Progress Toward Healthy People 2010 Targets

The following discussion highlights objectives that met or exceeded their 2010 targets; moved toward the targets, demonstrated no change, or moved away from the targets; and those that lacked data to assess progress. Progress is illustrated in the Progress Quotient chart (see Figure 24-1), which displays the percent of targeted change achieved for objectives and subobjectives with sufficient data to assess progress.

Objectives that met or exceeded their targets. No objectives in this focus area met or exceeded their targets at the midcourse review.

Objectives that moved toward their targets. Three objectives and two subobjectives demonstrated statistically significant changes from their baseline values in the direction of their targets. Deaths from asthma among adults aged 65 years and older (24-1e) declined from 69.5 per million population in 1999 to 58.1 per million population in 2002, achieving 51 percent of the targeted change. All death rates (that is, asthma and COPD) in this focus area are age adjusted. However, for ease of presentation, the phrase "death rate" will be used instead of "age adjusted death rate." The proportion of persons who ever had asthma and who also reported activity limitations from asthma (24-4) decreased from 10 percent in 1997 to 8 percent in 2003, achieving 50 percent of the targeted change. The proportion of persons aged 18 years and older who ever had asthma and who also reported ever receiving formal education (24-6) increased significantly from 8.4 percent in 1998 to 12.4 percent in 2003, achieving 19 percent of the targeted change. The proportion of persons who ever had asthma and who also reported receiving assistance in reducing exposure to environmental risk factors (24-7f) increased from 42 percent in 2002 to 49 percent in 2003, moving toward the target of 50 percent and achieving 88 percent of the targeted change. COPD deaths in adults aged 45 years and older (24-10) decreased from 123.9 per 100,000 population in 1999 to 118.9 per 100,000 population in 2002, achieving 8 percent of the targeted change.

Two objectives and six subobjectives moved toward their targets, but the levels of change were not statistically significant. Deaths from asthma among children aged 5 to 14 years (24-1b), adolescents and adults aged 15 to 34 years (24-1c), and adults aged 35 to 64 years (24-1d) declined but did not demonstrate statistically significant differences from the baseline values. Statistically insignificant declines were also seen for hospitalizations for asthma among children and adults aged 5 to 64 years (24-2b), hospital emergency department visits for asthma among children and adults aged 5 to 64 years (24-3b), and the average number of school or work days lost among persons aged 5 to 64 years who ever had asthma and who also reported an asthma attack in the past year (24-5). The proportion of persons who ever had asthma and who reported receiving a written asthma management plan from a health care provider (24-7a) also moved toward the target, but the increase was not statistically significant. Vehicular crash deaths related to excessive sleepiness (24-12) moved toward the target of 1.70 percent of fatal victims of motor vehicle crashes caused by persons with excessive sleepiness; however, the progress was not statistically significant.

The U.S. Department of Health and Human Services (HHS) supports programs to control asthma by improving the quality of life and daily functioning among persons with asthma, prevent severe exacerbations among persons with asthma, and discover ways to prevent the onset or progression of the disease. One program is the National Asthma Education and Prevention Program (NAEPP), which provides the latest clinical practice guidelines for both acute and chronic management of asthma.² These guidelines are used to address disparities in asthma care, including care received in emergency departments. Another program was the Asthma Surveillance and Emergency Department-Based Interventions Project, which linked asthma data to the implementation of emergency department-based strategies to improve asthma care, including offering asthma education, facilitating referrals, and providing inhaled corticosteroids.^{3, 4}

Research efforts to understand asthma triggers help to inform strategies and develop interventions. The results of a clinical trial reported that home-based interventions to reduce exposure to common allergens, such as cockroaches, house dust mites, and tobacco smoke, resulted in 20 percent fewer days with asthma symptoms and 14 percent fewer unscheduled clinic visits throughout the intervention year.⁵ A related study reported that the estimated cost-effectiveness of an environmental intervention is similar to that of inhaled corticosteroids.⁶

Initiatives specifically targeting asthma in children have also been developed. The Centers for Children's Environmental Health and Disease Prevention, implemented by the National Institutes of Health (NIH) within HHS, examines the effect of environmental exposures on children's health.⁷ Through a multidisciplinary research approach comprising basic, applied, and community-based participatory research, the centers translate and communicate their findings to clinical and public health professionals and policymakers to alleviate the burden of environmentally induced diseases in children. Another initiative is the Inner-City Asthma Consortium (ICAC), which evaluates the safety and efficacy of promising immune-based therapies to reduce asthma severity and prevent disease onset in inner-city children. ICAC investigates the mechanisms of action of the immune-based therapies; develops and validates biomarkers of disease stage, progression, and therapeutic effect; and investigates how asthma develops in relation to the immune system of inner-city children.⁸

In addition, the Childhood Asthma Research and Education (CARE) Network is a research network dedicated to addressing areas of clinical concern in childhood asthma, filling gaps in science identified by national guidelines, and rapidly translating findings into clinical practice. It has established that giving young children at high risk for developing persistent asthma daily inhaled corticosteroids provides significant benefit in increasing episode-free days and decreasing severe exacerbations, but does not alter the underlying course of the disease.⁹ The finding demonstrates to clinicians the effectiveness and general safety of treating young children long term to control the disease and underscores the need to develop other, novel therapies that might prevent its progression. Another study by the CARE Network has advanced the development of tools to help physicians efficiently select the most appropriate medication for children by identifying characteristics of a patient's asthma that can predict the patient's response to therapy.¹⁰ Through these and other studies, the CARE Network and the Asthma Clinical Research Network are advancing the emerging field of "pharmaco-genetics" through the examination of genetic and phenotypic information to personalize treatment choices.

Objectives that demonstrated no change.The proportion of adults aged 45 years and older who ever had asthma and who experience activity limitations due to chronic lung and breathing problems (24-9) was 2.5 percent in both 1997 and 2003.

Objectives that moved away from their targets. While five subobjectives moved away from their targets, none of the changes were statistically significant. The subobjectives are deaths from asthma among children under age 5 years (24-1a), hospitalizations for asthma in children under age 5 years (24-2a), hospitalizations for asthma among adults aged 65 years and older (24-2c), hospital emergency department visits for asthma among children under age 5 years (24-3a), and hospital emergency department visits for asthma among adults aged 65 years and older (24-3c).

Objectives that could not be assessed. Seven objectives and subobjectives lacked data to assess progress: receiving proper instructions for inhaler use for persons with asthma (24-7b); education on early signs, symptoms, and responses to episodes (24-7c); receiving medication regimens that prevent the need for more than one canister of rescue medication per month (24-7d); followup care after any hospitalization due to asthma (24-7e); surveillance systems for asthma (24-8); and medical evaluation (24-11a) and followup (24-11b) for sleep apnea. Data for these objectives and subobjectives are anticipated by the end of the decade.

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