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.
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Policy and system change and community coalitions: outcomes from allies against asthma.
Health Educ Behav. 2014 Oct;41(5):528-38
Authors: Clark NM, Lachance L, Doctor LJ, Gilmore L, Kelly C, Krieger J, Lara M, Meurer J, Milanovich AF, Nicholas E, Rosenthal M, Stoll SC, Wilkin M
Objectives. We assessed policy and system changes and health outcomes produced by the Allies Against Asthma program, a 5-year collaborative effort by 7 community coalitions to address childhood asthma. We also explored associations between community engagement and outcomes. Methods. We interviewed a sample of 1,477 parents of children with asthma in coalition target areas and comparison areas at baseline and 1 year to assess quality-of-life and symptom changes. An extensive tracking and documentation procedure and a survey of 284 participating individuals and organizations were used to ascertain policy and system changes and community engagement levels. Results. A total of 89 policy and system changes were achieved, ranging from changes in interinstitutional and intrainstitutional practices to statewide legislation. Allies children experienced fewer daytime (P = .008) and nighttime (P = .004) asthma symptoms than comparison children. In addition, Allies parents felt less helpless, frightened, and angry (P = .01) about their child's asthma. Type of community engagement was associated with number of policy and system changes. Conclusions. Community coalitions can successfully achieve asthma policy and system changes and improve health outcomes. Increased core and ongoing community stakeholder participation rather than a higher overall number of participants was associated with more change.
PMID: 25270178 [PubMed - indexed for MEDLINE]
Evaluation and treatment of critical asthma syndrome in children.
Clin Rev Allergy Immunol. 2015 Feb;48(1):66-83
Authors: Wade A, Chang C
The heterogeneity of asthma is illustrated by the significantly different features of pediatric asthma compared to adult asthma. One phenotype of severe asthma in pediatrics includes atopy, lack of reduction in lung function, and absence of gender bias as the main characteristics. Included in the NIH NAEPP EPR-3 are recommendations for the treatment and management of severe pediatric asthma and critical asthma syndrome, such as continuous nebulization treatments, intubation and mechanical ventilation, heliox, and magnesium sulfate. In addition, epinephrine, intravenous immunoglobulin, intravenous montelukast, extracorporeal membrane oxygenation, and many biological modulators currently under investigation are additional current and/or future treatment modalities for the severe pediatric asthmatic. But, perhaps the most important strategy for managing the severe asthmatic is preventative treatment, which can significantly decrease impairment and risk, particularly for severe acute exacerbations requiring emergency care and/or hospitalization. In order for preventative therapy to be successful, several challenges must be met, including selecting the correct therapy for each patient and then ensuring compliance or adherence to a treatment plan. The heterogeneity of asthma renders the former difficult in that not all patients will respond equally to the same treatment; the latter is only helpful if the correct treatment is employed. Strategies to ensure compliance include education of caregivers and patients and their families. As newer medications are introduced, options for individualized or customized medicine increase, and this may pave the way for significant decreases in morbidity and mortality in severe pediatric asthma.
PMID: 24488329 [PubMed - indexed for MEDLINE]
Pharmacotherapy of critical asthma syndrome: current and emerging therapies.
Clin Rev Allergy Immunol. 2015 Feb;48(1):7-30
Authors: Albertson TE, Schivo M, Gidwani N, Kenyon NJ, Sutter ME, Chan AL, Louie S
The critical asthma syndrome (CAS) encompasses the most severe, persistent, refractory asthma patients for the clinician to manage. Personalized pharmacotherapy is necessary to prevent the next acute severe asthma exacerbation, not just the control of symptoms. The 2007 National Asthma Education and Prevention Program Expert Panel 3 provides guidelines for the treatment of uncontrolled asthma. The patient's response to recommended pharmacotherapy is highly variable which risks poor asthma control leading to frequent exacerbations that can deteriorate into CAS. Controlling asthma symptoms and preventing acute exacerbations may be two separate clinical activities with their own unique demands. Clinicians must be prepared to use the entire spectrum of asthma medications available but must concurrently be aware of potential drug toxicities some of which can paradoxically worsen asthma control. Medications normally prescribed for COPD can potentially be useful in the CAS patient, particularly those with asthma-COPD overlap syndrome. Immunomodulation with drugs like omalizumab in IgE-mediated asthma syndromes is one important approach. New and emerging drugs address unique aspects of airway inflammation and biology but at a significant financial cost. The pharmacology and toxicities of the agents that may be used in the treatment of CAS to control asthma symptoms and prevent severe exacerbations are reviewed.
PMID: 24178860 [PubMed - indexed for MEDLINE]
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