National Asthma Education and Prevention Program
PROGRAM DESCRIPTION
Purpose
The National Asthma Education and Prevention Program
(NAEPP) was initiated in March 1989 to address the growing problem of asthma in
the United States. The goals of the NAEPP are to:
- Raise awareness of patients, health professionals,
and the public that asthma is a serious chronic disease.
- Ensure the recognition of the symptoms of asthma by
patients, families, and the public and the appropriate diagnosis by health
professionals.
- Ensure effective control of asthma by encouraging a
partnership among patients, physicians, and other health professionals through
modern treatment and education programs.
To accomplish these broad program goals, the NAEPP
works with intermediaries including major medical associations, voluntary
health organizations, and community programs to educate patients, health
professionals, and the public. The ultimate goal of the NAEPP is to enhance the
quality of life for patients with asthma and decrease asthma-related morbidity
and mortality.
Background
Asthma is a major public health problem in the United
States. The disease affects approximately 15 million people, nearly 5 million
of whom are under the age of 18. People with asthma experience well over 100
million days of restricted activity annually, and the total annual costs of the
disease are estimated at $11.3 billion.
Although asthma mortality in the United States is
among the lowest in the world, approximately 5,000 asthma-related deaths still
occur each year in this country. Moreover, the asthma mortality rate has risen
over the past 20 years or so, especially in African Americans and individuals
age 85 and older. This increase is of particular concern because it comes at a
time when mortality rates from most natural causes in the United States are on
the decline.
Rising asthma prevalence, especially among children,
is another cause for concern. Between 1980 and 1994, the prevalence of asthma
in the United States increased 75 percent overall and 74 percent among those
between the ages of 5 and 14. It is estimated that more than 7 percent of
children now have the disease.
Also disturbing are the number and rate of
asthma-related hospitalizations in this country. In 1994, 466,000
hospitalizations were directly related to the disease. The hospitalization
rates since 1979 have increased disproportionately among children and African
Americans. The rate of hospitalizations among African Americans was nearly
triple that of whites in 1993-1994.
-
- Percent Increase in Asthma Prevalence,
Death, and Hospitalization Rates
-
- Prevalence Rate: 75% Increase
- Death Rate: 56% Increase
- Hospitalization Rates
- Total Population: 3% Increase
- Children, 0-4 years: 45% Increase
- Children, 5-14 years: 13% Increase
- African Americans: 37% Increase
The reasons for the increases in morbidity seen with
asthma are not clear. However, certain factors indicate that many
asthma-related hospitalizations and deaths are preventable. For example, the
patient may fail to avoid environmental factors that make asthma worse,
recognize early warning signs of worsening asthma, appreciate the severity of
an exacerbation, take appropriate medication, or get prompt medical help when
problems occur. The clinician may fail to diagnose asthma, initiate appropriate
therapy, adequately monitor the patient's condition, recognize serious
exacerbations, or educate the patient to prevent symptoms and develop a crisis
plan for emergencies.
These issues indicate the need for asthma
educationfor both patients and health professionals. Such was the
conclusion at a 1988 NHLBI-sponsored workshop titled Asthma Education: A
National Strategy, which involved representatives for a number of lay and
professional organizations interested in asthma. The recommendations made at
this workshop, combined with the results of research demonstrating the benefits
of asthma education on disease outcome, became the impetus for the development
of the NAEPP and helped define the program's objectives.
NAEPP Objectives
For Patients and the Public
- Increase public awareness of asthma as a
significant public health problem.
- Increase public awareness of the signs and symptoms
of asthma
- Improve the knowledge, attitudes, and skills of
patients regarding the detection, treatment, and control of asthma,
particularly in high-risk populations.
- Define guidelines for effective asthma education
programs.
- Promote development, dissemination, and use of
patient and family education materials.
For Health Professionals
- Increase knowledge, attitudes, and skills of all
health professionals regarding signs, symptoms, and management strategies for
asthma.
- Encourage health professionals treating patients
with asthma to adequately track and monitor patient status and to use objective
measures of lung function.
- Assist and encourage health professional schools
and continuing education programs to include up-to-date and accurate
information on diagnosis, pathogenesis, and treatment of patients with asthma.
- Promote and encourage the concept of active patient
participation with the physician in the management of asthma.
- Develop resources and materials for use by health
professionals.
- Promote research to answer unresolved questions
about underlying causes of asthma and appropriate asthma treatment and
management practices.
Program Achievements
Since 1989, when the NAEPP began, much has been
accomplished to meet the program's objectives. The first significant
achievement was the development and wide distribution of the Expert Panel
Report: Guidelines for the Diagnosis and Management of Asthma. This
report changed common perceptions about asthma and its treatment by emphasizing
the role of inflammation in disease development, noting the importance of
objective monitoring of lung function, and stressing the need for establishing
partnerships between patients and health care providers through patient
education.
Hundreds of thousands of copies of the report have
since been distributed to physicians, medical schools, and other health
professionals and organizations, as well as to patients with asthma. In 1992,
the NAEPP sponsored the First National Conference on Asthma Management to
encourage implementation of the recommendations in the report. The guidelines
continue to be promoted at national health and medical association meetings and
in a variety of journals.
A number of companion documents also have been
developed for health professionals and patients. A practical guide with patient
handouts was produced to facilitate patient education by clinicians. An
easy-to-read booklet instructs patients how to control their asthma in
collaboration with their health care providers. Separate guides have been
prepared for emergency department personnel, pharmacists, and nurses.
Specialized reports on asthma in pregnancy and asthma in the elderly were also
developed. These materials and others are continually distributed through the
NHLBI Information Network and a variety of other channels.
In 1997, an updated version of the guidelines was
released. It builds upon the recommendations in the original report and, based
on more recent scientific findings, adds recommendations for clinicians and
patients about such important issues as the appropriate medications for
controlling asthma and for relieving asthma symptoms, the use of allergy
testing to identify perennial indoor allergens for some patients, the
importance of reducing patient exposures to tobacco smoke, the need to treat
suspected asthma in infants aggressively, and the value of using spirometry and
peak flow monitoring in diagnosing and monitoring asthma.
Because children are significantly affected by asthma,
a separate initiative is targeted to schools. A variety of materials have been
produced not only to teach children with asthma and their parents about the
disease, but also to educate school personnel about the important role they can
play in children's ability to manage their disease at school.
In 1998, the NAEPP expanded its activities with
intermediary organizations to focus on collaborative activities with the many
community-based asthma coalitions that are growing up across the country. More
than 40 local asthma coalitions were invited to a workshop in Washington in the
fall to promote networking among these groups and to identify opportunities for
the NAAEPP to support some of them. It is currently working to develop
innovative performance-based interventions through selected local asthma
coalitions to improve the way physicians manage asthma, to ensure that patients
are taught effective self-management skills, and to promote programs and
policies that support asthma-friendly environments.
The NAEPP also launched a Web site in December 1998 to
provide a focal point through which local asthma coalitions can learn about
each other's and the NAEPP's activities and exchange information. The Web site
also provides virtually all the scientific literature on chronic asthma that
has ever been published for physicians who want to provide the most up-to-date
diagnostic and treatment methods for their asthma patients. It is located at .
Complementing all of these efforts has been a number
of media campaigns to promote asthma awareness among the general public and to
encourage undiagnosed patients to seek care. These messages have been targeted
to African Americans and to Hispanics, who are at increased risk of
asthma-related hospitalizations and deaths.
In addition to conducting asthma education and
prevention activities, the NAEPP also contracts with other organizations to
develop educational programs for minority populations.
NAEPP Coordinating Committee
Key to the success of the NAEPP is the participation
of representatives from the major scientific, professional, governmental, and
voluntary organizations interested in asthma. Members of the NAEPP Coordinating
Committee not only provide input on program strategies and materials
development, but also implement many activities through their organizations.
Member Organizations of the NAEPP Coordinating
Committee
Allergy and Asthma Network/Mothers of Asthmatics, Inc.
American Academy of Allergy, Asthma, and Immunology American Academy
of Family Physicians American Academy of Pediatrics American Academy
of Physician Assistants American Association for Respiratory Care
American Association of Occupational Health Nurses American College of
Allergy, Asthma and Immunology American College of Chest Physicians
American College of Emergency Physicians American Lung Association
American Medical Association American Nurses Association American
Pharmaceutical Association American Public Health Association American
School Health Association American Society of Health-System Pharmacists
American Thoracic Society Association of State and Territorial
Directors of Public Health Education Asthma and Allergy Foundation of
America National Association of School Nurses National Black Nurses'
Association, Inc. National Medical Association Society for Academic
Emergency Medicine Society for Public Health Education
Federal Agencies
Agency for Healthcare Research and Quality
National Center for Chronic Disease Prevention National Center for
Environmental Health National Center for Health Statistics National
Heart, Lung, and Blood Institute NHLBI Ad Hoc Committee on Minority
Populations National Institute for Occupational Safety and Health
National Institute of Allergy and Infectious Diseases National Institute
of Environmental Health Sciences U.S. Department of Education U.S.
Environment Protection Agency U.S. Food and Drug Administration U.S.
Public Health Service
Additional Representatives to the NAEPP School Asthma
Subcommittee
American Association for Physical and Health
Education, Recreation, and Dance National Association of Elementary School
Principals National Education Association Health Information Network
National School Boards Association
For more information on the NAEPP, contact:
National Asthma Education and Prevention Program
NHLBI Health Information Network P.O. Box 30105 Bethesda, Maryland
20824-0105 (301) 592-8573 phone (301) 592-8563 fax
www.nhlbi.nih.gov
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