General Asthma Population

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.

The tools and information in this guidance will help keep the air clean where many Americans spend up to 90 percent of their time – indoors.  Some of the biggest threats to indoor air quality stem from moisture issues. Leaking roofs, plumbing problems, condensation issues, poor indoor humidity control, and lack of drainage around the base of buildings are  some of the commonly reported causes of moisture problems in the United States.  These problems can not only threaten the structural integrity of buildings, they can also increase exposure to mold and other biological contaminants. Such exposure is associated with increases in the occurrence and severity of allergies, asthma and other respiratory illnesses.