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Surveillance for Asthma: Measuring a Moving Target

Surveillance for Asthma: Measuring a Moving Target. David M. Mannino Air Pollution and Respiratory Health Branch Centers for Disease Control and Prevention. Why do surveillance for asthma?. Define magnitude of the problem Enable public health planning

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Surveillance for Asthma: Measuring a Moving Target

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  1. Surveillance for Asthma:Measuring a Moving Target David M. Mannino Air Pollution and Respiratory Health Branch Centers for Disease Control and Prevention

  2. Why do surveillance for asthma? • Define magnitude of the problem • Enable public health planning • Follow trends in magnitude of the problem over time • Evaluate the effectiveness of interventions

  3. Issues for asthma surveillance • How is asthma defined? • What questions need to be answered? • How many people have asthma? • How severe is asthma? • How well managed is asthma?

  4. Asthma • A disease characterized by wide variations over short periods of time in resistance to flow in intrapulmonary airways, and manifest by recurrent attacks of cough or wheeze separated by symptom free intervals. The airflow obstruction and clinical symptoms are largely or completely reversed by treatment with bronchodilator drugs or steroids - Godfrey, 1985

  5. CSTE case definition for asthma • Different definitions depending on source of data • patient interview • administrative data • interview plus laboratory findings • Confirmed, Probable, Suspected classification • Available at www.cste.org/ps/1998/1998-eh-cd-01.htm

  6. Prevalent Asthma in Surveys is based on…. Person (or proxy) reporting (hopefully accurately) of Physician (or health care provider) diagnosis of asthma that was (hopefully accurately) made based on the (hopefully accurate) report of symptoms by the person (or proxy) who (hopefully accurately) recognized these symptoms.

  7. Problems in Defining Asthma CENTERS FOR DISEASE CONTROL AND PREVENTION

  8. Problems in Defining Asthma 8 to 11 year olds in New South Wales, Australia Airways Hyperresponsiveness 18% Asthma 13% 7% 7% 5% 5% 17% Symptoms 34% 59% Salome et al, 1987 CENTERS FOR DISEASE CONTROL AND PREVENTION

  9. From Turner-Warwick’s Respiratory Disease, 1989

  10. Acute Reversibility in Clinic Patients with COPD or Asthma COPD Asthma N= 1095 COPD and 491 Asthma Personal Communication, F Hansen

  11. Asthma Prevalence in US, 1980-1999 Per 1,000 population. Race-, sex- and age-adjusted to 2000 U.S. population Lifetime Asthma Asthma prevalence during the preceding 12 months Episode of asthma or asthma attack during the preceding 12 months

  12. Restricted Activity Days Attributable to Asthma From NHIS, 1995

  13. Physician Office and Hospital Outpatient Visits for Asthma, United States, 1980-1999 Per 1,000 population. Race-, sex- and age-adjusted to 2000 U.S. population Includes hospital outpatient visits from 1992 forward

  14. Emergency Department Visits for Asthma, United States, 1992-1999 Per 10,000 population. Race-, sex- and age-adjusted to 2000 U.S. population

  15. Hospitalizations for Asthma, United States, 1980-1999 Per 10,000 population. Age-adjusted to 2000 U.S. population

  16. Asthma Deaths, United States 1980-1999 Per 1,000,000 population. Race-, sex- and age-adjusted to 2000 U.S. population International Classification of Disease, 9th Revision International Classification of Disease, 10th Revision

  17. Asthma in BRFSS • 1996-present: State added questions • 1999: Two optional questions • Have you ever been told you have asthma? • Do you still have asthma? • 2000-2009: Two questions in Core • 2001-2009: Optional module for asthma severity in adults and asthma prevalence in children

  18. Asthma Surveillance • Measuring Asthma Prevalence and Severity in Children • Lara Akinbami • Asthma in Adults- What you need to know • Deborah Rose • Update on the National Asthma Survey • Jeanne Moorman

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