1 / 28

Richard Kreutzer, M.D. California – China Environmental Health Training Program

Asthma in California: Challenges in Assessment and Intervention Shanghai-California Environmental Health Conference. Richard Kreutzer, M.D. California – China Environmental Health Training Program. Asthma in California. Asthma in California-Lifetime Prevalence.

laken
Download Presentation

Richard Kreutzer, M.D. California – China Environmental Health Training Program

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Asthma in California: Challenges in Assessment and InterventionShanghai-California Environmental Health Conference Richard Kreutzer, M.D. California – China Environmental Health Training Program

  2. Asthma in California Asthma in California-Lifetime Prevalence

  3. Asthma in California-Cohort Analysis

  4. Definition of Asthma • A chronic inflammatory disorder of the airway • Infiltration of mast cells, eosinophils and lymphocytes • Recurrent episodes of wheezing, coughing and shortness of breath • Widespread, variable and often reversible airflow limitation • Airway hyperresponsiveness Slide 1

  5. Magnitude of the Problem • 150 million asthmatics world wide • Prevalence increasing in most countries • (20 to 50% every 10 years) • Significant cause of school/work absence • Health care expenditures very high • 1 million unnecessary deaths each decade Slide 3

  6. Cost of Illness Direct Medical Care Indirect Costs • Hospital Stay • Intensive Care • Emergency Department • Primary Care • Medications • Social Security • Lost work output • Lost school days • Impact on individual/family/society Slide 5

  7. What is the cause of asthma?

  8. Mechanisms Underlying the Definition of Asthma Risk Factors (for development of asthma) Airway Hyperresponsiveness Airflow Limitation Risk Factors (for exacerbation) Symptoms Slide 2

  9. Risk Factors for Asthma • Asthma occurs in families • Atopy: The strongest identifiable risk factor for the development of asthma • Allergen and chemical sensitizer exposures • Contributing factors may increase susceptibility to development of asthma in predisposed individuals Slide 6

  10. Risk Factors that Lead to Asthma Development Predisposing Factors Contributing Factors • Atopy • Family history • Respiratory Infections • Small Size at Birth • Diet • Exercise • Cold air • Air Pollution/allergens • Outdoor Pollutants • Indoor Pollutants • Smoking • Passive Smoking • Active Smoking Causal Factors • Indoor Allergens • Domestic Mites and cockroach • Animal Allergens • Tobacco smoke • Fungi • Outdoor Pollution/Allergens • Ozone • Pollens • Occupational Sensitizers Slide 7

  11. Factors Influencing the Rise in Asthma Immune System Changes Lifestyle Changes Slide 8

  12. Role of “Western” Lifestyle • Increase in indoor furnishings • Humidity and indoor temperature • Decreased ventilation • Increased time indoors • Reduction in physical activity can result in allergic sensitization and “priming” for asthma development • Hygiene hypothesis Slide 10

  13. Factors Influencing Atopy Slide 9

  14. Immune System Balance in Asthma Development Slide 11

  15. Influences on the Developing Immune Response Inheritance of a genetic susceptibility to atopy 1st trimester of pregnancy Effect of the in utero environment created by the mother (diet, allergen exposure, etc.) 2nd and 3rd trimester of pregnancy Maternally directed development of the fetal immune response to common environmental antigens Birth Actions of early infections, gut microbial flora colonization and allergen exposures of the infant on the developing immune response after birth 1st year of life Development of a normal or allergic immune response (and symptoms) to common environmental antigens Slide 12 British Medical Bulletin 2000;56(No.4)

  16. Slide 13

  17. Slide 14

  18. Asthma Management Issues • Disease management model versus addressing the ecology of the disease • Clinical approach versus a population-based approach • What are the places in the community where changes can influence the course of asthma?

  19. Management by Patient Family Involvement Clinical Expertise Work/School Support Community Awareness, Support & Action Community-Wide Environmental Control Measures Conducive Policies Noreen Clark

  20. Place Location Purpose Physical Infrastructure Policies/Practices Multiplicity of Users Governance and Enforcement 16

  21. Stress Process Model Social Environment Stressors Physical Environment Stressors Intervening Factors Health Outcomes Amy Schulz, et.al.

  22. Potential Places for Intervention • Clinics and health care institutions • Home • Preschool • School • Workplace • Community- e.g. energy, agriculture, transportation, planning and zoning

  23. Strategic Plan for Asthma in California

  24. Strategic Plan for Asthma in California – Five Goals • Research, epidemiology, and evaluation • Public education • Treatment and management • Secondary prevention • Policy

  25. Overcoming barriers:Integration across organizations

  26. To conclude: • Integration is a powerful tool to extend current resources and develop new ones. • Integration doesn’t come easily but there are effective strategies to help get there. • Paths to integration will vary by community and must fit the local landscape.

More Related