P1258772459EhrSB

1
Sponsored by The American Lung Association of
Eastern Missouri
2
WHAT IS ASTHMA?

• ASTHMA IS A CHRONIC DISEASE THAT CAUSES THE
  AIRWAYS TO BECOME IRRITATED AND SWELL WHICH CAN
  CAUSE DIFFICULTY IN BREATHING. IT IS USUALLY
  PERIODIC IN NATURE BUT PEOPLE HAVE DIFFICULTY
  WITH IT YEAR ROUND.

3
IS ASTHMA SERIOUS?

• THE EFFECTS OF ASTHMA CAN RANGE FROM VERY MILD
  PROBLEMS TO LIFE THREATENING EVENTS.

4
WHO GETS ASTHMA?

• OVER 14.6 MILLION PEOPLE IN THIS COUNTRY ALONE
• CAN AFFECT ALL AGES
• 4 MILLION CHILDREN AFFECTED
• BOYS HAVE A SLIGHTLY HIGHER FREQUENCY THAN GIRLS
• TENDS TO RUN IN FAMILIES

5
Asthma in America

• Conducted between mid- May and mid-July 1998
• Explored asthma prevalence, frequency and
  severity of symptoms, utilization of emergency
  care, quality of life, and quality of care
• Initial screening of 42,022 geographically
  stratified U.S. households

6
Asthma in America

• Five Major Conclusions
• Asthma in America is falling far short of the
  goals established by the NHLBI/NIH
• Poorly controlled asthma symptoms cause
  hospitalizations, emergency room and urgent care
  visits, sick days, and activity limitations that
  may cause asthma suffers to accept a much lower
  quality of life than need be

7
Asthma in America

• Five Major Conclusions (cont)
• Although physicians report that they are
  following NHLBI guidelines and patients are
  generally satisfied with their care, the level of
  care reported by patients does not meet the
  current standards
• Patients misunderstand the underlying condition
  that causes asthma symptoms, and they are
  confused about appropriate treatment and other
  aspects of asthma management

8
Asthma in America

• Five major Conclusions (cont.)
• People with asthma recognize the need for greater
  patient education--71 believe there is a strong
  need for more patient education about asthma

9
Asthma in AmericaMissed Goals

• GOAL Minimal or no need for emergency room
  visits or hospitalizations no missed work or
  school no sleep disruption maintenance of
  normal activity levels
• Of patients over the past year
• 41 of adults and 54 of children were
  hospitalized, treated in emergency rooms or
  required other urgent care
• 49 of children missed school because of asthma
• 25 of adults missed work because of asthma
• 30 awakened at least one night a week

10
Asthma in AmericaMissed Goals

• GOAL Minimal or no need for emergency room
  visits or hospitalizations no missed work or
  school no sleep disruption maintenance of
  normal activity levels
• Of patients with asthma
• 48 say it limits their ability to take part in
  sports or recreation
• 36 say it limits their normal physical exertion
• 31 say it limits their lifestyle
• 25 say it limits their social activities

11
Grassroots Advocacy

• Affecting Change, Creating Laws

12
Why Legislative Action?

• Why Now?

13

• Because an estimated 17 million Americans
  suffer from asthma.
• Because nearly 5 million of those are under
  age 18.
• Because Asthma it is the most common chronic
  childhood disease, affecting more than one child
  in 20.

14
How can you Advocate?

• Write a letter
• Visit your legislator
• Make a phone call
• A 20-second phone call could make the
  difference between a bill becoming a law or
  failing!

15
What do I have to do?

• BE ACTIVE!!!

16
Remember. one person can make a difference!!!
17
What we know aboutAsthma

• A report to the community
• Fall 2001

18
Dr. Mario Castro, MD, MPH, chair of the St. Louis
Regional Asthma Consortium states in his open
letter to the community from this report that

• St. Louis City and County have the highest rate
  of asthma hospitalizations and emergency room
  visits in Missouri
• Some areas of St. Louis are estimated to have
  15-20 of children with asthma, and up to 50 of
  children experience some type of asthma-like
  wheezing or chronic cough
• African-Americans in the St. Louis region are
  3.6 times more likely than whites to die from
  asthma

19
According to the Missouri Department of Health,
approximately 10 of Missouri Adults report that
they have been diagnosed with asthma at some time
in their life. Approximately 14.4 of Missouri
households with children report having at least
one child with asthma. The Missouri Department
of Health ranks asthma as the second highest
occurring preventable hospitalization in the
state.

• 99 of asthma hospitalizations are estimated to
  be preventable. This equates to preventing
  49,656 hospital admissions, which would have save
  327 million dollars for the years 1993-1999.

Missouri Information for Community Assessment -
MICA
20
Missouris Eastern District leads the state in
asthma-related hospital admissions and emergency
room visits and represents 44 of the states
total cost, or 192 million.
The Eastern District includes St. Louis City,
St. Louis County, St. Charles, Jefferson and
Franklin counties.
21
Missouri Asthma Facts

• More women than men reported having asthma.
• Young adults aged 18-29 had the highest
  prevalence of asthma elderly adults over 75 the
  least.
• African-American adults and children had a higher
  prevalence of asthma than whites or other racial
  groups.

Missouri Department of Health Statistics,
1993-1998
22
Missouri Asthma Facts

• Nearly half of all asthma hospitalization cases
  came from the St. Louis area.
• Among males, the asthma hospitalization rate for
  African-Americans was greater than the rate for
  whites across all age groups in the state. The
  largest disparity is evident in the 15 and under
  age group.
• Among African-Americans in the state of Missouri,
  two thirds of emergency room cases came from the
  St. Louis Area.

23
The risk of hospitalization for children with
asthma was 8.4 times greater in lower
socioeconomic zip codes and 5.3 times greater in
those zip codes with a higher percentage of
African-Americans.

• Similarly, the risk of death due to asthma was
  6.4 times greater in the lower socioeconomic zip
  codes.

24
Asthma Deaths in Missouri
From 1993 to 1998, there were 589 deaths due to
asthma. The cumulative rate for all of Missouri
was 1.3 deaths per 100,000
25
The St. Louis Regional Asthma Consortium
conducted a survey in 2001 of 131 school
administrators, 119 health care providers and 7
medical directors of managed care plans. Based
on their responses, the survey tells us that a
disconnect exists among all the major players in
asthma care.

• Doctors believe they are doing what they should,
  yet patients report they are not receiving the
  type of care or information they need.
• School administrators believe policies are in
  place, while school nurses articulate frustration
  with a lack of policies and personnel.
• Managed care reports that resources are
  adequately provided for, yet patients feel there
  is a lack of these resources.

26
More than 34 of school administrators report
only a part-time nurse or no nurse in the school
setting.
27
What Physicians Think

• More than 85 of the physicians surveyed felt
  NAEPP (National Asthma Education and Prevention
  Program) guidelines were useful and 87 say
  NAEPP guidelines help standardize care. Of the
  physician groups surveyed, internists were the
  least likely to develop a written asthma action
  plan with the patient.

We need to acquaint the primary care physicians
with best practices for managing asthma,
especially emphasizing the early use of
anti-inflammatory drugs. Secondly, we need to
educate asthma patients and their
families. -Raymond Slavin, MD St. Louis
University School of Medicine
28
What Physicians Think

• Allergy/pulmonary specialists and general family
  practitioners reported that the current health
  care environment perpetuates the view that asthma
  is an episodic rather than a chronic disease.
  Finally, all the physicians strongly agreed that
  most patients were not aware of resources and
  services available to them regarding asthma.

29
Area Health Plans

• Type of Asthma Education Provided by St. Louis
  Area Health Plans

30
Most health plans surveyed have restricted
coverage or no coverage at all for nicotine
replacement products. None of the plans have a
protocol for identifying tobacco users, nor do
they refer tobacco users for cessation counseling.