ALA’s Asthma Programs

2. ALA’s Asthma Programs Reducing the Burden of Illness and Death Katherine Pruitt Director, Best Practices CDC Teleconference May 2003

3. About the Lung Association • Founded in 1904 to combat tuberculosis • Current mission is to prevent lung disease and promote lung health • Grass-roots association of 75 state and local constituents, with numerous additional small branch offices

4. Visionary Lung Health Goals • Tobacco-related lung disease will be eliminated in future generations • Asthma will no longer be a burden to patients and their families, nor will it cause illness and death • The air we breathe will not cause or worsen lung disease • ALA will monitor lung health status and be the champion for those affected by lung disease

5. Asthma Results Indicators • By 2007, states will have asthma public health infrastructures and 50% of states will meet minimum CDC guidelines for funding • By 2007, 75% of children will attend schools that have adopted a comprehensive asthma management program • By 2010, there will be a 50% reduction in hospitalization and emergency room visits • By 2007, there will be a 50% increase in people with asthma getting influenza vaccine

6. How Will We Get There? • Advocacy • Education • Research

7. Focus on Advocacy • Public Health Infrastructure • Schools • Access to Health Care • Air Quality

8. Public Health Infrastructure • State Health Program • Healthy People 2010 • Comprehensive Program Infrastructure

9. Asthma in Schools • Asthma Medication in Schools • School Nurses • Comprehensive School Legislation

10. Access to Health Care • Prescription Asthma Medications • Emergency Services • Specialty Care

11. Air Quality • Indoor Air Quality in Schools • Environmental Tobacco Smoke • High Air Pollution Days

12. Focus on Education • Early Childhood Asthma Programs • Open Airways For Schools • IAQ Tools for Schools • Asthma-Friendly Schools Initiative • Master Home Environmentalist • Asthma Certification Program

13. Early Childhood Asthma Programs • Co-sponsor, with Sesame Workshop, of Sesame Street A is for Asthma, a bilingual asthma management video for preschoolers • Counting on You, developed by ALA of Wisconsin, includes a concise manual and training materials for daycare and preschool providers

14. School-based asthma education program, developed and tested at Columbia University Teaches children, aged 8-11, how to detect asthma warning signs and environmental factors that can trigger an asthma attack Open Airways For Schools

15. Open Airways For Schools • Six 40-minute group sessions for children with asthma held during the school day • Written materials for parents • Homework assignments with parents

16. OAS Learning Objectives • Recognize asthma symptoms • Initiate management steps • Communicate with parents and teachers • Recognize when medical care is needed

17. OAS Outcomes • Increased self-management skills, self-efficacy and influence on parent’s management decisions. • Improved quality of life and social support from peers • Improved academic performance • Reduced frequency of days with symptoms of asthma

18. OAS School Study Outcomes

19. OAS Implementation • Trained volunteers, including school nurses, parents, health care students, and community groups teach the program • Funding for implementation from CDC and EPA • Since 1995, program has been implemented in over 30,000 schools reaching more than 400,000 children

20. Indoor Air Quality Tools for Schools • Partnership with EPA’s Indoor Environments Division since 1997 • Open Airways For Schools teaches children to take control of their asthma • However, children cannot control asthma triggers resulting from indoor air pollution

21. The US Government Accounting Office estimates that 28,100 schools housing some 15.5 million students, have less than adequate heating, ventilation and air conditioning systems. 15,000 schools, housing about 8.4 million students, characterized their air quality as unsatisfactory. Condition of America’s Schools

22. IAQ TfS Components Basics An overview of IAQ • How this Kit is organized • Who is the IAQ Coordinator • Who are the team members • Why IAQ is important • Understanding problems and solutions IAQ Management Plan A flexible format foraction • How the IAQ Management Plan works • 10 steps to activate the Plan • 19 steps for implementing the Plan • IAQ Management Plan checklist & log • Communication do’s and don’ts Resolving IAQ Problems Appendices How to identify and fix IAQ problems Additional supporting information • Identifying & reacting to emergencies • The Problem Solving Wheel • Problem Solving checklist • Crisis communication • Hiring outside help if needed • Developing IAQ policies • Information on specific pollutants • Resources for additional information

23. IAQ Checklists Building Maintenance Food Service Waste Management Renovation and Repairs Teachers Administrative Staff Health Officer Ventilation

24. IAQ TfS Implementation • About 60 local Lung Associations actively promoting IAQ Tools for Schools • Since 2000, involved in successful implementation in over 600 schools • Cleveland, Dallas and Denver Public Schools are implementing OAS and TfS • LA Unified and Boston have adopted a district wide resolutions calling for the adoption of both programs

25. Asthma-Friendly Schools Initiative • Use a coordinated community approach to the school asthma management program • Provide appropriate school health services • Provide asthma education and awareness • Provide a healthy school environment • Provide students with asthma with appropriate daily physical activity

26. AFSI Community-based Approach • Involve parents and students • Involve community healthcare providers • Involve community asthma programs • Involve school and community social support systems • Facilitate linkages with students’ medical home

27. AFSI School Health Services • Provide a fill time registered school nurse • Identify and track all students with asthma • Use Asthma Action Plans • Assure access to medications • Use standard emergency protocols • Assure access to a consulting physician • Provide intensive case management as needed

28. AFSI Asthma Education • Educate all school personnel, including bus drivers • Educate students with asthma • Educate parents • Provide asthma awareness education to all students

29. AFSI Healthy School Environment • Assure smoke-free buildings and grounds • Provide smoking cessation services for students and staff • Proactively maintain indoor air quality • Use Integrated Pest Management • Manage exposure to high levels of outdoor air pollution

30. Appropriate Daily Physical Activity • Encourage full participation when students are well • Assure ready access to pre-medication as prescribed • Provide modified activity as needed • Provide individualized health plan describing implementation steps for students Asthma Action Plan

31. Asthma-Friendly Schools Toolkit • Targets local Lung Associations and asthma coalitions • Customizable • Helps develop comprehensive asthma management plan for schools • Includes strategies for implementation of plans

32. Asthma-Friendly Schools Toolkit • Asthma-Friendly Schools Website • All forms available for download • Asthma Incident Report (AIR) database • Free to school nurses for case management/tracking of student’s asthma • CD-ROM • Contains copy of database, Toolkit, and Forms • Binder

33. Asthma-Friendly Schools Toolkit • Asthma-Friendly Schools Website • All forms available for download • Asthma Incident Report (AIR) database • Free to school nurses for case management/tracking of student’s asthma • CD-ROM • Contains copy of database, Toolkit, and Forms • Notebook

34. Coming Soon • Toolkit to be completed summer of 2003 • Available to all local lung associations and other agencies upon request • Validation of the Toolkit • Four mini-grants to local Lung Associations • Implement an Asthma-Friendly Schools Program • Evaluate the program, toolkit, and implementation process

35. Master Home Environmentalist • Home assessment program developed by the ALA of Washington • Intensively trained volunteers conduct home walk-through with checklist • Focus primarily on mitigation of asthma triggers • Evaluation results include long-term behavior change and anecdotal health improvements

36. Asthma Educator Certification Program • ALA a lead organization in developing the new nationwide asthma educator certification program • National Asthma Educator Certification Board started offering certification exam this year • Local Lung Associations conducting exam prep training courses

37. Focus on Research • Asthma Clinical Research Centers • “Career Ladder” grant support program for young lung health researchers • Locally-supported clinical, behavioral and intervention research

38. Asthma Clinical Research Centers • Network conducts large clinical trials that have direct impact on patient care and asthma treatment • Largest clinical network outside of the pharmaceutical industry

39. First Published ALA-ACRC Study Objective: “Does the flu vaccine make asthma better, worse or have no effect?”

40. Asthma and Flu Shot Findings “The inactivated influenza vaccine is safe to administer to adults and children with asthma, including those with severe asthma. Given the morbidity of influenza, all those with asthma should receive the vaccine annually.” N Engl J Med 2001;345:1529-36

41. Ongoing ACRC Investigations • Genetic Basis of Asthma • Are genes a cause of asthma; do they modify asthma or do they affect a patient’s response to asthma medication? • Monitoring Lung Function After Flu Vaccine • Are changes in lung function following the flu vaccine better calculated through a device called an airwatch spirometer, which measures FEV1? • Diet and Influenza Vaccine • What is the link between diet and asthma severity? • Corticosteroids and the Flu Vaccine • What are the long-term effect of corticosteriods on the immune system’s response to the flu vaccine? • Risk Stratification • What are specific patient characteristics associated with increased risk of asthma exacerbations?

42. ALA Working With Partners • State and local health, environmental, social service and education agencies • Health care providers • Schools • Academic institutions • Environmental organizations • Community groups

43. Lung disease is the third leading cause of death in America. Over the last decade, the death rate from lung disease has been growing faster than the rate from almost any other leading killer. Since 1904, the American Lung Association has been fighting lung disease through education, community service, advocacy, and research. We are working to help those who suffer from lung disease today, and to stop the spread of lung disease tomorrow. To succeed, we need your support. Contact your local Lung Association to find out how you can join the fight.