Understanding and addressing asthma in Florida: the role of community health workers

1. Understanding and addressing asthma in Florida: the role of community health workers Shaláwa Triggs Florida Department of Health, Bureau of Chronic Disease Prevention 8th Annual FL CHW Summit – Orlando, FL September 15, 2018

2. Presentation Learning Objectives • Participants will be able to: • Understand asthma and the current burden • Describe what happens during an asthma attack • Describe best practices to treat and manage asthma • Understand the CDC’s 6|18 Initiative • Describe ongoing efforts in Florida to address and improve asthma

3. Burden of Asthma

4. What is Asthma? • Asthma is a chronic disease of the airways that may cause: • Wheezing • Breathlessness • Chest tightness • Nighttime or early morning coughing

5. CDC Vital Signs – February 2018 https://www.cdc.gov/vitalsigns/childhood-asthma/index.html

6. CDC Vital Signs – February 2018 https://www.cdc.gov/vitalsigns/childhood-asthma/index.html

7. CDC Vital Signs – February 2018 https://www.cdc.gov/vitalsigns/childhood-asthma/index.html

8. Asthma Attack

9. What Happens During an Asthma Attack? • People with asthma have inflamed airways, making the airways swollen and very sensitive. • Muscles around the airways tighten, causing a narrowing of the airways and reducing air flow into the lungs. • Cells in the airways might make more mucus than usual which can further narrow the airways.

11. Management of Asthma

12. Expert Panel Report 3 (EPR-3) Guidelines for the Diagnosis and Management of Asthma • The 2007 EPR-3 Guidelines were developed by an expert panel commissioned by the National Asthma Education and Prevention Program (NAEPP), coordinated by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH). • The expert panel organized the literature review and final guidelines report around four essential components of asthma care: • assessment and monitoring • patient education • control of factors contributing to asthma severity • pharmacologic treatment https://www.nhlbi.nih.gov/files/docs/guidelines/asthsumm.pdf

13. Best Practices to Treat & Manage Asthma • Assess asthma severity at the first visit to determine initial treatment. • Use a written asthma action plan to guide patient self-management. • Use inhaled corticosteroids to control asthma. • Reduce exposure to allergens and irritants that worsen the patient’s asthma. • Provide patient self-management education at multiple points of care. https://www.nhlbi.nih.gov/files/docs/guidelines/asthsumm.pdf

14. Assess Asthma Severity • The 2007 EPR-3 Guidelines use the following severity of asthma classification, with features of asthma severity divided into three charts to reflect classification in different age groups (0-4, 5-11, and 12 and older).

15. Asthma Control Test

16. Asthma Action Plan • Individualized plan • Team-based care • Self, physician, family members, caregivers, school staff, coaches, etc. • Developed and REVISED

17. Inhalers & Spacers Controller • Long-term – taken daily over a period of time • Reduces inflammation • Relaxes airway muscles • Improves symptoms and lung function Rescue/ Relief • Short-acting – provides short-acting, quick relief in response to asthma attack • Opens airways quickly Spacers are recommended with inhaler use. This device is a type of chamber that attaches to the inhaler and slows the delivery of the medication. Spacers help deliver the medication directly into the lungs.

18. Control Exposure to Allergens & Irritants • Allergens • Indoor mold • Pollen • Air pollution • Animal dander • Dust mites • Cockroaches • Irritants • Tobacco smoke • Wood burning smoke • Perfumes and sprays • Household chemicals • Strong odors • Other • Flu and cold virus • Vacuum cleaning (use a dust mask) • Sulfites in foods • Cold air • Certain medicines • Extreme emotion (crying or laughing)

19. Asthma Self-Management Education

20. Address & Improve Asthma

21. CDC’s 6|18 Initiative • By 6|18, the CDC is targeting six common and costly health conditions – tobacco use, high blood pressure, healthcare-associated infections, asthma, unintended pregnancies, and diabetes – and, initially, 18 proven specific interventions that formed the starting point of discussions with purchasers, payers, and providers. The number of interventions may fluctuate over time. https://www.cdc.gov/sixeighteen/index.html

22. CDC’s 6|18 Initiative – Control Asthma • Promote evidence-based asthma medical management in accordance with the 2007 EPR-3 Guidelines. • Promote strategies that improve access and adherence to asthma medications and devices. • Expand access to intensive self-management education for individuals whose asthma is not well-controlled with guidelines-based medical management alone. • Expand access to home visits by licensed professionals or qualified lay health workers to improve self-management education and reduce home asthma triggers for individuals whose asthma is not well-controlled with guidelines-based medical management and intensive self-management education. https://www.cdc.gov/sixeighteen/index.html

23. Efforts of FAP to Address & Improve Asthma • Develop, manage, track, and analyze a uniform set of asthma health status indicators that are derived from a variety of sources and accommodate state and local asthma related data needs through the statewide asthma surveillance system. • Engage community partners to increase community readiness to identify gaps in the delivery of asthma-related programs and services to improve Florida’s existing asthma system of care. https://www.nichq.org/project/florida-asthma-and-tobacco-cessation-learning-and-action-network

24. Efforts of FAP to Address & Improve Asthma • Facilitate the statewide asthma coalition, Florida Asthma Coalition (FAC), focused on eliminating asthma disparities, improving quality of life, and reducing costs. • Promote and expand quality asthma self-management education and reduce exposure to asthma triggers through school-based programs and home-visiting environmental assessment. • Increase public awareness of the importance of reducing the burden of asthma and the need for supportive policies and environments. http://floridaasthmacoalition.com/

25. Comments/Questions

26. Contact Information: Shaláwa TriggsAsthmaProgramManagerFlorida Department of Health 4052 Bald Cypress Way, Bin A-18Tallahassee, FL 32399-1744 Phone: 850-901-6659Email: shalawa.triggs@flhealth.gov