How can we help communities across the country to better manage and treat asthma? That was the theme of the 8th annual USAsthma Summit held on Nov. 11, 2022 in Louisville, Kentucky.
More than 150 people attended the USAsthma Summit in person. Another 800+ joined our interactive livestream.
The USAsthma Summit provides an up-to-date look at the state of asthma care in the United States. This year’s event focused on topics centered around reaching new and underserved communities.
Each year, the USAsthma Summit brings together…
- asthma coalitions
- state asthma programs
- school nurses
- community health workers
- asthma patients and their caregivers
- patient advocates
- key stakeholders in asthma care
During the daylong Summit, presenters advanced Guidelines-based asthma care. They also discussed best practices and lessons learned from U.S. asthma programs. Many patients and caregivers were also in attendance. They shared their stories in-person and online of living with asthma.
“We all have a common interest, goals and passion in terms of reducing asthma-related deaths,” says Dennis Williams, PharmD, co-chair of Allergy & Asthma Network’s Board of Directors. “The Network aspires to include the principles of diversity and inclusion in all of our activities. You’ll find those principles are represented in the scope of the program developed for the Summit.”
Patient Testimony, Angel Melendez
Angel has lived with asthma his whole life. As a youth in El Paso, Texas, he dreamed of going to school every day, playing sports and living a normal life. Instead, he was in and out of the hospital.
When Angel was 12, he was so excited to start middle school that he had an asthma attack. He was hospitalized for almost four months. He learned that his emotions – getting too excited or angry – could trigger his asthma.
Angel began to retreat from life. He avoided everything. “The lack of proper asthma education just made it worse,” he says. “Growing up, I had to teach myself a lot about asthma. I had to learn my triggers.”
Angel called his asthma management as “trial and error.” It wasn’t until he was about 15 or 16 years old that he felt like his asthma was under control.
Angel eventually dedicated his life to helping others breathe easier. As a respiratory therapist in El Paso, asthma education is a cornerstone of his work. He served as a patient advisor on Allergy & Asthma Network’s Unidos Hablemos virtual conference series addressing asthma in the Hispanic/Latino community.
“Now that I’m older, I can look back at how my asthma was. Instead of being mad or angry about it, I realized that’s an opportunity for me to tell others about it. No matter how frustrated you are with your asthma, keep trying. Keep pushing.”
Updates on Global and National Strategies for Asthma Management, Dennis Williams, PharmD, Associate Professor, University of North Carolina Eshelman School of Pharmacy
In 2022, the Global Initiative for Asthma (GINA) Treatment Report updated its recommendations for asthma treatment.
In the first presentation of the Summit, Williams reviewed the 2022 GINA updates. These can be found on our EPR-4 vs. GINA summary.
Cases of asthma are rising, Williams reported.
- 300 million people living with asthma worldwide
- 1 in 10 are children
- 50% have uncontrolled asthma
- 1,000 people per day due from asthma
Future GINA updates are expected to focus on the following:
- allergen immunotherapy for asthma
- asthma management of children 5 years of age and younger
- the use of digital tools in asthma management
- how to better define mild asthma
9:00-9:30 – The State of Asthma in the United States, Mark Corbett, MD, President, American College of Allergy, Asthma and Immunology (ACAAI)
In the annual ACAAI address at the USAsthma Summit, Dr. Corbett focused on the critical role that allergists play in asthma management.
“Asthma and allergies, even when they are not life-threatening, can have a profound effect on patients’ quality of life,” he says. “They miss work, they miss school. Parents have to stay home, so even though they are noy running to the emergency department or being hospitalized, it has a huge impact.”
Some key research studies ACAAI focused on last year included:
- Reducing hospitalizations for asthma
- the growth of telemedicine
- obesity as an asthma risk factor
Dr. Corbett reiterated the need for asthma patients to continue taking their medications during COVID-19. He discussed a recent study showing asthma hospitalizations declined during the pandemic. It suggested that isolation measures and wearing masks may reduce exposure to respiratory viruses that trigger asthma attacks.
ACAAI continues to focus on closing gaps in asthma care by raising awareness of health disparities among people of color and in underserved communities.
9:35-10:05 – Into Thin Air: E-cigarettes, Vaping and Schools, Elizabeth Anderson-Hoagland, Tobacco Prevention and Cessation Program, Kentucky Department of Public Health
E-cigarette use continues to be popular among many middle and high school-aged children. Vaping is the inhaling and exhaling of a vapor produced by e-cigarettes. These devices are smokeless and battery-operated. They deliver flavored nicotine to the lungs. Some deliver the same amount of nicotine as tobacco cigarettes.
Many schoolchildren are becoming addicted to nicotine at a young age, Anderson-Hoagland says. E-cigarettes can also increase risk of asthma and worsen respiratory symptoms.
In looking at data of first-time e-cigarette use, the National Youth Tobacco Survey found in 2021 that half are ages 13 and under.
“So that means if you are waiting until middle school or high school to talk to young people about the health impact of vaping, you have missed the boat,” Anderson-Hoagland says. “You need to start in elementary school.”
10:25-10:50 – Asthma & COVID-19: Care & Education at Appropriate Literacy Levels, Michael Bowman, MD, AE-C, Pediatric Pulmonologist
Dr. Bowman explained the urgency of health literacy, saying that 130 million adults in the United States read at a 5th-grade or lower level.
Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services. This is important because understanding your healthcare informs your health-related decisions and actions. Further, many patients are reluctant to admit they don’t understand, compounding the problem.
Dr. Bowman cited several strategies for caregivers and health professionals:
- use clear and effective communication
- teach both parents and children
- avoid medical jargon
- use pictures and demonstrations, such as when showing proper inhaler use
- use the teach-back method to assess a patient’s understanding
10:55-11:40 – EPA Award Winners: Innovative Strategies & Partnerships to Improve Asthma Through a Comprehensive Approach: The UTAH Asthma Program. Presenting: Tracey Mitchell, Environmental Protection Agency. Panel: Andrea Jensen, CHES, AE-C, Education Specialist, Allergy & Asthma Network; and Nichole Shepard, MPH, EP-C, Program Manager, Asthma Program & Healthy Aging Program
The U.S. Environmental Protection Agency (EPA) recognizes outstanding community-based asthma programs with the National Environmental Leadership Award. In 2022, the award was given to the Utah Department of Health Asthma Program.
The Utah Department of Health Asthma Program expands the reach, quality, effectiveness, and sustainability of comprehensive asthma control services in Utah. it serves the entire state, with a focus on disproportionately impacted communities – urban, suburban and rural.
One feature is the Asthma Home Visiting Program, an in-home asthma self-management program that has been shown to reduce severe asthma outcomes. Those who complete the program report a 75% reduction in asthma-related emergency department visits and a 90% reduction in asthma-related hospitalizations.
11:45-12:10 – Unidos Hablemos: Engaging Hispanic/Latino in PCOR/CER Asthma Research, Vivian Hernandez-Trujillo, MD, Director, Division of Allergy & Immunology, Nicklaus Children’s Hospital, Miami
In 2021-22, Allergy & Asthma Network launched the Unidos Hablemos virtual conference series thanks to a grant from the Patient-Centered Outcomes and Research Institute (PCORI). The series was designed to connect people and address the impact of asthma and COVID-19 in the Hispanic/Latino communities.
Dr. Hernandez-Trujillo served as project leader for the Unidos Hablemos program. During the USAsthma Summit she focused on how we can address asthma health disparities among underserved groups, including Hispanic/Latino community.
Advancing the patient voice and engagement in research to reflect the full community is a positive first step, Dr. Hernandez-Trujillo says. “Addressing distrust is very important, as many Hispanic and Latino patients have a fear of influencing immigration status.”
Unidos Hablemos was designed to bring the patient voice into research and clinical trials. The virtual conference series:
- increased trust in asthma medicine and research
- helped remove obstacles to participation, including language and cultural barriers
“People from the Hispanic/Latino community are interested in furthering their involvement, which is the best news,” Dr. Hernandez-Trujillo says.
The next step is to develop Patient Research Ambassadors who can become trainers in their communities, leading to further engagement based on trust.
Patient Testimony, Renee Matthews, MD
Dr. Matthews is not only an asthma patient but also a doctor. She was inspired by her mom, a respiratory therapist, to dedicate her career to helping others with chronic diseases.
Dr. Matthews developed asthma as a young child growing up in Detroit. Her mom made sure she received proper medical care, but it was often a struggle. She noted the disparities in asthma education and care in the Black community.
“When I was an adult, I decided that it was very important people understand that this could be you,” she said. “In the Black community, unfortunately, there’s so much we don’t know. I’ve met so many people in my community who have no idea what allergists and immunologists are. They are carrying around asthma inhalers and don’t know what they do or how to use them right.”
Dr. Matthews works to raise awareness of asthma in her current city of Chicago and as a blogger and social media influencer.
“I love to educate and hopefully we can all get on the same page, so we can all breathe easy,” she said.
1:30-1:55 – Air Pollution Exposure in Urban Schools and the Influence on Childhood Asthma, Stephanie Lovinsky-Desir, MD, MS, Pediatric Pulmonologist, Columbia University Irving Medical Center, New York, NY
Dr. Lovinsky-Desir discussed ongoing research examining air pollution in urban homes and schools. The primary source of indoor air pollution in school is from outdoor sources. She explained the harmful process of redlining in the 1940s that impacted African-American communities in many cities, causing health inequities.
The COVID-19 pandemic forced many schools to reconsider air flow in schools, Dr. Lovinsky-Desir says.
“Schools were thinking about, ‘How do we get kids back in the classroom? And how do we keep kids safe in the classroom while mitigating exposure to the coronavirus,’” she says. “We saw a surge of research trying to understand the impact of air purifiers and high-efficiency particulate air (HEPA) filters on reducing COVID-19.
“The plus side for children with asthma is that HEPA filters can also be a source of improving air quality and reducing the risk of not only viruses that trigger asthma but also environmental air pollution.”
Dr. Lovinsky-Desir cited a Boston study that found HEPA filters in schools can significantly reduce air pollution exposure in the classroom. Researchers also found modest improvement in lung function in children with asthma.
2:00-2:25 – Creating a Home Environment Checklist for Tenants Living with Asthma. Panel: Sharmilee M. Nyenhuis, MD, FAAAAI, Associate Professor, Department of Pediatrics, Section of Allergy and Immunology, University of Chicago Medicine; Laura R. García, Healthy Homes Organizer and Policy Lead, Metropolitan Tenants Organization/Chicago Healthy Homes Coalition
The Chicago Asthma Consortium and Metropolitan Tenants Organization partnered to develop an “Environmental Checklist” for tenants with asthma. It is a tool to identify and lessen potential asthma triggers for any tenant or family member with asthma.
Many times people find health issues after they have moved into an apartment or home, Garcia says.
The “Environmental Checklist” includes:
- Keep it dry: find ways to reduce mold and mold exposure.
- Keep it clean: reduce household dust and third-hand smoke created from byproducts of cigarettes, candles and incense.
- Keep it pest-free: get rid of mice, cockroaches and dust mites that can make asthma worse.
- Keep it ventilated: increase the fresh air supply in the home.
- Keep it contaminant-free: reduce or eliminate chemical exposures to lead, pesticides, volatile organic compounds and environmental tobacco smoke.
2:45-3:10 – Caring for Students with Asthma in School, Megan Habich, MSN, APRN, NP-C, PPCNP-BC, BSN, RN, Health Services Nurse Practitioner, Jefferson County Public Schools, Louisville, KY
Asthma flares should be treated with albuterol at the first sign of symptoms. Any delay increases the risk for hospitalization or death. Ensuring schools have emergency supplies of stock albuterol on site, we can keep all children with asthma safe.
In Louisville, Kentucky, Habich detailed the policies and procedures her school district put in place to ensure stock albuterol was available.
“We do have a large percentage of students that have reported being diagnosed with asthma, that they are also chronically absent due to asthma,” Habich said. “So the stock albuterol is also going to increase the amount of time that our students are in the classroom and decrease the number of students that are either sent home or to the emergency room.”
Each school in her school district purchased 1-2 albuterol inhalers and 10 spacers, she said. The inhaler and spacer were cleaned after each use.
Upon administering the albuterol inhaler to a student experiencing an asthma flare, the nurse waited 15 minutes to look for signs of improvement. If there’s improvement, the child can go back to class. “We notified the parents of what happened,” Habich added.
If there’s no improvement, another dose is given and an ambulance is called.
3:15-3:35 – The Diversity of Asthma Care Beliefs and Practices: The Findings of the Asthma Caregivers and Children Project, Sienna Ruiz, BA, and Erika Waters, PhD, MPH, Washington University School of Medicine, St. Louis, MO
The Asthma Caregivers and Children Project aims to understand the social, psychological and health system factors that shape how caregivers made decisions about managing their child’s asthma.
The research found that children’s asthma was often undertreated. children and parents often had different understandings of asthma.
In the study, caregivers expressed challenges that impacted asthma management:
- Living in inadequate or poorly maintained housing influenced how caregivers managed asthma.
- Comparing their child’s asthma to other people with asthma sometimes impacted asthma care.
- Addressing acute asthma symptoms such as coughing and wheezing more than underlying airway inflammation.
Children’s approach to managing asthma was often shaped by things outside of their control, such as school policies on stock albuterol. Many children also felt asthma inhalers were stressful to use.
3:50-4:15 – Helping Patients with Asthma Navigate the Health Care System; Andrea Jensen, CHES, AE-C; Lorene Alba, AE-C, Patient Advocate
Patients don’t have to just navigate their personal health. They must also learn to navigate insurance companies and health care visits. They must also learn how to access resources that can help them.
This is where community health workers, public health educators, chronic disease educators, social workers and patient navigators can step in, Jensen says.
- Community health workers can serve as a go-between for families and healthcare professionals. They can provide hands-on assistance to connect families to resources. They are often bilingual and understand cultural preferences and values.
- Public health educators partner with community organizations. They can provide self-management education and resources in different languages.
- Chronic disease educators are skilled in understanding public health and can develop, deliver and evaluate asthma treatment plans. They recognize social determinants of health.
- Social workers and patient navigators can also help arrange follow-up care, connect patients with prescription assistance programs and provide resources to help with transportation issues.