged children)
Sufficient evidence of an association
NO2, NOx (high levels)
Limited or suggestive evidence of an association
Environmental tobacco smoke (school-aged, older children and adults)
Formaldehyde
Fragrances

Clinical Management of Asthma

Diagnosing Asthma:
Medical History
Symptoms
Coughing
Wheezing
Shortness of breath
Chest tightness
Patterns to Symptoms
Severity
Family History

Diagnosing Asthma:
Patient Checklist
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 exposure to allergens
Colds that last more than 10 days
Relief when medication is used

Diagnosing Asthma:
Physical Examination
Sounds of wheezing during normal breathing
Hyperexpansion of the thorax
Increased nasal secretions or nasal polyps
Atopic dermatitis, eczema, or other allergic skin conditions

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

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 pulmonary function
Inhaled corticosteroids
Long-acting beta2-agonists
Leukotriene modifiers

Medications to Treat Asthma:
Quick-Relief
Used in acute asthma episodes
Generally they are short-acting beta2-agonists

Medications to Treat Asthma:
How to Use a Spray Inhaler

Medications to Treat Asthma:
Inhalers and Spacers

Medications to Treat Asthma:
Nebulizers
Uses compressed air machine to deliver medicine as a mist
Good for small children or for severe asthma episodes

Managing Asthma:
Asthma Management Goals
Control symptoms
Prevent exacerbation
Maintain lung function as close to normal as possible
Avoid adverse effects from medications
Prevent irreversible airway obstruction
Prevent asthma mortality

Managing Asthma:
Asthma Management Plan

Managing Asthma:
Sample Asthma Management Plan

Managing Asthma:
Peak Expiratory Flow (PEF) Meters

Managing Asthma:
Peak Flow Chart

Managing Asthma:
Indications of a Severe Attack
Breathless at rest
Hunched forward
Talking in words rather than sentences
Agitated
Peak flow rate is less than 60% of normal

Managing Asthma:
Things You Can Do
Have an individual management plan
Educate yourself and others about—
Asthma management plans
Environmental interventions
Seek help from asthma resources
Join an asthma support group

A Public Health Response
to Asthma

A Public Health Response to Asthma: Surveillance

A Public Health Response to Asthma:
Uses of Surveillance Data
Education about asthma in the population
Basis for planning and targeting intervention activities
Evaluation of intervention activities

A Public Health Response to Asthma: Education

A Public Health Response to Asthma: Coalitions

A Public Health Response to Asthma: Advocacy

A Public Health Response to Asthma: Interventions

A Public Health Response to Asthma: Medical Management
Interventions

A Public Health Response to Asthma:
Environmental
Interventions

A Public Health Response to Asthma:
School
Interventions
Education
Environment
Resolution of school issues


A Public Health Response to Asthma:
School
Interventions

A Public Health Response to Asthma:
School
Interventions

A Public Health Response to Asthma:
School 
Interventions

A Public Health Response to Asthma: Evaluation

A Public Health Response to Asthma:  Summary
Asthma is complex and 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.

Resources
National Asthma Education and Prevention Program
http://www.nhlbi.nih.gov/about/naepp/index.htm
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

Resources
Allergy and Asthma Network, Mothers of Asthmatics. Inc.
http://www.aanma.org/
American College of Allergy, Asthma, and Immunology
http://allergy.mcg.edu
American College of Chest Physicians
http://www.chestnet.org
American Thoracic Society
http://www.thoracic.org