Shining a Light on Asthma Challenges

Dr. John H. Armstrong.

Nine Florida cities among nation’s most challenging places for asthmatics

Florida’s not faring very well for people living with asthma, yet strides are being made to improve the environment.

In the “2014 Asthma Capitals” report, released by the Asthma & Allergy Foundation of America (AAFA), the Sunshine State represents 9 percent of the list. Conditions have worsened since the 2013 list debuted, with “the most challenging places to live with asthma,” collectively dropping 117 spots.

A few startling Florida statistics:

  • From 2000 to 2010, lifetime asthma prevalence among adults increased by 52 percent, and asthma-related hospitalizations statewide rose by more than 32 percent.

  • Between 2006 and 2012, the lifetime asthma prevalence among middle and high school students increased by 21 percent.

  • In 2012, more than 2.6 million Florida adults and children had lifetime asthma, and approximately 1.6 million had current asthma. That statistic represents one of eight adults with lifetime asthma and one in 12 with current asthma; and one of five children with lifetime asthma, and one in 10 with current asthma.

“Asthma rates and healthcare utilization for asthma have increased dramatically over the last 30 years in all populations in Florida, and across the United States,” wrote John H. Armstrong, MD, FACS, surgeon general and Secretary of Health, in the Sept. 2013 report, “Health: Burden of Asthma in Florida.”

“Asthma incurs high expenses, in terms of cost of care, lost workdays and productivity, and lower quality of life for persons with asthma and their families,” he noted. “Asthma is a leading cause of preventable emergency department visits and hospitalizations.”

Before Florida became one of 36 states selected to receive funding and technical support from the Centers for Disease Control and Prevention’s (CDC) National Asthma Control Program, and established the Florida Asthma Program in 2009, the state had no systematic approach to state and local asthma surveillance, yet 15 percent of county health departments listed asthma as a priority health issue.

Now with the CDC’s support, the program has developed a comprehensive system for asthma data-gathering that provides easy, round-the-clock access to the latest county-specific asthma data, providing communities with information to better develop local Asthma Action Plans.

“One-on-one care between patients and doctors isn’t enough to really control asthma,” said Julie Dudley, manager of the Florida Asthma Program. “Asthma requires coordinated care, and public health has the infrastructure to create the connections and partnerships needed to make that happen.”


Focusing on Children with Asthma

Among responses to asthma challenges statewide, the Florida Asthma Program has launched its asthma control curriculum for child care providers and its Asthma-Friendly Childcare Award program. To receive an award, child care centers must participate in asthma control training and keep Asthma Action Plans on file. Within two years of its impetus, nearly 1,000 child care providers had completed the training, seven child care centers had achieved silver-level recognition, and nine had achieved bronze-level recognition. As a result, a record number of child care centers across the state now have Asthma Action Plans on file.

The program’s partnership with the state chapter of the American Lung Association has also infused asthma education in schools. By early 2013, more than 1,300 third, fourth and fifth graders had learned how to better control their asthma through the Open Airways for Schools program, and some 600 school faculty participated in the Asthma 101 program.

“Identify schoolchildren with asthma at the beginning of each school year,” urged Armstrong. “This will enable schools to track absenteeism, health room visits, 9-1-1 calls, and the number of times children leave school with asthma-related issues. This will enable school staff to identify and monitor students in need for additional asthma management support.”

Jason E. Lang, MD, a pediatric pulmonologist with Nemours Children’s Health System, said that measures taken by the Florida Asthma Program represent “a great step in the right direction to make it safe for children with asthma.”


Lack of Asthma Action Plans

The report also addresses another startling statistic: Three of four adults in Florida with asthma (75.3 percent) report never having received an Asthma Action Plan from a doctor or other health professional.

“It’s especially important for schoolchildren to have easily understandable Asthma Action Plans because of the decrease in the number of school nurses resulting from budgetary cutbacks,” said allergist-immunologist Thomas B. Casale, MD, professor of internal medicine at the Ujniversity of South Florida’s Morsani College of Medicine in Tampa. “The acute management plan needs to be very simple so that patients or parents/school nurses can manage asthma to a better degree. Then they’ll know when to call a healthcare provider for an adjustment in medications versus when to go to the ER.”

The “Burden of Asthma” lists action measures to prompt the development of these action plans:

For physicians and other primary care providers:

  • Develop an Asthma Action Plan and review it with each patient to ensure the patient understands daily medications and proper usage techniques, how to avoid asthma triggers, and how to identify warning signs that require quick-relief medications or additional medical interventions.

  • Use data systems to track and monitor Asthma Action Plans and other components of asthma care.

For hospitals and emergency departments:

  • Ensure patients have an Asthma Action Plan, provide or make referrals to self-management education, provide education and resources on managing environmental triggers in the home, and communicate with primary care and community care providers as needed.

For pharmacists:

  • Monitor your pharmacy’s asthma medication order and refill intervals to identify patients with poorly controlled asthma. Contribute to the community’s asthma management team by alerting prescribers about patients whose asthma may be poorly controlled

For healthcare professional associations:

  • Include a link to the National Asthma Control Initiative on your website and promote the six priority action messages for members:

  1. Prescribe inhaled corticosteroids as indicated by the guidelines.

  2. Use written Asthma Action Plans to guide patient self-management.

  3. Assess asthma severity at the initial visit to determine initial treatment.

  4. Assess and monitor asthma control and adjust treatment if needed.

  5. Schedule follow-up visits at periodic intervals.

  6. Act to control environmental exposures that worsen asthma.

“Large disparities related to race/ethnicity, gender, age, and income exist when reviewing the most severe outcomes of the disease,” noted Armstrong. “While the prevalence of asthma in Florida is similar among all race/ethnicity groups, substantial disparities exist in the rate of ED visits and hospitalizations, an indication of poorly controlled asthma.

“Improving asthma outcomes among disparate populations must be a priority for all partners involved in asthma management.”



2014 Asthma Capitals in Florida

  • No. 20: Jacksonville

  • No. 49: Orlando

  • No. 50 Tampa

  • No. 55: Lakeland

  • No. 58: Miami

  • No. 64: Daytona Beach

  • No. 75: Sarasota

  • No. 76: Palm Bay

  • No. 82: Cape Coral


Groundbreaking Change

On June 13, Gov. Rick Scott signed into law the most comprehensive epinephrine-stocking legislation introduced to date in any U.S. state.

The Emergency Allergy Treatment Act, which will allow some public venues – Walt Disney World, restaurants, sports arenas – to stock epinephrine auto-injectors (epi-pens), improved upon previous legislation. It calls for trained personnel, or non-trained personnel in an emergency with authorization from a medical provider, to administer epi-pens.

Florida had previously passed similar stock epinephrine legislation for schools. However, that legislation only allows schools to stock epi-pens; it doesn’t mandate them. Only four states – Maryland, Nebraska, Nevada, and Virginia – require stocking epinephrine in schools. At press time, five states had pending legislation to require schools to stock epinephrine auto-injectors – California, Illinois, Massachusetts, New Jersey and North Carolina.


Local Data Resources

Florida Community Health Assessment Resource Toolset (CHARTS), part of the Florida Department of Health’s Division of Public Health Statistics and Performance Management, is a one-stop-site for Florida public health statistics and community health data:

Florida Environmental Public Health Tracking (EPHT) Program is grant-funded, to identify and promote the use of nationally consistent data in partnership with the Centers for Disease Control and Prevention and other grantee states:


August 2014