National Asthma Education Program

Abstract

Asthma, a serious chronic condition affecting approximately 10 million Americans, is receiving increased attention as a public health concern because prevalence, health care utilization and expenditures, and mortality have increased significantly in the United States in the past ten years. During this period, the percentage of the US population with asthma increased by one-third. In an effort to improve early detection, treatment and management of asthma, the National Heart, Lung, and Blood Institute (NHLBI) launched a National Asthma Education Program in March, 1989. Chaired by the Director, NHLBI, and comprised of representatives from over 20 professional and lay organizations, the Coordinating Committee helps to plan program objectives, set goals and disseminate information about asthma. The American College of Chest Physicians is represented on the Coordinating Committee by Dr. Robert Barbee, University of Arizona, Tucson. To emphasize the magnitude of the problem, one of the first public documents to be prepared was a Data Fact Sheet on Asthma Statistics. This document, which has already received wide distribution, provides information along with graphs and charts to illustrate a variety of important trends. For example, in 1987, asthma was the primary diagnosis for 450,000 hospitalized patients. Nearly 15 million asthma-related physician visits took place and the annual cost of asthma health care exceeded $4 billion. Health care utilization is disproportionately greater for asthmatic children as compared to asthmatic adults. About 34 percent of all physician visits for asthma involve children under age 20 (Fig 1). Hospital discharge rates for children increased 43 percent between 1979 and 1987. Asthma accounts for well over 100 million days of restricted activity each year. The asthma morbidity and mortality seen during the period 1979 to 1987 occurred across all age, race and sex groups. However, the racial disparity in asthma deaths is significant and continues to increase. In 1979, blacks were nearly twice as likely as whites to die from asthma. By 1987, the asthma death rate was almost three times greater among blacks than among whites (Fig 2). The NHLBI established the National Asthma Education Program to coordinate the efforts of a network of intermediaries including major medical associations, private and voluntary health organizations, and community programs to educate health professionals, patients and the public about asthma treatment and control. By raising awareness of the public and by assuring use of optimal therapeutic and management strategies, the National Asthma Education Program will work to enhance the quality of life for asthmatic patients and thereby decrease asthma morbidity and mortality. The Coordinating Committee is comprised of organizations with a variety of interests. Physicians and nurses from the disciplines of pulmonary, allergy and immunology, pediatrics, family medicine and emergency room medicine are represented. Respiratory therapists, school nurses, mothers of asthmatics and organizations which have a specific interest in minority populations are also represented. In addition to the National Heart, Lung, and Blood Institute, other Federal Agencies participating in this effort include the Center for Disease Control, the Department of Education and the National Institute of Allergy and Infectious Diseases. The specific goals of the program are: to raise awareness among patients, health professionals and the public that asthma is a serious chronic disease; to ensure that patients, their families and the general public recognize the symptoms of asthma and that health professionals diagnose it properly; to encourage a partnership among patients, health professionals and the public to promote effective control of asthma through modern treatment and education programs. Through the efforts of the National Asthma Education Coordinating Committee, programs and activities will be developed to promote better professional and patient education, stressing cooperative management of asthma among health professionals and patients. These efforts will be evaluated to assess the impact on reduction of acute asthma attacks, emergency room visits, and associated days of loss of work or school. One of the first activities is the development of an expert panel report on asthma management with suggested diagnostic and treatment guidelines. This report, scheduled for release in early 1991, will include information on the roles of exercise and allergy in asthma, and asthma in special populations such as the elderly and pregnant women. The Coordinating Committee has divided its efforts into three major areas: school asthma education, professional education and patient/public education. Three panels have initiated their work which will include the development of information packages about asthma targeted to specific groups as well as goals for evaluation. Information about the National Asthma Education program can be obtained from the National Heart, Lung, and Blood Institute, Building 31, Room 4A18, National Institutes of Health, Bethesda, Maryland, 20982.