U.S. Department of Health & Human Services
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In fiscal year 2001, HHS will spend an estimated $223 million on asthma research and prevention. This represents a 20 percent increase over spending in fiscal year 2000 and a 42 percent increase over spending in fiscal year 1999. Much more is spent on direct delivery of medical care. Estimates of Medicaid and Medicare expenditures for treatment of asthma exceed $1 billion per year. In addition, HHS-funded clinics and hospitals treat thousands of people for their asthma.

BACKGROUND

Asthma is a chronic lung disease that is characterized by intermittent, recurring episodes of wheezing, breathlessness, tightness of the chest and coughing. Over the past 15 years, the number of Americans afflicted with asthma has doubled to an estimated 15 million people, including an estimated 4.4 million children. Between 1980 and 1994, the percentage of Americans with asthma increased 75 percent, and the percentage of pre-school age children with asthma increased 160 percent. Taking care of asthma is expensive and imposes financial burdens on the families of people who have it. In 1998, the National Heart, Lung and Blood Institute (NHLBI) estimated that the annual costs of asthma were $11.3 billion.

Although asthma affects Americans of all ages, races and ethnic groups, low income and minority populations experience significantly higher rates of fatalities, hospital admissions and emergency room visits due to the disease. From 1993-1995, there were an average of 38.5 deaths per million from asthma in African-Americans compared to 15.1 per million in whites. In 1995, African-Americans were more than four times more likely than whites to visit an emergency room because of asthma. The prevalence of asthma is also high among some populations of Hispanics, with those of Puerto Rican descent having the highest incidence. Hospitalization and death rates for Hispanic children due to asthma in New York City are three times higher than the national average. Although asthma was once considered rare among American Indians and Alaska Natives, studies have shown that asthma prevalence is increasing in this group. Indian children appear to be especially affected, with prevalence rates as high as 12 percent.

HHS EFFORTS TO COMBAT ASTHMA

Many ongoing HHS programs work to help the management and, ultimately, prevention of asthma. To more effectively confront these challenges, HHS began a special asthma initiative. Agencies within the department worked together to assess current efforts on asthma and to develop a set of priorities for the future. Released in May 2000, HHS' strategic plan, "Action Against Asthma," describes the priority research needed to learn how to prevent asthma, and the public health actions and research needed to eliminate the disparities in the impact of asthma and to reduce the burden on all who suffer from the disease. The strategy is available at aspe.hhs.gov/sp/asthma.

HHS is conducting research into determining the causes of asthma and developing interventions to prevent its onset. Research has not yet identified or demonstrated how to prevent the onset of asthma. However, research continues both into ways to understand the causes of asthma and into testing strategies to prevent its occurrence. Such research is essential for "primary prevention" - preventing the onset of asthma in individual patients and in high-risk populations.

Most HHS-sponsored asthma prevention research is done by the National Institutes of Health, including the NHLBI, the National Institute of Allergy and Infectious Diseases (NIAID), and the National Institute of Environmental Health Sciences (NIEHS). Extensive research focuses on the natural history of asthma, risk factors, genetics, and the basic mechanisms and pathogens of asthma. Current research projects include: a joint NHLBI and NIAID study on the role of respiratory infections in the development of childhood asthma; an NHLBI-sponsored initiative on the origins of asthma in early life; an NHLBI study on nocturnal asthma; and an NIEHS study on environmental intervention to prevent the onset of asthma in children.

HHS programs work toward reducing the burden of asthma for people who already have the disease. HHS supports an array of public health activities designed to improve the diagnosis and treatment of asthma, including clinician education, family and patient education, community-based asthma programs and public education, and public health activities at the state level.

The NHLBI's National Asthma Education and Prevention Program developed and distributes "Guidelines for the Diagnosis and Management of Asthma," which help doctors put the latest scientific knowledge about asthma into practice. Other outreach activities include a school-based asthma education program in partnership with the Environmental Protection Agency and the American Lung Association; and a bilingual asthma awareness program with the Children's Television Workshop. More information on these outreach efforts is available at www.nhlbi.nih.gov/about/naepp/. HHS' Administration for Children and Families (ACF) also distributes information on asthma to Head Start centers for use by staff, management and parents.

The Centers for Disease Control and Prevention (CDC) is developing case studies of effective public health interventions for asthma that have been validated in research settings. CDC has funded three universities to evaluate methods for the early detection of asthma in preschool and school populations. In addition, CDC has funded 12 states to develop state plans to respond to the increasing burden of asthma. These plans are being developed in collaboration with local non-profit and professional organizations and, in some cases, with the managed care industry.

HHS also sponsors numerous studies and programs into secondary prevention to help people who already suffer from asthma to better manage the disease. In 1999, NHLBI created the Pediatric Asthma Clinical Research Network, which evaluates different asthma treatments in six cities. And, NIAID and NIEHS are continuing the Inner City Asthma Study, a study of children with asthma in seven U.S. cities that is testing the effects of interventions that reduce children's exposure to indoor allergens and improves communication with their primary care physicians.

The Medicare and Medicaid programs, administered by the Health Care Financing Administration (HCFA), both cover asthma treatment. Specifically, Medicaid covers medically necessary services for the diagnosis and treatment of asthma in eligible children, including X-rays, drugs, inpatient stays, and outpatient and emergency room visits. States may also provide many of these services for Medicaid-eligible adults. In addition, some state Medicaid programs are using disease management programs as an effective means of improving outcomes for asthma patients. Medicare covers both physician visits and oxygen equipment, asthma inhalers and medications, and other durable medical equipment required by some asthmatic patients.

HHS efforts include programs to eliminate the disproportionate health burden of asthma in minority populations and those living in poverty. Low-income individuals and minorities suffer from asthma at a disproportionately high rate. While the reasons for these disparities are not clearly understood, an interaction of factors is most likely responsible, including: lack of access to quality medical care, high levels of exposure to environmental allergens, language barriers, and lack of financial resources and social support to treat the disease effectively on a long-term basis.

Several HHS agencies support public health programs designed to meet the needs of people living in poverty or of minorities who are at risk. ACF's Head Start program offers comprehensive early childhood education, nutrition, and health and social services to low-income children nationwide. And, the HHS Office of Minority Health supports the "Minority Health Asthma Attack Avoidance Education Program," which is designed to increase awareness of asthma triggers and to ensure appropriate referral to medical care.

In 2001 CDC is funding 23 community organizations to implement the Inner City Asthma Intervention, a research-proven asthma intervention program based on the National Collaborative Inner City Asthma Study, an NIAID-funded research project.

In addition, the Health Resources and Services Administration (HRSA) is supporting 23 HRSA-supported health centers, including five school-based health centers, to participate in an Institute for Healthcare Improvement Breakthrough Series on asthma. Participants in this collaborative are learning and implementing an organizational approach to caring for people with chronic disease in a primary care setting.

The majority of HHS funds dedicated to asthma treatment in underserved populations provide direct health services. For instance, the Medicaid program reimbursed costs of asthma care for more than 1 million low-income patients in 1995; primary care services in health centers supported by HRSA include treatment of asthma; and the Indian Health Service has established several specialty clinics focused on asthma.

HHS agencies are tracking the disease to build data necessary for assessing the effectiveness of asthma programs. Surveillance is critical to research and public health practice. Combined with studies in large groups of people, surveillance results can identify populations with particularly high or low prevalence of a disease and can shed light on factors influencing the development of asthma.

CDC analyzes and publishes data from ongoing surveys on health events such as deaths due to asthma, asthma hospitalizations and emergency department visits for asthma. In 1999, CDC began generating state-level asthma prevalence data through the Behavioral Risk Factor Surveillance System. In 2001, specific questions on the severity and management of asthma will be included.

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Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.