Asthma continues to be one of the most prevalent chronic lung diseases and growing health concerns in the state of Texas. Asthma, a potentially deadly illness, affects the lungs and causes the airways to become inflamed and swollen, and surrounding muscles to tighten. Symptoms include episodes of coughing, chest tightness, wheezing and shortness of breath.
According to the Texas Behavioral Risk Factor Surveillance System in 2005, an estimated 1.5 million (6.8 percent) adult Texans and 458 thousand (7.3 percent) children 0-17 years of age currently report having asthma. Also, an estimated 2.5 million (11.1 percent) adult Texans and 728 thousand (11.6 percent) children report having had asthma during their lifetime.
In addition, asthma has had a significant economic impact on the state of Texas. According to the Texas Health Care Information Collection in 2004, hospital discharges listing asthma as the principle diagnosis and other diagnoses account for about $353 million in total charges.
The Texas Asthma Plan serves as a planning tool to initiate asthma activities in the state of Texas. The 2007-2010 Edition contains issue items with updated goals and action steps specific to regional areas throughout Texas.
2013 environmental health legislation.
J Environ Health. 2013 Oct;76(3):52-7
Authors: Farquhar D, Ellis AC
The NEHA Government Affairs program has a long and productive association with the National Conference of State Legislatures (NCSL). The organizations have worked together on any number of legislative and policy areas that directly impact the environmental health profession. One of the keys to the successes of the NEHA/NCSL collaboration has been the recognition of the fact that often some of the most significant legislation and policy initiatives related to environmental public health occur in state legislatures. The states have, in a very real sense, been the innovators in developing new programs and practices. In recognition of this fact, we have asked NCSL to provide occasional overviews of state environmental public health legislative activity, covering topics that are of the most pressing public concern. Doug Farquhar, program director for NCSI's Environmental Health Program, has worked with NCSL since 1990. Mr. Farquhar directs development, management, and research for the Environmental Health Program. These projects encompass consultation and policy analysis of state and federal policies and statutes, regulations, and programs regarding environmental and related topics for state legislatures and administrative programs. Amy Ellis is a law clerk for NCSL within the Environment, Energy, and Transportation Group. As a law clerk she has researched a wide variety of environmental health policies. She is expected to obtain her JD from the University of Colorado Law School in 2015.
PMID: 24288852 [PubMed - indexed for MEDLINE]
From phenotypes to endotypes to asthma treatment.
Curr Opin Allergy Clin Immunol. 2013 Jun;13(3):249-56
Authors: Agache IO
PURPOSE OF REVIEW: The current guidelines for asthma diagnosis and management do not recognize that different phenotypes of asthma exist, with significant variations in the manifestation of airway inflammation, symptoms, severity, and response to treatment. This article will critically review new approaches to classify asthma together with the emerging endotype-driven therapeutic strategies.
RECENT FINDINGS: Several new approaches for classifying asthma are available, from precision and deep phenotyping to identification of novel causal pathways and translation of biomarkers into pathway-specific diagnostic tests. New phenotypes, such as epigenetic phenotypes, asthmatic granulomatosis, or neurophenotypes are described. Large clinical trials testing the endotype-driven approach are increasingly successful, but the dissociated effect and the drug efficacy at the target site remain unsolved issues. Profiling the Th2 low and the resident cell compartment of asthma are major unmet needs in asthma endotyping.
SUMMARY: Each of the hallmark characteristics of asthma (inflammation, remodeling, airway hyperreactivity) is the expression of a complex network of molecules, very diverse both within any given patient in time and between any two patients. Some of these networks are repetitive across individuals with asthma and specific for clinical expression, gene-environment interaction and inflammatory cell profiles represent novel endotype-specific diagnostic and therapeutic strategies.
PMID: 23587683 [PubMed - indexed for MEDLINE]
Have expert guidelines made a difference in asthma outcomes?
Curr Opin Allergy Clin Immunol. 2013 Jun;13(3):237-43
Authors: Podjasek JC, Rank MA
PURPOSE OF REVIEW: To analyze and summarize research from 2011 to 2012 that examines the relationship of guideline implementation and asthma outcomes.
RECENT FINDINGS: Evidence of an unmet need for better asthma management was reported in two large survey studies from the US and Europe. Interventional studies of guideline implementation were often limited by lack of uptake of the intervention (i.e. educational program, computer-assisted assessment). Even studies in which there was uptake to the intervention, asthma outcomes often did not improve. Certain interventions (specific electronic asthma management tools, provider education workshops, community-wide interventional programs, and parental educational programs) were associated with improved asthma outcomes. Observational studies, likewise, revealed that evidence of guideline implementation did not necessarily translate into improved asthma outcomes.
SUMMARY: Asthma guideline implementation studies are frequently associated with a limited impact on asthma outcomes. Understanding the gaps between guideline recommendations and translation to clinical practice remains an important opportunity to improve asthma outcomes.
PMID: 23571409 [PubMed - indexed for MEDLINE]
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