Asthma Disparities

Leadership

Michelle M. Freemer, M.D., M.P.H.

Medical Officer, Division of Lung Diseases
National heart, Lung, and Blood Institute, NIH
U.S. Department of Health and Human Services

Mary Jo Errico, Ph.D.

Biologist
Office of Radiation and Indoor Air
U.S. Environmental Protection Agency

Purpose

The purpose of the Asthma Disparities Subcommittee is to address preventable factors that impact differences in the burden of asthma in some communities compared to others.

Current priorities of the group include to:

Broaden interagency and stakeholder collaboration on initiatives for reimbursement of care for asthma
Expand research coordination to leverage resources across federal agencies to address differences in asthma outcomes among children
Explore opportunities to partner and leverage efforts to provide comprehensive asthma care in tribal communities

Activities

Recognizing the barriers that families of children with asthma who bear a disproportionate burden of disease may face, the subcommittee works to share resources created through interagency collaborations. Examples include:

Reducing the Impact of Asthma on Medicaid and CHIP Beneficiary Families

The Centers for Medicare and Medicaid Services (CMS) created the Improving Asthma Control Affinity Group to provide states with technical assistance from CMS and partners including other federal agencies. Examples of the work in the states that participated in this program continue to provide resources that partner agencies are promoting, as well as technical assistance.

Home Characteristics and Asthma Triggers Checklist Update

Federal agencies continue to update this checklist and training for use by home visitors in communities, who are essential partners in efforts to provide home based asthma care to families who need it.
The tools help home visitors learn how to identify and reduce exposures that may trigger asthma in children and their families.

Accomplishments

Home Characteristics and Asthma Triggers - Checklist for Home Visitors

A trained home visitor can help find common asthma triggers in homes and discuss ways to reduce and remove triggers. Removing asthma triggers in the home, along with proper medical care, can improve health. To help train home visitors to identify and address environmental asthma triggers in the home, CDC, EPA, and HUD co-developed a checklist and associated training. The checklist is organized into a Core Assessment plus two appendices (Dust Mite Module and Mold and Moisture Module). The Core Assessment can be used for all types of housing and climates, but the additional modules can be used if dust mites or mold/moisture issues are suspected by the trained home visitor. The suggested action items in this checklist are generally simple and low cost.

Coordinated Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities (-1B)

In May 2012, the subcommittee combined the efforts of federal agencies to launch the Coordinated Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities. The plan presented a framework to maximize the use of federal resources to address the major public health challenge of differences in asthma outcomes among children.

The plan comprised four major goals:

Reduce barriers to the implementation of guidelines-based asthma management. This goal has been implemented in a variety of activities including Asthma Reimbursement Summits that HUD created in collaboration with CDC and EPA, These Summits bring together diverse stakeholders in cities across the United States to address changes to homes that impact children with asthma.
Enhance capacity to deliver integrated, comprehensive asthma care to children in communities that are most affected by asthma. This goal has been addressed through funding opportunity announcements from the National Heart, Lung, and Blood Institute (NHLBI) that challenge investigators to create systems that provide such comprehensive care. This goal is also supported by the Asthma Community Network.org, an online network coordinated by EPA that allows organizations to share effective practices to help community-based asthma programs and accelerate the improvement of health and quality or life outcomes for people with asthma.
Improve capacity to Identify the children most affected by their asthma. The CDC led the subcommittee in developing measures to identify and track the children with the highest rates of medical visits (including emergency room visits and hospitalizations) in response to this plan.
Accelerate efforts to identify and test interventions that may prevent the onset of asthma in communities where children are most affected by their asthma. Efforts to address this goal include the creation of the Asthma Birth Cohorts Database by the National Institute of Allergy and Infectious Diseases (NIAID), which followed a workshop supported by NLHBI, NIAID, and Mechanisms of the Development of Allergy (MeDALL, FP7—a project supported by the European Union). Such databases are intended to facilitate research to identify the origins of asthma.

Create Asthma Empowerment Collaborations to Reduce Childhood Asthma and Asthma Empowerment Collaborations to Reduce Childhood Asthma Disparities

The purpose of Create Asthma Empowerment Collaborations to Reduce Childhood Asthma and Asthma Empowerment Collaborations to Reduce Childhood Asthma Disparities paired funding opportunity announcements is to support investigators planning and conducting a clinical trial to evaluate Asthma Care Implementation Programs (ACIP) for children at high risk of poor asthma outcomes. In the first announcement, investigators had to propose an ACIP for this population that translates research into community practice by integrating interventions with demonstrated efficacy from multiple sectors into a comprehensive program. The second announcement supported clinical trials to evaluate community-based ACIPs to address the needs of the U.S. community in which the study was conducted and integrate interventions with demonstrated efficacy from four different sectors (medical care, family, home, and community).

Measures to Identify and Track Racial Disparities in Childhood Asthma

The Centers for Disease Control (CDC) is leading response to the Asthma Disparities Subcommittee’s recommendations to standardize definitions, measures, outcomes, and data/information collection methods across federal programs and in state, local, and community settings. This work is expected to maximize the availability and use of collected data across federal asthma programs.

Asthma and the Environment: A Strategy to Protect Children

Asthma is one of the original focus areas of the Task Force. In 1998, the Task Force conducted a review of Federal efforts to address asthma in children and released a report, Asthma and the Environment: A Strategy to Protect Children (1013KB) (1013KB), that describes our early commitment to ensure that children live, learn, work, and play in communities that strive to prevent asthma or reduce the burden of disease.