Clear Messaging for Asthma

Education and awareness play key roles in the diagnosis and management of asthma. Nurses, respiratory therapists, physicians and asthma educators need to partner with patients in order to minimize the impact of asthma on their lives, according to Cary Sennett, MD, PhD, president and CEO of the Asthma and Allergy Foundation of America (AAFA), and Fellow of the American College of Physicians.

The primary focus of asthma control is to reduce impairment and risk by working with patients to understand the severity of their asthma, identify ways to control the disease and measure how responsive they are to their asthma plan, said Robert Jones, RRT, RPFT, AE-C, certified asthma educator, Memorial Medical Center in Ashland, Wisc.

Have Asthma Rates Decreased?
The National Health Interview Survey (NHIS) released by the U.S. Centers for Disease Control and Prevention (CDC) in 2013 revealed, after years of steady increase, a significant decrease in “self-reported prevalence” of asthma. As reported by the CDC, the percentage of persons of all ages who experienced an asthma episode in 2013 was 3.8% (95% confidence interval = 3.53%-4.02%), significantly lower than the 2012 estimate of 4.4%.

While happy that reports like this get people thinking and talking about asthma, Sennett finds the results surprising and instructs others to interpret with some caution.

Even if the prevalence of asthma has come down, Sennett reminds us there are still 25 million Americans suffering from asthma. “We can’t become complacent about asthma but rather need to continue to minimize environmental risks for those individuals, provide access to care, and educate about the disease,” he said.

The CDC conducted household interviews to collect data from a sample of the civilian non-institutionalized population. Information on an episode of asthma or asthma attack during 2013 was self-reported by adults aged 18 and over. For children under age 18, the information was collected from an adult family member knowledgeable about the child’s health.

Sennett believes there are methodological issues that might affect the results. Noting that the survey was primarily conducted via telephone, he explained asthma prevalence rates are “highest among urban poor who are the least likely to have landlines so they might have been more difficult to reach. This could skew the results.”

NHIS results are widely distributed and could be misinterpreted by consumers and policymakers at the local, state and national levels. “We need to take a step back and make sure we really understand what these prevalence results mean, before reacting to the report,” Sennett said. “The CDC reported data for 2013. We should be cautious about what a single year’s results mean: one data point does not make a trend.”

Asthma statistics suggest prevalence in urban, disadvantaged populations is higher than in other populations, Sennett told ADVANCE. “Asthma affects all Americans, but a disproportionate share of the burden of illness falls to those in urban settings-regrettably, many of whom are children.”

According to Jones, the statistics in Wisconsin show the number of local asthma cases have stabilized or increased slightly. “We don’t have the triggers that other places have,” he said. “We have pollen and tree pollen but we don’t have smog or other allergens that are a problem in big cities.”

Educate the Masses
Air quality, a significant trigger for asthma, is poorer in urban than in suburban settings. Additional triggers include dust, mites, rodents, cockroaches and other environmental allergens that are harder to clear or dispose of in urban settings, and in particular, in homes where individuals may not have the financial means to deal with infestation and other triggers.

“The presence of mites, dust, air pollution and other allergenic triggers accounts for the higher rate of asthma in urban areas,” Sennett said.

AAFA provides a certification program that allows individuals to recognize products in the marketplace that can help reduce allergens and pollutants. “After rigorous testing, we put a seal on products or services that help reduce allergen exposure,” Sennett said. “Our organization has evaluated and certified vacuums, air conditioners and other household products.”

According to Sennett, the air quality issue needs to be solved but will require vigilance over many years. “Locally, we need to educate people who work with patients who have asthma; patients with asthma; and parents of children with asthma about what they can do to mitigate risks at home and in the workplace and schools,” he said.

People need to be educated about what triggers asthma, but also how to use medications to prevent and control episodes when they occur. “We need to make sure that people have access to medications but also know how to use them and understand the importance of compliance with controller medications,” Sennett said.

Jones agrees that educating patients about asthma, including the types of things that can trigger asthma and what they can do to improve their quality of life, is the cornerstone of asthma care. He encourages patients to take allergy tests to discover their specific allergies. Common irritants and triggers include hayfever, cats, dust, mold, perfume and secondhand smoke.

“We can usually pinpoint a change in lifestyle, such as adding a pet to the household, that is triggering asthma,” Jones said. “We can treat with medication so patients can continue to live the lifestyle they are looking for and not have to live without their pets, for example.”

Diagnosis & Treatment
Jones spends about 50% of his time working in the cardiopulmonary department where he conducts tests such as the methacholine challenge test, a definitive test for asthma for those older than 5 years old.

Jones spends up to one and a half hours interviewing patients during an assessment. He has the patients fill out an asthma control test (ACT test), which asks a series of relevant questions to collect information including number of nighttime awakenings, a profile of activity level and effects of asthma on activity level.

Once Jones has conducted a pulmonary function test, he then identifies a step-by-step plan to manage the patient’s asthma. “I administer tests for asthma and make recommendations to physicians on how to treat and manage patients with asthma,” Jones said.

Jones helps patients establish goals about their activity level and determine what they want to change to achieve those goals. “Then we can monitor their activity limitations, pulmonary function testing, frequency of symptoms, and manage their asthma to achieve those goals by possibly increasing or decreasing medications as needed,” he explained.

Role of Allied Health
Nurse practitioners and physicians should apply the knowledge and resources collected by asthma educators to help manage their patients with asthma. “We use a step-wise approach that can help the care of asthma patients,” Jones said. “We put all of the elements together during the visit to make an asthma care plan.”

Jones became interested in the asthma educator role when credentialing opened up to nurses, doctors, RTs, social workers and pharmacists. “With the certification, I feel more confident and prepared making recommendations to physicians regarding treatment of this patient population,” he stated. “Further, there are resources available to reinforce my suggestions.”

AAFA educates allied health professionals, asthma educators and nurses who can help patients who are at risk for or who have asthma. The organization offers an online education program for providers and offers free continuing education credits, all targeted at non-physician providers.

The organization educates patients as well by providing tools on its website, www.aafa.org, that can be used to assess triggers in their home and environment and to identify ways to reduce the severity of their (or their child’s) illness. “We focus on helping patients, caregivers and policymakers to understand and address the issues of asthma,” Sennett said.

Asthma is truly a life threatening disease, Sennett added. He would like organizations to focus on addressing the issues that limit the lives of those suffering from asthma. “We are nowhere near eliminating the disease,” he said. “But, there are many things we can do better to reduce the impact that asthma has on the lives of those with the disease.”

Rebecca Mayer Knutsen is on staff at ADVANCE. Contact: rknutsen@advanceweb.com

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