Relating Asthma to Public Health Factors

Destiny Nemeth


            According to the Centers for Disease Control and Prevention (CDC),  “asthma is a chronic respiratory disease characterized by episodes or attacks of inflammation and narrowing of small airways in response to asthma ‘triggers’”  (Asthma Prevalence).  These triggers have a wide range of sources; although the actual cause of onset asthma is unknown.  Even so, it is quite possible for asthmatics to have active, functional lives as long as asthma triggers are prevented and medications are monitored and taken for long-term treatment (National Asthma).  Too frequently people are only treating the asthma attack, as opposed to the actual inflammatory cause of the attack, thereby relying on fast-acting inhalers.  This not only becomes a major medical issue, but it also becomes a public health issue.  Asthmatics need to become more educated about the causes and the preventative care for this disease, because only then can asthma treatment be more completely followed and understood by individuals (Woolston, Preventing).    

            Asthma has been growing as a public health concern over the past couple of decades because of its prevalence throughout the United States.  As of 2001, the number of Americans diagnosed with asthma at some point during their lifetime was estimated to be 31.3 million people—22.2 million adults and 9.2 million children (Asthma Prevalence).  These numbers are extremely high, and it contributes to missed workdays, missed schooldays, hospitalizations, emergency room visits, and limited exercise-related activities (National Asthma). 

            In order to target this growing public health concern, many different organizations are creating programs to help limit and decrease the prevalence throughout the United States.  The Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), National Institute of Allergy and Infectious Diseases (NIAID), and the National Institute of Health (NIH)  are just four of the national and international organizations involved in programs pertaining to asthma awareness.   There is a growing interest in targeting this population of affected individuals, and an even greater drive to eliminate the mortality and limit the morbidity associated with this chronic disease.


Causes and Symptoms          

            There are many different causes of asthma, and the severity for each varies.  The most common asthmatic stimulants for children over the age of two through their teenage years are related to allergies (Woolston, Causes).  In fact, for children under the age of sixteen suffering from the disease, allergies are the source of ninety percent of the attacks, and seventy percent of the cases for asthmatics under thirty are caused by allergies (Common Causes).  Dander, dust mites, mold, pollen, and food-related allergies are examples of ordinary causes of asthma attacks (Woolston, Causes).  If a person is suffering from an allergic reaction, his or her immune system fights the allergen, thereby releasing antibodies, in particular immunoglobulin E (IgE), into the body (Asthma Basics).  This molecule releases chemicals in to the body, which causes the airways to become inflamed and constricted (Asthma Basics).  Allergic reactions are burdensome to all those afflicted by them, but they are particularly harmful for asthmatics since those people naturally have inflamed airways.  Having a genetic predisposition to either allergies or asthma significantly increases the chances of having asthmatic children, especially if one or both parents are already afflicted with asthma (Common Causes).  Whether or not asthma is based upon heredity is disputable, but some scientists believe that “variation in chromosome 11 is linked to the causes of asthma,”  and that this gene is passed to offspring as a sex-linked trait through the mother’s chromosomes (Common Causes). 

            Another major set-back for asthmatics is being around people who smoke.  Smoking causes irritation of the airways, thereby resulting in more wheezing and coughing.  Other irritants are air pollution, smog, cold air, temperature and humidity changes, pungent odors, and airborne particles (Woolston, Causes).  If an asthmatic is afflicted with some type of respiratory infection, this can cause additional attacks, particularly in older people and children under the age of two.  Similarly, some medications will also trigger attacks (Woolston, Causes). 

            Major changes in one’s emotional life can also cause an asthma attack, thereby making it more difficult to control the episode.  It is quite common for stressful situations to raise a person’s blood pressure and make him or her extremely agitated, while at the same time “disrupting the normal balance of hormones and brain chemicals”  (Woolston, Causes).  If a person is suffering from some type of mood disorder, such as anxiety or depression, then the person’s immune system is compromised and the body is much more susceptible to infections and viruses (Woolston, Causes).  Another major source of asthma attacks is exercising, particularly under cold, dry air conditions (Woolston, Causes).  Many people suffer from “exercise-induced asthma,”  thereby indicating that symptoms only exist during sports-related and exercise activities.  However, eleven percent of non-asthmatic people also suffer from “exercise-induced asthma,”  but this population either has a family history of allergies or experiences it themselves (Common Causes). 

            The following is a list of symptoms those that are common during asthma attacks:  (Child & Adult)

It is not necessary for all of these to be present in order to diagnosis a case as being an asthma attack, although shortness of breath, wheezing, coughing, excess rapid breathing, and rapid heart rate are typical signs that an attack is occurring.  Some adults may experience different symptoms, particularly if they develop the disorder after childhood.  Their symptoms may comprise of:  chronic nighttime coughing, chest pains, chest tightness, and insomnia due to shortness of breath (Child & Adult).  Asthma is such a serious condition because attacks can arise at any time, and the “airflow to the lungs can vary considerably at different times”  (Child & Adult).  This risk is not only very worrisome, but it is also extremely dangerous since reactions can flare up under many different conditions.  When an asthma attack is occurring, “the bronchial muscles tighten and constrict the flow of air through the tubes”  (Child & Adult).  This causes the asthmatic to have difficulty breathing, because the airways are much smaller than when an attack is not taking place.  As a result, it is very important to monitor the causes and symptoms in order to prevent a serious situation from arising.


Different types of Asthma

            There are eight different classifications of asthma that may affect individuals.  They are divided into categories based upon age, those afflicted, and source of the attack, although it is quite possible for an asthmatic person to be represented by more than one of these classes.  All eight of these categories are presented using a basic definition of a specific type of asthma in order to provide the reader with a broad range of information that may be used in discussions with a primary care physician or medical caretaker. 

1.  Childhood Asthma:  For children under the age of 18, 3.8 million have experienced an asthma attack within the last 12 months.  As a result, it is the number one cause of absenteeism due to chronic illness from school (Childhood Asthma). 

2.  Adult Onset Asthma:  Individuals who develop asthma during adulthood fall under this category, and women are more commonly affected by this (Childhood & Adult Onset).  This is typically triggered by allergies.

3.  Occupational Asthma:  People who develop asthma and work in an environment in which they are exposed to pollutants, chemicals, allergens, etc. (Childhood & Adult Onset). 

4.  Exercise-linked Asthma:  Both asthmatics and non-asthmatics may fall under this category.  An asthma attack occurs due to exercise and sports related activities (Childhood & Adult Onset). 

5.  Pregnant Women and Asthma:  Three different scenarios usually exist while a woman is pregnant—asthma improves, remains the same, or worsens; however, it is possible to continue medications related to asthma control during pregnancy (Childhood & Adult Onset). 

6.  The Elderly and Asthma:  Some of people develop and/or continue experiencing asthmatic attacks as they age; however, this is typically related to other medical issues, such as emphysema and other respiratory problems (Childhood & Adult Onset). 

7.  Nocturnal Asthma:  These people experience difficulty sleeping due to “reduced lung function at nighttime,”  and the effects of this are usually at its worst in the early morning (Childhood & Adult Onset). 

8.  Steroid-resistant Asthma:  Some people develop resistance to steroid treatments, thereby causing the person to become steroid-resistant (Childhood & Adult Onset). 


Internal and External Environmental Factors Affecting Asthma

            Many internal environmental factors, such as dust mites, molds, fungus, and pet dander, can be monitored by taking added precautions in order to limit the quantity and existence of these elements (Woolston, Causes).  For those people how are allergic to certain household pets, it is possible to lessen the reactions by routinely bathing the animal, investing in a hypo-allergic pet, or getting rid of the one that is cause of so much physical distress.  As a result, fewer allergic responses will decrease the magnitude and severity of the asthma attack.

            It is much harder to limit the effects of smoking on asthmatics.  Mothers who choose to smoke during pregnancy increase their future child’s predisposition to developing respiratory illnesses and asthma (Asthma & Smoking).  If a child is exposed to smoking in the home because one or both parents are smokers, that child is twenty to thirty percent more susceptible to developing asthma (Woolston, Smoking).  In fact, if he or she is already diagnosed as having asthma, conditions will be noticeably worse for a child living with smoking parents as compared to one living with non-smoking parents (Asthma & Smoking).  According to the Environmental Protective Agency (EPA), an estimated “200,000 to 1,000,000 asthmatic children have their condition made worse by exposure to secondhand smoke”  (Indoor Air). 

            Public exposure to tobacco if a person is in a restaurant, bars, or another type of public facility is extremely difficult to limit. Even though some laws have banned smoking in certain establishments or at least separated smoking and non-smoking areas, there is still involuntary exposure to some of the toxins and fumes (Indoor Air).  This leaves significant cause for concern for those people passively subjected to environmental tobacco smoking (ETS), because it is not possible for them to truly get away from people who smoke in public.  About eighty percent of those afflicted with adult onset asthma can correlate an asthma attack with exposure to tobacco smoke (Asthma & Smoking).  An extremely worrisome collection of data has found that “exposure to cigarette smoke for just one hour causes a twenty percent deterioration in the short-term lung function for adults with asthma” (Asthma & Smoking).  Since there are no laws completely banning smoking in public facilities, this finding is extremely disturbing for many individuals suffering from asthma. 

            Another external environmental exposure that leaves asthmatics having more frequent attacks and causes non-asthmatics to develop the disease is ozone and smog.  Studies have found that ozone cannot only cause an attack, but it can also be the source of asthma development (Study Links).  There have also been studies in twelve Southern California communities that follow the effects of polluted air on the development of children—six with low ozone concentrations and six with high ozone concentrations.  One study compared children who lived in areas where ozone levels were known to be high and they either did or did not participate in sports.  In fact, those children who are active in sports are more susceptible to developing asthma than those children who do not play sports (Study Links).  Since children who are involved in sports “draw up to 17 times the ‘normal’ amount of air into the lung,”  they have more exposure to the high levels of ozone (Study Links).  In these same communities on higher ozone concentration days, data indicate that there are significantly greater missed schooldays related to respiratory illness (Study Links).  Another study examined children who moved out of these high ozone regions to areas that had lower levels of pollution, or from low to high pollution communities.  For these children, increased or decreased lung development due to the change in conditions was clearly noticed, respectively.  As a result, these findings prove that ozone and pollutions correlate with asthma development and attacks, thereby indicating that environmental efforts must be made in order to decrease the prevalence of this disease.


Morbidity and Mortality

            Asthma is considered such a huge problem because it not only results in direct costs, but it also creates indirect costs.  Direct costs of asthma are associated with the money lost due to missed workdays, totaling around $8.1 billion in the United States (Fact Sheet).  The loss of productivity, both at work or in school, are considered to be the indirect costs related to asthma, thereby adding $4.6 billion to the amount lost due to this chronic disease.  This totals $12.7 billion and approximately 3 million lost days of productivity (Fact Sheet).  If an individual dies as a result of an asthma attack or complication, this is also considered an indirect cost.  In 2000, the mortality of men cost $805,000 and the mortality of women cost $887,800 (Trends). 

            The price for women was significantly higher than for men because women have a much greater mortality rate.  In 1999, 4,657 deaths resulted from asthma, with about 65% occurring in women (Trends).  However, if data are corresponded to age-adjusted death rate, 43 % more females died in 1999 compared to males (Trends).  Asthma-related deaths not only correspond with gender, but also with race as well (See Table 1).  When examining the age-adjusted death rate per 100,000 population, African Americans were three times more likely to die than Caucasians (Trends).   It is unclear as to the exact causes of such large variation, although living conditions and lifestyle may significantly play a role in this variation. 


All Males

All Females

White Males

White Females

Black Males

Black Females

Number of Deaths







Age-adjusted Death Rate







Table 1.  Correlating race and gender with mortality rates (Trends).

            Black populations also have a 21.6% higher prevalence rate for asthma compared to White populations (Trends).  This may be directly related to the state in which these individuals live.  The United State 2000 asthma prevalence rate was 7.2%, whereas the Ohio prevalence rate was 8.6% (Trends).  According to this data, Ohioans are significantly more susceptible to developing asthma than the average US citizen.  This information may or may not be true.  Only 3,247 Ohioans were sampled, although it is uncertain as to where these individuals worked and lived (Trends).  Different environments (internal, external, and work)  create different opportunities for the development of this disease.  As a result, this statistic is based upon the lifestyle and living conditions of those people sampled. 


Inner-city and Poor Communities Compared to Suburban Communities

            There is a significant distinction between the number of asthmatics that live in urban dwellings compared to those living in suburban settings.  One reason for this distinction is that the number of people who smoke in the inner cities tends to be high, thereby contributing to the development of asthma (Samet, 36).  As was stated in an earlier portion of this chapter, smoking irritates the airways, resulting in more wheezing and coughing.   According to the National Institute of Allergy and Infectious Diseases (NIAID), another significant cause of asthma attacks and hospitalizations of inner-city children is the living conditions.  Many urban dwellers are exposed to sub-standard living conditions, such as excessive cockroaches and insects, and they are having allergic reactions that are triggering asthma attacks (NIAID Study).  The National Cooperative Inner-City Asthma Study (NCICAS)  has found that children who are exposed and have allergies to cockroaches are hospitalized 3.3 more times than children not under these same conditions, and they are also much more likely to miss school, need more acute asthma care, and have more difficulty sleeping (NIAID Study).   

            Poverty in the inner cities is major contributor to inadequate medical care for children.  In fact, “poor children are twice as likely as non-poor children to lack usual sources of primary care,”  thereby providing insufficient medical and prescription coverage for those people who cannot afford insurance (Shapiro, 50).  When comparing poor children to non-poor children, poor children are forty percent more likely to be hospitalized as treatment for asthma attacks than non-poor children (Shapiro, 48).  This is an example of the inadequate health coverage for the poor, so they must resort to emergency room visits for acute care.  Studies have found that poor children receive acute asthma care in emergency rooms nearly four times more than non-poor children, which also creates problems for follow-up visits since many poor families do not have access to a pediatrician (Shapiro, 50).  Not only is this extremely costly for hospitals, but it also results in absenteeism from work (for the parents)  and school (for the children).  As a result, the parents are experiencing additional economic loss, and the child may fall behind in school.  Another risk factor for asthma is obesity.  If a child is not an active participant in sports and exercise, he or she is at risk of becoming obese due to this sedentary lifestyle, thereby creating physical, mental, and emotional harm for himself or herself (Shapiro, 48).

            Urban communities are also greatly at risk of high ozone and pollution concentrations.  Studies have found that “elevated ozone concentrations have been correlated with daily emergency visits for asthma to an inner city hospital in Atlanta, and with reduced lung function of children living in Mexico City”  (Shapiro, 49).  Diesel fuel exhaust and other such pollutants are another major problem for inner-city dwellers, because these types of environmental irritants are abundant in these areas.  They cause irritation to the airways and enhance antibodies to start fighting these foreign particles in the body, thus creating further inflammation and asthmatic responses (Shapiro, 49).  For more information correlating ozone concentrations with asthma, see the section entitled “Internal and External Environmental Factors Affecting Asthma.”


Attempting to Decrease the Prevalence of Asthma in the United States

National Goals

            Asthma is a chronic illness that affects almost half of American families, encompassing about 15 million people (Asthma Care).  These numbers are staggeringly high, especially given the fact that the National Hearth, Lung, and Blood Institute (NHLBI)  has set standards that need to be met in order to decrease the prevalence of asthma; however, these goals have not been met (Missing the Mark).  There are 5 national goals created by the NHLBI:  (Missing the Mark)

            1.  “No sleep disruption;

            2.  No missed school or work;

            3.  No (or minimal)  need for emergency room visits and hospitalizations;

            4.  Maintain normal activity levels; and

            5.  Have normal or near-normal lung function.”

Asthma in America:  A Landmark Survey was a study performed in 13 large cities across the United States evaluating the level of implementation of these goals and finding that none of these objectives has been achieved.  In fact, this survey has found that while sleeping, 30 percent of asthmatics are still awakened at least once a week with breathing problems, and “49 percent of children with asthma—and 25 percent of adults with asthma—missed school or work because of asthma in the past year”  (Missing the Mark). 

            Emergency room visits related to asthma care have not been eliminated, because 32 percent of children still needed to receive acute treatment and 41 percent of all asthmatics sought care at an emergency room, hospital, or clinic (Missing the Mark).  Many people are also limited in the level of normal activities in which they can participate.  According to Asthma in America, 48 percent of asthmatics had limited sport and recreational activities, 36 percent were “limited in normal physical exertion,”  and 25 percent had limitations on social activities (Missing the Mark).  When monitoring the normalcy of patients’ lung function during this survey, the results were somewhat skewed because of the inadequate availability of tests and monitoring systems.  Asthmatics should have a lung-function test performed every year, but only 35 percent of patients in this survey had one, and only 28 percent of patients had access to a peak flow meter to monitor airflow—with only 9 percent using it at least once a week (Missing the Mark).  All of the statistics from the Asthma in America survey are astounding, because even though national goals have been established, they certainly have not been implemented.


A Closer Look at Cleveland, Ohio

            Cleveland, Ohio was one of the cities studied in the Asthma in America survey, and its results were not impressive.  It indicates that there is a low level of knowledge about the cause of the disease, because only 10 percent of those questioned could relate the cause of asthma symptoms to inflammation (Cleveland, OH).  In fact, 46 percent of Clevelanders questioned thought that the underlying cause of asthma attacks could not be treated, but that the only the symptoms and actual attacks were treatable (Cleveland, OH).  These data indicate that people in this region have not been properly and fully educated about the causes and prevention of asthma.  The problem with simply treating asthma symptoms as opposed to the issue of inflammation is apparent since 58 percent of patients use quick-relief inhalers several times a week to control attacks, and only 1 in 5 patients (19 percent)  use inhaled corticosteroids for long-term control of the disease (Cleveland, OH). 

            When comparing Cleveland, Ohio to the national goals of asthma therapy, the city is above the national average in almost all of the categories, but Cleveland still does not meet any of the national objectives.  Clevelanders are almost exactly the same as the national average for sleep disruption, in that 31 percent of Clevelanders are awakened due to breathing problems (Cleveland, OH).  A smaller percent of children and adults, when compared to the national average, miss school or work—39 percent of children and 20 percent of adults in Cleveland, compared to 49 percent of children and 25 percent of adults in the nation (Cleveland, OH).  Twenty-six percent of children made emergency room visits for asthma treatment, and 37 percent of all asthmatics had to seek medical care in Cleveland (Cleveland, OH).  A smaller percentage, 40 percent compared to the national average of 48 percent, of Clevelanders had limited sport and recreational activities, and significantly lower numbers, 23 and 13 percent, had “limited normal physical exertion”  and limitations on social activities, respectively (Cleveland, OH).  A slightly higher proportion of Clevelanders have been monitored using a lung-function test within the past year and peak-flow meter each week (Cleveland, OH). 

            All of this data indicate that Cleveland, Ohio is promoting public health education concerning asthma than other major cities in the United States, but that more needs to be done in order to meet the national goals set for by the NHLBI.  One person who is dedicated to learning more about this chronic disease is Dr. Norman Robbins, MD, PhD.  Dr. Robbins is the Director for The Center for the Environment at Case Western Reserve University, as well as the chair of the asthma coalition in Cleveland.  The coalition began around the year 2000, and over the past three or four years it has developed to encompass approximately fifty members.  In the beginning, this organization strictly consisted of volunteers, and it was not until 2001 that the first grant was received toward asthma research projects for the group (Robbins).  Members come from a wide range of backgrounds, but everyone is fighting for the same cause—preventing asthma and educating the public so that they can have a better understanding on how important this issue truly is.   

            Several important programs are currently implemented by the coalition in Cleveland, with the aid of the American Lung Association.  One program is called “A is for Asthma,”  and it is a national resource that is used in relation to local divisions of asthma prevention teams.  The purpose of this plan is to go into schools with the intention of educating and training nurses, teachers, and schoolchildren (Robbins).  Two other programs are currently being studied and will soon take affect across the nation:  “Certified Asthma Educator”  and the “Policy Committee”  on a reimbursement policy. 

            Under the “Certified Asthma Educator”  plan, training programs for nurses and respiratory therapists will be developed in order to give them a broad background about asthma.  At the end of this program, participants are required to take a test, thereby certifying them if they pass.  However, there is one concern with this plan—there is no uniform way to use these individuals after they have become certified (Robbins).  The second program developing may allow some of these certified caregivers to treat asthmatic patients.  Many patients are treated by their primary care physicians (PCPs)  for asthma care, but most of these PCPs are not able to give patients enough time to adequately educate them about asthma. 

            The “Policy Committee,”  is a plan that will allow patients to visit with their PCP, but then go across the hall to be educated by an asthma educator.  The educator will also charge a fee, but this will be much smaller than one charged by a physician.  However, cost may not even be an issue, because the Cleveland coalition is working with Medicaid HMO’s in order to construct a policy that will reimburse educators for their time and money, because of the pure economic benefits that such a program would have for insurers.  This type of treatment is considered to be preventative care, and insurers would actually save money because fewer people would have to make emergency room visits and be hospitalized for asthma attacks.  In fact, Dr. Robbins believes that even though it will cost money to run such a program, it will ultimately be more cost efficient for Medicaid, as well as extremely beneficial for those asthmatic patients treated with this type of care.


Asthma Prevention

            Many different measures must be taken in order to firmly grasp and control the prevalence of asthma across the United States.  This is not only on a national level, but it must also be handled on a state, city, and individual basis.  In order to combat asthma across the United States, environmental factors and poverty must be assessed and recognized.  Both of these issues are such huge problems that they must first be handled by the federal and state governments in order for implementation to expand to the public.  Reductions on the usage of diesel fuel and other ozone-releasing pollutants will decrease ozone concentrations, especially in urban regions where poverty is high.  The issue of poverty is much to broad and complex to be densely discussed here, but one fact is certain—poverty is clearly associated with the number of emergency room visits by asthmatic children and missed schooldays, so this topic must be assessed in order to analyze asthma triggers and causes of development.

            On a more individual and physician-patient level, many of the current problems with asthma prevention may be alleviated.  Impeding attacks through the use of medications is an extremely successful technique.  Beclomethasone and budesonide are two corticosteroids that are taken through an inhaler and are used as anti-inflammatory agents in the bronchial tubes (Woolston, Preventing).  The two drugs are so effective because they help “airways become less sensitive to their surroundings and [make it so that they] are less likely to go into spasms”  (Woolston, Preventing).  For people with severe asthma, corticosteroids in either the inhaler, tablet, or syrup form are the best recommendations for long-term treatments, as opposed to other, milder drugs (Woolston, Preventing).  Keeping up with these medications on a long-term basis is extremely important, because it prevents inflammation, as opposed to simply treating the attack.  “Quick relief”  bronchodilators are useful for short-term relief, but they only treat asthma for a couple hours, as opposed to all-day relief. 

            It is important to fully understand the reasons behind the disease, rather than simply fast relief from the symptoms.  This is one reason why asthma has not been properly controlled across the nation, because there is a large communication gap between physicians and patients.  In fact, only 9 percent of patients were able to identify inflammation as the cause of asthma (Asthma Care).  Patients are either not given the full amount of information about their disease, or they simply do not understand the context of what they are told.  As a result, some people are not taking their medications as it is prescribed—for example, studies suggest “that many asthma patients take medication only when they have symptoms”  (Asthma Care).  If this is the case, then they are only treating the symptom, rather than the actual cause of asthma, thereby creating a higher predisposition to future attacks.  The Asthma in America survey indicates that only 19 percent of patients are even taking corticosteroids—the most effective drug for long-term asthma care (Asthma Care)!  This data indicates that asthma care is not only a medical problem, but that it is also a major public health issue.  Too few Americans properly understand the implications and repercussions of asthma attacks and treatment, thereby perpetrating the seriousness of this disease further. 

            If patients learn how to monitor asthma symptoms using a peak-flow meter, they will begin to understand the triggers of attacks and how to handle an attack when it occurs.  According to the NHLBI, there are five guidelines that can be used to better manage asthma:  (Asthma Care)

            1.  “Reduce exposure to allergens and other asthma triggers like tobacco smoke, pollen,            animal dander, mold, strong fumes and other irritants;

            2.  Talk with their doctor about using long-term control medications like inhaled             corticosteroids to reduce the airway inflammation that underlies asthma symptoms;

            3.  Regularly monitor their asthma symptoms and peak flow;

            4.  Develop an action plan for use during asthma attacks; and

            5.  Regularly visit their doctor to measure progress and adjust therapy as needed.”

These objectives have been stated throughout this chapter, but it is important to give them emphasis since they are not being properly implemented. 

            Many people may consider staying away from allergens as an obvious fact, but data indicates that some people do not correlate asthma with allergies.  It is extremely important to limit exposure to irritants in order to prevent excessive inflammation of the airways.  This is not only limited to allergens, because other triggers such as tobacco smoke, high ozone concentrations, and environmental pollutants also fall under this category.  As a result, any additional precautions that can be made should be implemented in order to better preserve one’s health and prevent possible attacks.


Ten Public Health Programs that Make a Difference

1.  “Sesame Street A is For Asthma.”  This program is co-hosted by the American Lung Association and the Sesame Workshop and funded by the Prudential Foundation (Asthma Programs).  It is a bilingual multimedia educational effort that targets preschoolers ages 3-6, and its goal is “to provide support to families and health and child care providers who are caring for young children with asthma”  (Asthma Programs).

2.   “Open Airways For School.”  This is a nationwide program reaching 18,631 schools and 197,248 children (Open Airways).  It is an important public health effort because “the program teaches children, aged 8-11, how to detect the warning signs of asthma, including the environmental factors that can trigger an attack”  (Open Airways).  These children usually suffer from two major drawbacks:  one, they are either a minority or a disadvantaged child; and two, their asthma care is usually under-treated or undiagnosed (Open Airways).  However, this program is extremely important because it “empowers [these children]  to better manage their asthma, with the assistance of parents, teachers, school nurses and physicians”  (Asthma Programs).

3.  “World Asthma Day.”  This year’s World Asthma Day is scheduled to take place on May 6, 2003, and it is coordinated by the National Heart, Lung, and Blood Institute’s (NHLBI’s)  National Asthma Education and Prevention Program (NAEPP)  (About World).  Millions of people participate in this program around the world, and those involved “will conduct activities to increase awareness of the global burden of asthma and the need to improve its care”  (About World).  This program is vital for asthma education efforts, because it is internationally recognized and instructs individuals about awareness, recognition, prevention, and treatment (About World). 

4.  “Indoor Air Quality Tools for Schools.”  Not all asthma programs have to be completely toward asthma education—they can also be indirectly related to asthma control.  This program was developed by the American Lung Association and the Environmental Protection Agency with the intention of improving indoor air quality (Asthma Programs).  As a result of such preventative activities being implemented in schools, children will be able to breath better while in the classroom and fewer allergens will be present to trigger asthma attacks.

5.  “AsthmATTACK!”  This is a $25 million campaign founded by the American Lung Association.  The goal of this program is to “raise crucial funds to support the nationwide Asthma Research Initiative—the most ambitious research effort ever undertaken by a single voluntary organization”  (Asthma Programs).  Researchers will be examining environmental and biological causes of asthma and correlating this data to ethnicity, genetics, and other traits of asthmatics (Asthma Programs). 

6.  “National Asthma Education and Prevention Program.”  This program was founded in March 1989 with several prospective goals in mind: 


Not only does this program target educating asthmatics, but it also targets volunteers, health care professionals, community organizations, and the public (NAEPP).  It also established the “Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma”  in order to help organize public health educational efforts throughout the nation (NAEPP).

7.  “National Asthma Control Program.”  This program was initiated in 1999 by the Centers for Disease Control and Prevention (CDC)  in order to “reduce the number of deaths, hospitalizations, emergency room visits, school or work days missed, and limitations on activity due to asthma”  (National Asthma).  Three major steps are used in order to reach these objectives:  tracking, interventions, and partnerships (National Asthma).  During 2003, the CDC plans on conducting the following large-scale public health program to promote asthma awareness:  “11 tracking projects, 48 asthma interventions, and 33 asthma partnership projects” using the $35.2 million it appropriated in 2002  (National Asthma).

8.  “National Asthma Educator Certification board.”  This program was established by the American Lung Association in order to train nurses and respiratory therapists to have a strong background in asthma management, care, and prevention.  Participants are then tested and certified to be an asthma educator (Robbins).  As more certified educators are working in society, they will be able to enforce more public awareness and understanding about asthma, as well as uphold their mission, which is “to promote optimal asthma management and quality of life among individuals with asthma, their families and communities”  (Update). 

9.  “Policy Committee”  (on reimbursement policy).  The Cleveland Coalition is currently working on a project in order to reimburse the hourly rate of asthma educators through Medicaid Health Maintenance Organizations (Robbins).  Primary care physicians (PCPs)  are usually the asthma educators when a patient is treated for the chronic disease, but these physicians do not have enough time to properly and fully educate asthma patients due to time constraints.  As a result, this program will allow the patient to visit the PCP, and then go across the hall to an asthma educator who will charge less and spend more time explaining the disease and how to treat and prevent asthma attacks (Robbins).  One argument that the Coalition is using to support this project is that emergency room visits and hospitalization due to asthma episodes will cost much more than paying for this program.  This project is still at the beginning of development, but PCPs agree with the Coalition that this program is necessary and needed (Robbins).    

10.  “Camp SUPERKIDS® 2003.”  This is an extremely important program for children, because it is “designed to teach asthma self-management skills while allowing children with asthma to enjoy an outdoor living experience while under the supervision of an on-site volunteer medical staff of physicians, nurses and respiratory therapists”  (Camp).  There is another major advantage of this program—it is open to all asthmatic children within this ages of 7 and 12, because there is no cost to enroll and attend the camp, although voluntary contributions are welcome (Camp).  By participating in this camp, children are able to have fun, while at the same time learn about how to identify symptoms of an asthma attack and how to use their asthma medications properly (Camp).


Ten Beneficial Websites To-Be-Used as References

1.  “Asthma and Smoking.”

2.  “Asthma Care in America Falls Far Short of National Treatment Standards.”

3.  “Asthma Programs.”

4.  “Fact Sheet:  Asthma in Adults.”

5.  “National Asthma Control Program.”

6.  “Open Airways for Schools Program.”

7.  “Study Links Air Pollution, Ozone, and Asthma.”

8.  “Trends in Asthma Morbidity and Mortality.”

9.  “Preventing Attacks.”  Chris Woolston.

10.  “What Causes Attacks.”  Chris Woolston.


            Asthma is a very serious chronic disease that affects millions of children, adolescents, and adults each year.  There is no known cause of the disease, but it is possible to limit the onset of attacks by recognizing and avoiding the triggers of asthma attacks.  Through the use of various asthma organizations—at the local, state, and national levels—it is possible to increase asthma awareness and educate individuals about this chronic disease.  Many different asthma programs are currently being implemented throughout the United States, and they are reaching asthmatics in schools, physician offices, and inner-city communities.  A major focus of these projects is education, as opposed to simply treatment.  If people are taught about the underlying cause of asthma attacks, they will be able to understand more about their disease.  Another important aspect of these programs is that they help individuals understand that long-term medications, as opposed to quick-acting inhalers, are vital components of asthma care.  All of these public health measures have significantly aided in drawing nationwide attention to this disease, and with further support, it may be possible to decrease the number of emergency room visits, hospitalizations, and missed workdays and schooldays for asthmatics in all age groups.



















Asthma and Other Allergic Diseases:  NIAID Task Force Report.  U.S. Department of Health,             Education, and Welfare:  National Institutes of Health.  1979.


“About World Asthma Day.”  13 April 2003.  World Asthma Day.  2003.


“Asthma and Smoking.”  5 February 2003.  Action on Smoking and Health.  June 2002. 



“Asthma Basics.”  5 February 2003.  NIAID:  Focus on Asthma.  30 August 2001.


“Asthma Care in America Falls Far Short of National Treatment Standards.”  8 February 2003.

            Asthma in America.  4 December 1998.  


“Asthma Prevalence, Health Care Use and Mortality, 2000-2001.”  9 April 2003.  CDC:          National Centers for     Health Statistics.  28 January 2003.  


“Asthma Programs.”  13 April 2003.  American Lung Association of Ohio.  2002.


“Camp SUPERKIDS® 2003.”  14 April 2003.  American Lung Association of Ohio.  2002.


 “Child and Adult Asthma Symptoms.”  8 February 2003.  About Asthma.  25 January 2003. 



“Childhood and Adult Onset Asthma Symptoms, Causes and Risks.”  8 February 2003.  About            Asthma.  25 January 2003.


“Childhood Asthma:  An Overview.”  17 March 2003.  American Lung Association.  2002. 



“Cleveland, OH.”  8 February 2003.  Asthma in America:  A Landmark Survey.  2003. 



“Common Causes of Asthma:  Allergic and Non-Allergic.”  8 February 2003.  About Asthma.             

            25 January 2003.


“Fact Sheet:  Asthma in Adults.”  8 February 2003.  American Lung Association.  March 2002.



Harris, M. Coleman, and Norman Shure.  All About Allergy.  Englewood Cliffs:  Prentice-Hall,             Inc.  1969.


“Indoor Air—Secondhand Smoke.”  16 March 2003.  U.S. Environmental Protection Agency.                         10 February 2003.


“Missing the Mark:  U.S. Not Meeting Asthma Goals.”  8 February 2003.  Asthma in America.



“National Asthma Control Program.”  9 April 2003.  CDC:  Air Pollution and Respiratory         Health Branch.  28 January 2003.


“National Asthma Education and Prevention Program.”  13 April 2003.  National Heart, Lung, and Blood Institute.  2002.


“NIAID Study:  Cockroaches Important Cause of Asthma Morbidity Among Inner-City            Children.”  16 March 2003.  National Institutes of Health.  7 May 1997.


“Open Airways for Schools Program.”  13 April 2003.  American Lung Association.  2002.


Robbins, Norman.  Personal interview.  10 April 2003.


Samet, Jonathan M.  “Asthma and the environment:  do environmental factors affect the             incidence and prognosis of asthma?”  Toxicology Letters.  82/83 (December 1995).  33-            38.


Shapiro, Gail G., and James W. Stout.  “Childhood Asthma in the United States:  Urban Issues.”           Pediatric Pulmonology.  33:  1 (January 2002).  47-55.


 “Study Links Air Pollution, Ozone, and Asthma.”  8 February 2003.  Sinus News.  1 October 2002.


“Trends in Asthma Morbidity and Mortality.”  8 February 2003.  American Lung Association.  February 2002.


“Update on Asthma Certification.”  14 April 2003.  American Lung Association.  2002.  


Woolston, Chris.  “Preventing Attacks.”  16 March 2003.  aHealthy Advantage.  11 March      2003.


Woolston, Chris.  “Smoking and Asthma.”  8 February 2003.  aHealthy Advantage.  27 March 2002.


Woolston, Chris.  “What Causes Attacks.”  16  March 2003.  aHealthy Advantage.  11 March             2003.


Young, Patrick.  Asthma and Allergies:  An Optimistic Future.  U.S. Department of Health and Human Services:  National Institutes of Health.  1980.