Asthma Program Evaluator

Low-income adults with uncontrolled asthma saw both their asthma control and quality of life improve with the help of an in-home, self-management asthma support program delivered by community health workers (CHWs), according to a report published online by JAMA Internal Medicine.

Asthma affects 24.6 million American, including 17.5 million adults. Control of asthma is inadequate despite the availability of effective methods to manage it. Home-based self-management support to improve asthma control among children is well established. However, the effectiveness of home visits for adults has not been well studied.

James Krieger, M.D., M.P.H., of Public Health-Seattle and King County, Washington, and co-authors report on the Home-Based Asthma Support and Education trial (HomeBASE). The study enrolled 366 participants with uncontrolled asthma: 189 to usual care and 177 to the intervention, which included CHWs who provided education, support and service coordination during home visits. The CHWs provided an average of 4.9 home visits during a one-year period.

The intervention group had greater increases in the average number of symptom-free days over two weeks (2.02 days per two weeks more) and quality of life as measured on a questionnaire increased an average of 0.50 points. However, average urgent health care use episodes in the past 12 months decreased similarly in both groups from an average of 3.46 to 1.99 episodes in the intervention group and from an average of 3.30 to 1.96 episodes in the usual care group.

“We anticipate that this intervention could be readily replicated by health organizations serving diverse, low-income clients, suggesting that it could reduce asthma-related health inequities. Intervention protocols can be implemented without specialized training or resources. The cost per participant was approximately $1,300 (2013 U.S. dollars), substantially less than one year’s supply of an inhaled corticosteroid,” the study concludes.

"Trends in Racial Disparities for Asthma Outcomes among Children 0 to 17 Years, 2001-2010."

Authors: Akinbami, Lara J., MD, Jeanne E. Moorman, MS, Alan E. Simon, MD, and Kenneth C. Schoendorf, MD

Journal of Allergy and Clinical Immunology, Volume 134.3 (2014), 547-553

View the full article here: http://www.jacionline.org/article/S0091-6749(14)00798-2/fulltext

Abstract:
Background –
Racial disparities in childhood asthma have been a long-standing target for intervention, especially disparities in hospitalization and mortality.

Objectives –
Describe trends in racial disparities in asthma outcomes using both traditional population-based rates and at-risk rates (based on the estimated number of children with asthma) to account for prevalence differences between race groups.

Methods –
Estimates of asthma prevalence and outcomes (emergency department [ED] visits, hospitalizations, and deaths) were calculated from national data for 2001 to 2010 for black and white children. Trends were calculated using weighted loglinear regression, and changes in racial disparities over time were assessed using Joinpoint.

Results –
Disparities in asthma prevalence between black and white children increased from 2001 to 2010; at the end of this period, black children were twice as likely as white children to have asthma. Population-based rates showed that disparities in asthma outcomes remained stable (ED visits and hospitalizations) or increased (asthma attack prevalence, deaths). In contrast, analysis with at-risk rates, which account for differences in asthma prevalence, showed that disparities in asthma outcomes remained stable (deaths), decreased (ED visits, hospitalizations), or did not exist (asthma attack prevalence).

Conclusions –
Using at-risk rates to assess racial disparities in asthma outcomes accounts for prevalence differences between black and white children, and adds another perspective to the population-based examination of asthma disparities. An at-risk rate analysis shows that among children with asthma, there is no disparity for asthma attack prevalence and that progress has been made in decreasing disparities in asthma ED visit and hospitalization rates.

In recent years, defilement of the air has significantly impacted the health and hygiene of the population at large. In order to address this issue properly, information is needed on the particulates responsible for affecting the quality of air both outdoor as well as indoors. Pollutants vary greatly in their composition, as well as from place to place. Data is required to interpret a correlation between particulates with that of health and hygiene. This information may signify an overall idea about the air that composes an environment and its quality.

Therefore it is essential to have data available to properly manage the local air quality. It is in this context that EDLab has decided to provide Pollen grains and Mold count in the ambient air on a daily basis, available for the general public and professionals interested in this endeavor.

Pure Air Control Services through its AIHA accredited laboratory will be publish the Allergen & Asthma Alert www.pureaircontrols.com on a daily basis Monday through Friday.  A team of aerobiologists, under the supervision of Dr. Rajiv Sahay, FIAS, CIAQP (Laboratory Director of EDLab at Pure Air Control Services), will collect and analyze samples with cutting age technology from an air sampling station located at Clearwater, Florida (Tampa Bay Area 27.97° N and 82.76°W)

Each day the Pollengrains and Mold counts will be compared to the normal indoor environmental quality (IEQ) guideline. The groupings of the trap Pollen grains and Mold/Fungi are rated on a scale ranging from high, medium or low. High counts of these outdoor air quality pollutants correlate to an elevated rating, while low counts suggest reduced exposure to such allergens.

These same counts can be measured indoors. Subsequently, viewers, doctors, patients and allergy sufferers can determine the level of air quality and the corresponding effects upon their individual allergy symptoms.

“The EDLab staff is pleased to make this valuable and important aero-allergen information available to the public in the Tampa Bay area. It is important to raise our awareness to outdoor and indoor air quality issues, which affect our health and well-being, and the AAA is contributing to that awareness,” states Dr. Sahay.