Health Policy and Pediatric Asthma

1. Health Policy and Pediatric Asthma By Gail Brottman MD Director, Pediatric Pulmonary Medicine Hennepin County Medical Center Minneapolis, MN

2. The Issues • Asthma is the most common chronic illness in children • The prevalence is increasing, especially in the very young • Huge psychosocial burdens • The economic burden of asthma are increasing into the 10s of billions of dollars • School days are lost • Parent work days are lost

3. Asthma Statistics

4. What are the Goals of Asthma Care? The National Institutes of Health (NIH) has established the following goals for asthma management: • No missed school or work due to asthma • No sleep disruption • Maintenance of normal activity levels • No (or minimal) need for ER visits/hospitalizations • Normal or near-normal lung function Reference: National Asthma Education and Prevention Program. Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma. Bethesda, Md: National Heart, Lung, and Blood Institute, National Institutes of Health; April 1997. NIH publication 97-4051.

5. No missed school or workdue to asthma No sleep disruption 24% of children with asthma and 25% of adults with asthma have missed school or work because of asthma-related problems in the past year Almost one in three asthma patients (29%) reported being awakened with breathing problems at least once a week How Far Have We Fallen Short? Researchers for Asthma in America™ discovered the following discrepancies: Data from Minneapolis and St Paul (Continued)

6. Maintenance of normal activity levels No (or minimal) need for ER visits/hospitalizations 40% of patients say asthma limits their ability to take part in sports or recreation; 25% say it limits their normal physical exertion; 21% say it interferes with social activities 18% of children and 19% of adults went to the emergency room for asthma attacks in the past year 55% of children and 36% of adults had unscheduled emergency visits to a doctor’s office, clinic, or somewhere else in the past year How Far Have We Fallen Short? (continued)

7. Asthma Significantly Disrupted School and Work for Many Asthma Patients, Contrary to NIH Goals,Have Missed Work/School in the Past Year Due to Asthma 49% 32% 25% Base: All respondents (unweighted N=2509).

8. Barriers to Asthma Care: A Potential Gap inPatient-Provider CommunicationsAsthma Practices- Two Perspectives: Patients and Doctors 97% Patient Doctor 92% 90% 83% 70% 70% 55% 35% 28% 27% Base: All patients (unweighted N=2509), all doctors (unweighted N=512).

9. Asthma As a Community-wide Problem • Factors contributing to successful Asthma management • Timely diagnosis/access to providers • Treatment based on severity level • Culturally sensitive asthma education • Access to medication and spacers • Meaningful communication with schools/daycares • Trigger-free environments

10. Policy Changes? • Asthma screening at well child visits • Establish a tracking system for high risk patients to facilitate case management services • No Written Asthma-Plan, No School • Reimbursement for asthma education services delivered by certified asthma educators

11. Policy Changes? • “Asthma Friendly” certification for schools and daycares who receive special training • Establish pediatric asthma performance criteria for health care providers • Establish standard health benefits for children with asthma • Facilitate better housing and indoor air quality standards • Support anti-smoking legislation

12. The Ultimate Goal • Develop and Maintain Asthma Friendly Communities in Minnesota • Minnesota Asthma Coalition • Controlling Asthma in American Cities Project • State Strategic Plan for Addressing Asthma in Minnesota