The State of Childhood Asthma

1
The State of Childhood Asthma Future
Directions Strategies for Addressing a Leading
Chronic Childhood Disease in the United States

• December 14, 2006

2
Introduction Overview of Childhood Asthma

• Floyd Malveaux, MD
• Executive Director
• Merck Childhood Asthma Network, Inc.

3
Background Background and Rationale

• Childhood asthma is one of the most common
  chronic diseases among children in the United
  States.
• The debilitating effects of this condition are
  well-documented and exact a huge toll on the
  affected children and their families, especially
  in medically underserved communities.
• While asthma is a treatable disease, actual
  treatment falls far short of recommended care for
  many children.
• We face a major challenge and opportunity to
  address this urgent public health issue.

4
Goal

• The goal of this conference was to convene a
  round table of experts and thought leaders from
  multiple disciplines across the United States to
  identify, discuss and recommend strategies for
  best practices in research, policy, management,
  and prevention that will begin to close the gap
  between recommended and actual management.

5
Collaborators and Steering Committee

• Agency for Healthcare Quality Research
• Helen Burstin, Denise Dougherty
• Centers for Disease Control Prevention
• Paul Garbe, Elizabeth Herman (NCEH)
• Lara Akinbami, Jennifer Madans, Edward Sondik
  (NCHS)
• National Heart, Lung and Blood Institute
• Robert Fulwood, Virginia Taggart
• National Institute of Allergies Infectious
  Diseases
• Peter Gergen
• National Institute of Environmental Health
  Sciences
• Mary Gant
• US Environmental Protection Agency
• Alisa Smith

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Merck Childhood Asthma Networks (MCAN) Mission

• To support and advance evidence-based programs
  that improve the quality of life for children
  with asthma and their families and to reduce the
  burden of the disease on them and society through
  the dissemination of effective interventions.

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The State of Childhood AsthmaNational Picture of
Asthma

• Asthma is a leading chronic childhood disease in
  the United States with 6.5 million children
  affected nearly 9 percent of children
• Large burden for affected children and their
  families and major cause of childhood disability
• Causes of asthma and rising prevalence remain
  unclear
• Means to control asthma are well-established, yet
  many children with asthma still have poor asthma
  control
• Growing evidence of environmental impact (e.g.,
  allergens, pollution, and social determinants) on
  incidence and morbidity

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The State of Childhood AsthmaCurrent Trends

• After dramatic rise from 1980 to the mid-1990s,
  asthma prevalence remains at historically high
  levels
• Visits to physician offices and hospital
  outpatient departments have continued to grow
  since 2000, despite the plateau in prevalence
• Asthma hospitalization rates also remain at
  historically high levels reached during the
  mid-1990s
• The burden of avoidable emergency department
  visits and hospitalizations for asthma is high
  and has remained relatively resistant to
  intervention efforts

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The State of Childhood AsthmaPatterns by Age and
Race

• Asthma prevalence increases with age, but health
  care use is highest among the youngest children.
• One in 11 of all children in the United States
  suffer from asthma. Even more alarming
• 1 in 5 Puerto Rican children have asthma
• 1 in 8 African-American children have asthma
• Racial disparities in adverse outcomes such as
  emergency department visits, hospitalizations and
  death are substantially higher than prevalence
  disparities.
• Compared to Caucasian children, African-American
  children have
• 260 more emergency department visits
• 250 more hospitalizations
• 500 high death rate from asthma
• The disparity in asthma mortality between
  African-American and Caucasian children has
  increased in recent years.

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Overview of Conference Process and Discussion

• Herman Mitchell, PhD
• Senior Research Scientist
• Rho, Inc.

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Conference Objectives

• Review the status of childhood asthma in the
  United
• States
• Identify ongoing and latest developments in
  best
• practices
• Identify priority strategies to implement best
• practices
• Develop consensus regarding next steps
• Issue new recommendations and calls-to-action

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Day 1 Topics of Discussion

• Status of Childhood Asthma in the U.S.
• Development and Management of Asthma in Children
• Critical Role of the Environment Emerging Risk
  Factors
• Gene-Environment Interactions and the Development
  of Asthma
• Quality Care Challenges Opportunities
• Effectiveness of Evidence-Based Interventions

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Day 2

• Finalize and Prioritize Findings
  Recommendations
• Development and Consensus of the Call-to-Action

14
Recap of Touchstone Presentation

• Nicole Lurie, MD, MSPH
• Senior Natural Scientist and Paul O'Neill Alcoa
  Professor of Policy Analysis
• RAND Corporation

15
Call-to-Action

• Floyd Malveaux, MD
• Executive Director
• Merck Childhood Asthma Network, Inc.
• Noreen Clark, PhD
• University of Michigan

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Call-to-Action

• According to a recent report by the CDC, the
  prevalence of childhood asthma, one of the
  nations leading chronic disease affecting
  children, is at unacceptable high levels.
• Much has been done over the past 20 years to
  address treatment and management of the
  condition, yet we continue to see an increase in
  disparities among underserved minority
  populations.
• The time has come to put childhood asthma back on
  Americas radar screen by encouraging action by
• Policy makers
• Healthcare community
• Researchers
• Communities
• Families and their children
• The goal of the call-to-action is to apply those
  best practices that we know work on a national
  level to reduce the burden of this condition,
  particularly in underserved minority communities
  across the United States.

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General Recommendation

• Recommendation to encourage the federal agencies
  to develop a coordinated asthma research strategy
  across all agencies

18
Share Community Data

• Develop a national network for local asthma
  surveillance to gather, evaluate, and disseminate
  asthma information (e.g. incidence, prevalence,
  cost, morbidity, mortality, SES and ethnicity) to
  key community audiences
• Policy makers
• Healthcare community
• Researchers
• Communities
• Families and their children

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Develop Education Tools

• Engage and equip the asthma care team with tools
  which provide them with knowledge, skills, and
  resources to effectively advise asthmatic
  patients about environmental triggers, including
• Smoking cessation
• Allergen mitigation
• Public education classes for families

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Create a National Movement

• Galvanize a national childrens asthma movement
  linked directly to local to local community-based
  organizations and coalitions
• Focus this movement on key policy issues and
  barriers to quality care leadership coalition
  will be charged with establishing strategies for
• Promoting and implementing the adoption of the
  revised NAEPP guidelines scheduled for release in
  2007
• Identifying data on the cost-effectiveness and
  return of investment of quality initiatives/best
  practices
• Developing a repository of best practices and
  quality information
• Protecting the program that provides early
  periodic screening, detection and treatment for
  children which is critical to help the most
  vulnerable children
• Utilize social marketing strategies to convey
  important asthma messages to key audiences and
  the general public
• Work with CMS to assess best practices in
  Medicaid and S-CHIP and promote best practices
  across the country
• Evaluate reimbursement strategies to ensure that
  those who are most in need receive access to
  quality care

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Implement Known Effective Strategies

• Improve quality care for all children with
  asthma, across the board by
• Targeting key influentials to invest resources in
  evidence-based community and individual
  interventions, including
• CEOs of hospitals
• MCO managers
• Community-based organizations
• Other public and private reimbursers of care such
  as S-CHIP
• Implementing tailored interventions strategies
  community and/or home-based that focus on
  individualized risks

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Questions Answers
23
Thank You

• For more information on childhood asthma,
• please visit www.mcanonline.org
• A Web cast of the two day conference will also be
  available on the Web site on December 20th