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Asthma 2009: Overview of Asthma Prevalence Mortality

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Asthma 2009: Overview of Asthma Prevalence Mortality

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    1. Asthma 2009: Overview of Asthma Prevalence & Mortality Karen Meyerson, MSN, RN, FNP-C, AE-C Asthma Network of West Michigan April 21, 2009

    2. Prevalence of Asthma Among Michigan Children (<18 Years), 2007 Over 235,000 children currently have asthma. No significant differences between groups…black vs. white or male vs. femaleOver 235,000 children currently have asthma. No significant differences between groups…black vs. white or male vs. female

    3. Prevalence of Asthma Among Michigan Adults (?18 Years), 2007 Over 723,000 adults currently have asthma. Among adults, the prevalence is significantly higher among females than males. The prevalence is significantly higher among blacks than whites….not other significant differences observed. The prevalence of current asthma for Michigan adults are higher than those for the United States: US Current Asthma Prevalence = 8.2% (18,272,438), 2006Over 723,000 adults currently have asthma. Among adults, the prevalence is significantly higher among females than males. The prevalence is significantly higher among blacks than whites….not other significant differences observed. The prevalence of current asthma for Michigan adults are higher than those for the United States: US Current Asthma Prevalence = 8.2% (18,272,438), 2006

    4. Prevalence of Asthma for Adults (?18 Years) by Indicators of Socioeconomic Status, Michigan, 2007 As education level increases, the prevalence of current asthma among adults generally decreases. As income increases, the prevalence of current asthma among adults generally decreases. These trends are not tested for statistical significance. As education level increases, the prevalence of current asthma among adults generally decreases. As income increases, the prevalence of current asthma among adults generally decreases. These trends are not tested for statistical significance.

    5. Prevalence of Asthma Among Michigan Adults (?18 Years) by County, 2005 Areas with the highest prevalence… City of Detroit Jackson Sanilac GT and the UPAreas with the highest prevalence… City of Detroit Jackson Sanilac GT and the UP

    6. Percent of Children with Persistent Asthma by County of Residence, Medicaid, Michigan, 2005 About 34,000 children in Medicaid have healthcare utilization consistent with persistent asthma. About 17,200 of these are white and 15,000 of these are black. Annual prevalence for black is 10-25% higher than whites. Highest prevalence: Clare Clinton Gladwin Isabella Midland Otsego WashtenawAbout 34,000 children in Medicaid have healthcare utilization consistent with persistent asthma. About 17,200 of these are white and 15,000 of these are black. Annual prevalence for black is 10-25% higher than whites. Highest prevalence: Clare Clinton Gladwin Isabella Midland Otsego Washtenaw

    7. Rates of Hospitalization due to Asthma by Sex, by Race and by Age Group, Michigan, 2004-2006 Total rate 16.6 per 10,000 population Highest rates among children 0-4 years of age….lowest rates among those 15-34 years. The rate for blacks is 4 times higher than the rate for whites. The rate for females is 44% higher than the rate for males.Total rate 16.6 per 10,000 population Highest rates among children 0-4 years of age….lowest rates among those 15-34 years. The rate for blacks is 4 times higher than the rate for whites. The rate for females is 44% higher than the rate for males.

    8. Rates* of Hospitalization due to Asthma by Race and Income, Michigan, 2000-2002 The rate of hospitalizations for people living in poor areas is 4 times higher than for those living in areas with the most money. As area income increases, the asthma hospitalization rates decrease…more pronounced trend for black persons than white persons. Black persons living in poor areas have the highest rates of asthma hospitalization, 56.3 per 10,000. The rate of asthma hospitalizations for black persons living in wealthy areas is 28% higher than that for white persons living in the poorest areas. The rate of hospitalizations for people living in poor areas is 4 times higher than for those living in areas with the most money. As area income increases, the asthma hospitalization rates decrease…more pronounced trend for black persons than white persons. Black persons living in poor areas have the highest rates of asthma hospitalization, 56.3 per 10,000. The rate of asthma hospitalizations for black persons living in wealthy areas is 28% higher than that for white persons living in the poorest areas.

    9. Asthma Hospitalization Rates* by Age-Race Group and Year, All Ages, Michigan, 1990-2006 Each race-age group demonstrates a different trend. The highest asthma hospitalization rates are among black children, across all years. Rates are increasing for black adults…while there is a general decrease in black children. Rates for white children are decreasing as well…however rates for white adults are generally stable over time. Each race-age group demonstrates a different trend. The highest asthma hospitalization rates are among black children, across all years. Rates are increasing for black adults…while there is a general decrease in black children. Rates for white children are decreasing as well…however rates for white adults are generally stable over time.

    10. Asthma Hospitalization Rates** by Race and County of Residence, All Ages, Michigan, 2004-2006 Black > White for all counties where a comparison could be made – 2 to 4 times higher. Note the difference in the range b/w maps. Regional differences in racial disparity evident. For whites, highest rates = Baraga and Bay For Blacks, highest rates = Bay, Saginaw, Ingham, and Wayne Statewide White: 11.1 per 10,000 Black: 47.5 per 10,000…over 4x higher than whites.Black > White for all counties where a comparison could be made – 2 to 4 times higher. Note the difference in the range b/w maps. Regional differences in racial disparity evident. For whites, highest rates = Baraga and Bay For Blacks, highest rates = Bay, Saginaw, Ingham, and Wayne Statewide White: 11.1 per 10,000 Black: 47.5 per 10,000…over 4x higher than whites.

    11. Emergency Department Reliance Methodological Notes: All asthma outpatient visits (office, urgent care, and Emergency Department), ICD-CM-9 493.xx Among these, the percent of asthma visits that occurred in the emergency department Interpretation of the Indicator X% of outpatient asthma visits that occurred in the emergency department for children in Medicaid with persistent asthma

    12. Percent Reliance on Emergency Department by Race among Children with Persistent Asthma, Medicaid, Michigan, 2001-2005 Proportion of OP visits that occur in ED is 30% (2005) Reliance among blacks is 2x higher compared to whites Proportion of OP visits that occur in ED is 30% (2005) Reliance among blacks is 2x higher compared to whites

    13. Percent Reliance on Emergency Department by Race among Children with Persistent Asthma, Medicaid, Michigan, 2005 Greatest reliance on ED Clare Gogebic Hillsdale Mason Menominee Oceana WayneGreatest reliance on ED Clare Gogebic Hillsdale Mason Menominee Oceana Wayne

    14. Proportion with Overuse of SABA Medication Methodological Notes: SABA medications defined by NCQA HEDIS list of asthma medications Overuse defined as >6 filled prescriptions of SABA filled in 12 months Interpretation of the Indicator X% of children in Medicaid with persistent asthma filled >6 prescriptions for SABA medication

    15. Percent of Overuse of Short-Acting ?-Agonist Medication among Children with Persistent Asthma, Medicaid, Michigan, 2001-2005 Prevalence of SABA overuse is 12.7% (2005) Black (13.4%) significantly higher than white (12%) (2005)Prevalence of SABA overuse is 12.7% (2005) Black (13.4%) significantly higher than white (12%) (2005)

    16. Proportion taking Inhaled Corticosteroid Medication Methodological Notes: Inhaled corticosteroid (ICS) medications defined by NCQA HEDIS list of asthma medications ICS use defined as ?1 filled prescriptions of ICS filled in 12 months ICS includes bronchodilator combination therapy Interpretation of the Indicator X% of children in Medicaid with persistent asthma filled ?1 prescriptions for ICS medication

    17. Percent of Children with Persistent Asthma with ?1 Inhaled Corticosteroid or Bronchodilator Combination by Race, Medicaid, Michigan, 2001-2005 Statistically significant difference by race (2005) Black: 52% White: 56% Statistically significant difference by race (2005) Black: 52% White: 56%

    18. Rates of Mortality due to Asthma by Sex, by Race and by Age Group, Michigan, 2004-2006 Total mortality rate is 12.6 per million – an average of 142 deaths per year. Females > Males Blacks >> Whites Mortality increases with increasing age.Total mortality rate is 12.6 per million – an average of 142 deaths per year. Females > Males Blacks >> Whites Mortality increases with increasing age.

    19. Thirty-Two Deaths from Asthma in Michigan 2002, Age 2 - 34 Demographics Age <19 38% Male 59% African-American 56% High School Graduate 70% Wayne County 44% Pronounced Dead Prior to Hospitalization 84% Medical Insurance 78%

    20. Thirty-Two Deaths from Asthma in Michigan 2002, Age 2 - 34 Tox/Alcohol Screen ? 0% Steroids 50% Prior Intubation 13% Prior Hospitalization 48% Treated in ED 80% Allergist 38% Pulmonologist 40% PFTs 33% Peak Flow Meter 63% Used Regularly 13% Asthma Management Plan 0% BMI > 30 37% Type 2 – 18%

    21. Causal Factors Based on 18 Deaths Reviewed for Adults (ages 19-34), Michigan 2002

    22. Suggested Intervention Based on 18 Deaths Reviewed for Adults (ages 19-34), Michigan 2002 Educate Health Care Providers Steroids 8 Referrals 3 Pulmonary function tests 2 Educate Patients Steroids 6 Provide education in ED 3 Aspirin 1 Society Case manager 5 Insurance 5 Public awareness 2 Regulation insurance companies on referrals Labeling aspirin products 1 Medical Examiners Criteria for asthma deaths 4

    23. Issues Not Found to be Important Previously Reported in Literature Issues Consistent with Factors Previously Reported in Literature

    24. Summary of Risk Factors for Fatal and Near-Fatal Asthma from Medical Literature

    25. Risk Factors for Death from Asthma – EPR-3 Asthma History Previous Severe Exacerbation (i.e., intubation or ICU admission) 2 or more hospitalizations within the past year 3 or more ED visits in the past year Hospitalization or ED visit in the last month Using > 2 canisters of SABA in the last month Poor perception of symptoms or severity of exacerbation Lack of a written asthma action plan Sensitivity to Alternaria

    26. Summary Asthma deaths – relatively rare Death occurring prior to hospitalization Generally preventable MORE INHALED STEROIDS

    27. Questions? Karen Meyerson, MSN, RN, FNP-C, AE-C Phone: 616-685-1432 E-mail: meyersok@trinity-health.org Websites: www.asthmanetworkwm.org www.GetAsthmaHelp.org

    28. Asthma 2009: Asthma Guidelines and Goals of Therapy Karen Meyerson, MSN, RN, FNP-C, AE-C Asthma Network of West Michigan April 21, 2009 Acknowledgements: LeRoy M. Graham, MD, Atlanta, GA Allan T. Luskin, MD, Madison, WI

    31. Guidelines For The Diagnosis and Management of Asthma (EPR-3) Expert Panel Report 3 National Heart, Lung and Blood Institute (NHLBI) National Asthma Education and Prevention Program (NAEPP) August 29, 2007

    32. Asthma Assessment and Monitoring: Key Differences from 1997 and 2002 Key elements of assessment and monitoring Severity Control Responsiveness to treatment Severity emphasized for initiating therapy Control emphasized for monitoring and adjusting therapy Severity and control defined by 2 domains: Impairment Risk

    33. Severity & Control are assessed based on 2 domains: Impairment (present) frequency and intensity of symptoms functional limitations (quality of life) Risk (future) asthma exacerbations (utilization) progressive loss of pulmonary function (lung growth) risk of adverse reaction from medication

    34. Domain: Impairment What the patient tells US in terms of frequency and intensity of symptoms. This is the disruption of their ability to function or current limitations in their lives due to asthma. Impairment is the burden of illness.

    35. Goals of Asthma Therapy Reducing Impairment Prevent chronic and troublesome symptoms Require infrequent (<2x/week) use of rescue therapy Maintain (near) normal lung function Maintain normal activity levels Meet patients’ and families’ expectation of and satisfaction with asthma care

    36. Domain: Risk What we tell PATIENTS This is the likelihood of asthma exacerbations, progressive decline in lung function or risk of adverse effects from medications - examples: LABA may decrease impairment but may increase risk ICS may decrease impairment but also decrease risk

    37. Goals of Asthma Therapy Reducing Risk Reduce recurrent exacerbations of asthma and minimize the need for ED visits or hospitalizations Prevent progressive loss of lung function; for children, prevent reduction of lung growth Provide pharmacotherapy with minimal or no adverse effects

    38. Asthma: Establishing and Maintaining Control Periodic Assessment and Monitoring Monitor signs and symptoms of asthma Monitor pulmonary function Spirometry Peak Flow Monitoring Monitoring quality of life Monitoring history of asthma exacerbations Monitoring pharmacotherapy for adherence and side effects

    39. Questions? Download the Guidelines at: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf Download the Summary Report at: http://www.nhlbi.nih.gov/guidelines/asthma/asthsumm.pdf

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