Download Asthma Rate Rises Sharply in US, Government Says

ASTHMA NEWS AND NOTES
MARCH 25, 2011
Topics for the week:
Asthma Program
Asthma News in Ohio
Ohio Department of Health Asthma Program
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Ohio Statewide Asthma Plan now on the Web.
ODH Asthma Program submits application for 2011-12 funding.
Ohio Surveillance System for Asthma to publish new reports.
Local Coalition News:
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Greater Cleveland Asthma Coalition reorganizes and sets meeting time.
Northwest Ohio Asthma Coalition bids convener goodbye.
Ohio Asthma Coalition News:
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Ohio Asthma Coalition meeting March 11, 2011.
 Initiative reports: Schools, Home Visits, Clinical.
Archived Webinar on Website: Incorporating Asthma Action Plans into Clinical Practice
National Asthma Educators Certification Board News
Asthma News from the Media and Educational Topics
Anything Asthma:
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Everyone Breathe™ announces grants to children with asthma and schools.
Asthma Rate Rises Sharply in U.S., Government Says
High-Dose Inhaled Steroids Reduce Cold-Related Asthma Attacks
May is National Asthma Month and World Asthma Day is May 3, 2011.
Asthma more likely in children from poor, rural areas, study finds
New very large study on Long Acting Beta Agonist’s may contradict SMART study.
o Abstract of the Research article
Asthma Drug Added to Standard Therapy Effective for Inner City Children CME/CE
NIH Study Finds Omalizumab Relieves Seasonal Asthma Attacks in Youth
FDA delays a decision on Novartis' COPD drug until July
Paediatric asthma outpatient care by asthma nurse, paediatrician or general practitioner: randomised
controlled trial with two-year followup.
Extreme Prematurity Linked to Asthma Risk in Young Adults CME
COPD Drug Test of Questionable Diagnostic Value CME
Asthma in the Primary Care Practice
Study questions benefits of acid-suppressing drugs in children
Tiotropium: A Safe Solution for Long-Acting Asthma Control?
Study questions benefits of acid-suppressing drugs in children
PPIs Not Recommended for Routine Treatment of Adult Asthma
Lung Defects More Common in Girls Than in Boys at Risk for Asthma
Resource for asthma research and presentations: Clinical Directors Network
Why Are Asthma Rates Soaring? Researchers once blamed a cleaner world. Now they are not so sure
National Healthy Schools Day: EPA Administrator, Parent Speak out on need to improve indoor air quality
in schools, academic performance
H1N1 Vaccinations and Asthma:
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H275Y Mutant Pandemic (H1N1) 2009 Virus in Immunocompromised Patients CME
FDA approves shingles vaccine Zostavax for those in their 50s
Medications
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Experts look at ways to boost medication adherence
FDA Orders Safety Studies for Some Asthma Drugs
Changing Practices
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Practitioners stress comprehensivist approach in patient care
CDC to poll providers on chronic disease management
ED visits are on the rise, survey finds
"Evidence-based health" model could improve patient care
Patients have growing influence in medical care, health industry
Hydrocortisone may curb hospital-acquired pneumonia, study finds
Health Care Quality: Resources for Local Change
Transition to medical home model has challenges, study finds
Study projects 83% of providers may qualify for EHR incentives
Review: Health literacy affects quality, outcomes
Study: Most U.S. patients seek online access to physicians
Community health centers are medical homes by necessity
Performance Measurement and Public Reporting: Lessons Learned: Lessons Learned About Measuring
and Reporting Physician Performance
Health industry taps IT to boost patient care education
Hospital benefits from chronic care management technology
Tobacco Issues:
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U.S. sees a decline in the prevalence of heavy smoking
Smoking Cessation Before Surgery May Not Increase Post-Op Complications CME
A Nationwide Analysis of US Racial/Ethnic Disparities in Smoking Behaviors, Smoking Cessation, and
Cessation-Related Factors.
Moderate Levels of Secondhand Smoke Deliver Nicotine to the Brain NIH-funded study
Webinars and Continuing Education:
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CDC May 2011 Asthma Webinar – Tuesday, May 10, 2011, at 3:15 – 4:15pm
Asthma Drug Added to Standard Therapy Effective in Inner-City Children CME/CE
Disparities:
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LIVE Webcast: Today's Topics in Health Disparities -HHS' Action Plan to Reduce Health Disparities
Webinar: Looking Upstream: How Income, Education and Racial Inequalities Shape Health
OHIO DEPARTMENT OF HEALTH ASTHMA PROGRAM (ODHAP)
Ohio Statewide Asthma Plan now on Website
The completed version of the Ohio Statewide Asthma Plan is now on the Ohio Department of Health Asthma
Program’s (ODHAP) Website and will be published shortly on the Ohio Asthma Coalition (OAC) Website. Also on
the site is the Strategic Evaluation Plan which will guide the evaluation of the Asthma Program, the OAC and
accomplishment of the Ohio Statewide Asthma Plan. The plans can be accessed at:
http://www.odh.ohio.gov/odhPrograms/eh/asthma/asthma1.aspx .
ODH Asthma Program Submits Application for 2011-12 Funding.
The Ohio Department of Health Asthma Program (ODHAP) submitted its grant application for the third year of its
5 year grant to the Centers for Disease Control and Prevention (CDC) at the beginning of April. Prior to submitting
the grant the ODHAP staff participated in a teleconference with Paul Garbe, DVM, MPH, Chief, Air Pollution and
Respiratory Health Branch (APRHB), in the National Center for Environmental Health and Dan Burrows, the
Asthma Program Team Lead. Paul discussed the uncertainty in the federal budget at this time and the fact that it
is unknown if there will be funds available to continue funding the 36 comprehensive state asthma programs that
are two years into a five year funding cycle.
The CDC Asthma Grant funds three activities of the ODHAP: Surveillance, Partnerships, and Interventions. Here is
a brief overview of the goals and objectives the staff has for the grant. These goals and objectives describe the
role of the ODHAP in support of the Ohio Statewide Asthma Plan goals and objectives and other objectives where
the program staff is involved.
1.0 Goal: Assess the burden of asthma in Ohio
Toward this goal, ODHAP will be working to define and implement plans to share asthma data among
Ohio’s major health plans. ODHAP will also be working toward increasing the amount of surveillance data
that is shared with partners and the general public and, also, the type of reports offered. Increasing research
on asthma in Ohio and facilitating networking among researchers in Ohio is an additional focus of activity for
surveillance.
2.0 Goal: Reduce asthma disparities among disproportionately affected population segments in Ohio.
Toward this goal the ODHAP will be working with partners to include in plans and initiatives, multiple
strategies to increase specific strategies to reduce disparities in asthma care. Also all initiatives of the
coalition will be implemented first in areas with people with asthma who are vulnerable because of age, race,
ethnic background and poverty.
3.0 Goal: Decrease the number of asthma hospitalizations, emergency department and urgent care visits.
The ODHAP is working with three initiative committees to design evidence based multifaceted
interventions that will accomplish this goal. Each initiative will promote asthma self-management and
promote a team approach including transitions of care. The initiaitives are Clinical, Home Visit and School,.
4.0 Goal: Develop, facilitate and strengthen partnerships and collaborations to improve Ohio’s ability to
address the burden of asthma in Ohio.
The ODHAP team is working more intensively with the members of the Ohio Asthma Coalition and other
recruited committee partners than ever before. Each member of the asthma program is providing staff
support to committees and working toward limited implementation of initiative no later than the end of the
year.
Below is a description of each staff member’s activities related to the CDC grant.
Surveillance: Cynthia Weiss, ODHAP Epidemiologist, is responsible for development and maintenance of the
Ohio Surveillance System for Asthma (OSSA). She works with data sets from sources such as the Behavioral Risk
Factor Surveillance System, the Asthma Call Back Survey aka the National Asthma Survey, Ohio Hospital
Association data on asthma discharges and emergency visits, ODH Vital Statistics data on mortality, and Epi
Center data. She also sits on several committees to develop more comprehensive local level data profiles, and
Maternal and Child Health Data. She is currently part of a fellowship to build capacity at ODH to conduct
environmental public health tracking and is also part of the climate change workgroup of the Council of State and
Territorial Epidemiologists (CSTE) to develop environmental indicators. Ms. Weiss can be reached by phone at
614-728-3620 or by email at [email protected].
Partnerships: Barbara Hickcox, the Asthma Coordinator, is the prime person working with partners although all
of the staff works with partners, initiatives and committees. She has provided staff support for the Ohio Asthma
Coalition (OAC) since its founding when a steering committee was brought together in 2002. She works closely
with the executive committee of the coalition and the steering committee and provides the staff support for
meetings and other functions of the coalition. She also staffs the OAC Clinical Initiative and the Ohio Asthma
Health Plan Collaborative. She has developed and distributed the Asthma News and Notes on a regular basis
since 2009. She speaks about asthma to conferences on a regular basis and also teaches a course on work
related asthma through the Ohio Bureau of Workers Compensation Training System on a regular basis.
Interventions: All the staff is involved in support of initiative committees on a regular basis. Below is staffing
and progress information about the initiatives:
Clinical Initiative – The co-chairs leading this committee are Dr. John Carl and Dr. Amy Chuang with Barbara
Hickcox providing staff support.
Synopsis of plans: The Clinical Initiative committee is developing a module for asthma that will fit within a
patient centered medical home and provide assistance to the practices to adequately develop the model in family
and internal medicine practices. A pilot of the model is to begin in federally qualified community health care
centers in the Ohio Appalachian Counties by the end of the year. Subcommittees of the initiative will begin
meeting in the next two weeks for: patient self-management education, the clinical visit for asthma and chronic
care, technological process for the model, continuous quality improvement and evaluation, office systems
including new roles and education for all staff and policy and procedure development, and finally the connections
committee to focus on relationships with patients, care givers, community and other healthcare providers.
School Initiative – Led by committee chair by Dawn Abbott (ODH School & Adolescent Health), co-chair Andy
Thomas (Asthma Program Sanitarian), and Mandy Burkett (ODH Indoor Environments Chief)
Synopsis of plans: The School Initiative Committee is planning for limited implementation to begin at the start of
the next school year. The School Asthma Initiative is a comprehensive school-based asthma intervention based
on the CDC’s Addressing Asthma Within a Coordinated School Health Plan. One of the elements of this complex
initiative is a video for coaches and physical education teachers on how to work with students with asthma called
Staying in the Game with Asthma. Several Ohio sports personalities are being recruited to give this an Ohio
flavor. The initiative is also working on increasing asthma education in the school, including use of ALA’s Open
Airways for Schools (elementary students), Kickin’ Asthma (adolescent students), and Asthma 1-2-3 (staff) as well
as the development of an asthma education video for adolescent aged students to help them better understand
what asthma is and how it can be managed. They are also working to develop model policies that schools can
adopt to better support students with asthma, as well as medical guidance for school nurses to properly treat
students with asthma.
Asthma Home Visit Initiative: Led by committee chair Belinda Huffman (Dayton Children’s Medical Center), cochair Cynthia Weiss (ODH Asthma Epidemiologist) and Andy Thomas (Asthma Program Sanitarian)
Synopsis of Plans: The Asthma Home Visit Initiative committee is finalizing details of a multi-faceted home-based
asthma intervention. The initiative will educate and empower families of children with asthma to manage their
child’s asthma as well as reduce exposure to triggers in the home environment. The initiative will be
administered by a community health worker under the supervision of a nurse case-manager. The initiative
includes three primary components: medical management, environmental trigger management, and asthma
education. The initiative includes an environmental home assessment as well as an asthma control assessment
that will be used to guide the content of the education and materials provided to participating families. In
addition to providing education on environmental trigger management in the home, the initiative plans to
provide materials to assist in reducing exposure, including allergen bedding encasements, basic cleaning supplies,
and possibly even a HEPA vac with allergen bags, amongst other supplies. Limited implementation of the
initiative may begin as early as June 2011.
ODH: Ohio Surveillance System for Asthma to publish new data reports.
Two three page fact sheets are soon to be available from the Ohio Department of Health. These are:
”Asthma Deaths in Ohio” and “Childhood Asthma in Ohio”. A brief synopsis follows.
Childhood Asthma in Ohio: Asthma is more common among school age children than adults, especially
those from low-income, Appalachian and African American communities. In general, these populations
experience above-average asthma prevalence.
The reasons for these disparities are complex. Individuals within disadvantaged populations also may face
substandard housing conditions that place them at greater risk for frequent and prolonged exposure to
environmental allergens and irritants that worsen asthma.
Bridging the disparity gap will be a challenge. It will require innovative and sustained efforts to deliver
effective asthma care to diverse populations.
Asthma Deaths in Ohio: Deaths from asthma are rare in Ohio, with an average of approximately 160 per
year. However, most deaths can be prevented and many represent treatment failure. There are also
disparities in race and sex with regard to asthma deaths. Adult women face a higher asthma mortality
rate than men. Black residents of Ohio are more likely to die from asthma than white residents.
The reports will be posted on the ODH Asthma Program Website at:
http://www.odh.ohio.gov/odhPrograms/eh/asthma/asthma1.aspx
LOCAL COALITION NEWS
Greater Cleveland Asthma Coalition:
After a long hiatus, the Greater Cleveland Asthma Coalition (GCAC) is reemerging through a strategic alliance
with the Greater Cleveland Lead Poisoning Advisory Council to form the Healthy Housing Advisory Council of
Greater Cleveland, under the joint leadership of the Cleveland Department of Public Health and the Cuyahoga
County Board of Health.
The Asthma Coalition met on Thursday, April 7, 2011, 9:00-11:30a.m., at the Cuyahoga County Board of Health,
5550 Venture Drive, Parma 44130. Representatives of the major health systems, the American Lung Association®
of Ohio (ALAO), the health departments for Cleveland and Cuyahoga Counties, the Northeast Ohio Areawide
Coordinating Agency, the Gund, Sisters of Charity, Cleveland and St. Luke’s Foundations, United Way, Case
Western Reserve University, Environmental Health Watch, HUD and the Ohio Department of Health Asthma
Program attended.
The following transition team of the coalition presented on the history and transitions of the coalition:
Dorr Dearborn, MD, PhD, Co-Chair, GCAC, Department of Environmental Health Sciences, CWRU School of
Medicine
Terry Allan, RS, MPH, Post Co-Chair GCAC, Health Commissioner - Cuyahoga County Board of Health
Sumita Khatri, MD, MS, Co-Director, Asthma Center, Cleveland Clinic
Stuart Greenberg, MA, President, Environmental Health Watch
In the year and a half since the ALAO lost the staff necessary to support the coalition, Environmental Health
Watch has completed the work on the outstanding grants of the coalition. During that time much discussion with
a great many people was held to find a permanent home for the coalition and to reorganize with organizations
the coalition had been closely linked with.
In the last ten years both the local health departments have been awarded Healthy Homes grants from the U.S.
Department of Housing and Urban Development (HUD). Each of those grants delivered home services to clients
including asthma and indoor environment interventions. HUD, the U.S. Environmental Protection Agency
(USEPA), the Department of Energy (Home Weatherization) and the Centers for Disease Control and Prevention
(CDC) are moving to support of the Healthy Homes programming for lead prevention, asthma and indoor
environments through their grant programs to state and local health departments. Both Dr. Dearborn and
Stuart Greenberg have been part of these national focuses and recommendations for homes.
The GCAC transition team, in discussions with the Cuyahoga County Board of Health and the Cleveland Health
Department, proposed to align with the healthy and green housing movements and the Lead Advisory Council to
create a new organization. The final form of the organization is not determined and further work will be done
with input from the membership.
Dr. Sumita Khatri, Co-director, the Asthma Center at Cleveland Clinic, proposed the coalition also consider adding
COPD to the focus of the coalition. In support of that issue COPD is currently the third leading cause of death,
recently moving ahead of stroke, but there is currently no other data available for COPD and no disparity data
relevant to COPD. Biomass burning is a major cause of COPD in the world and more women have died from the
disease than men. The World Health Organization has released the GOLD Guidelines for diagnosis and treatment
of COPD. There may be funding available to work on COPD issues, which could enhance asthma efforts as well.
She listed the negatives as well as the positives about adding COPD as a focus of the coalition including that the
addition could weaken the focus on asthma.
The proposed relationships of the organizations being linked with the GCAC are shown below. There may be
some joint committees such as data, advocacy and outreach/education and there may be some separate
committees. The structure will be worked out by the parties involved. It is important that the GCAC continue its
asthma work and the other programs continue their programming without losing their identities. The new
structures may assist with reducing redundancy among programs.
Green & Healthy
Housing Initiative/ Healthy
Housing Strategic Alliance
Warm & Healthy
Housing Project
Asthma/COPD
Lead
Poisoning
Healthy
Housing
Advisory
Council
Questions on the new relationships can be directed to Stuart Greenberg at [email protected] , Dorr
Dearborn at [email protected] , Terry Allen at [email protected] or Sumita Khatri at [email protected] . Stay
tuned for more updates.
Northwest Ohio Asthma Coalition bids Julie Majo Goodbye.
Julie Majo, Outreach Coordinator for St. Vincent Mercy Children’s Hospital, coordinated the work of the NWOAC
for the last several years. She actually restarted and coordinated the coalition which developed interventions for
asthma in the schools, the yearly “Strike Out Asthma” events held at the Toledo Mud Hens stadium, the yearly
Northwest Ohio Asthma School Nursing conference and grant writing efforts for the coalition.
Dawn Bolyard, Chair of the OAC and member of NWOAC writes: “Julie has been instrumental in keeping the
NWOAC motivated and moving forward. Under her leadership the coalition has accomplished many goals and
has increased knowledge and awareness about asthma throughout northwest Ohio. The Northwest Ohio
Coalition would like to thank Julie for her years of service and wish her further success in her new endeavors.”
For matters related to the Northwest Ohio Asthma Coalition contact either of the co-chairs, Jodi Gajdostic at
[email protected] , or Anne Kwiatkowski at [email protected].
OHIO ASTHMA COALITION NEWS:
The Ohio Asthma Coalition met on March 11, 2011, at the offices of the American Lung Association. Barbara
Hickcox, RN, MS, presented a program on work related asthma. During the business meeting of the coalition
Chair-elect Kevin Morris announced that he is taking a new position that will not allow him to continue in the
coalition. Dawn Bolyard was re-elected to serve a second one year term as Chair. Barb Rushley was elected
Chair-elect.
Phyllis Scheiderer was elected to a member at large position. Karen Florkey will continue for a second term in the
other member at large position.
Reports were given on the budget, the October 8, 2010, conference and on all the initiatives of the coalition –
Schools, Home Visits and Clinical Initiatives.
 Schools – the committee has completed a limited implementation plan to begin implementation of the
school initiative in the fall, 2011. The initiative will include several interventions including a training program
for coaches, elements for nurses and other school personnel, policies, systems changes and self management
education for students with asthma. The program will be rolled out in pieces so that no school is
overwhelmed with the changes. Plans are underway for filming the coaches training in the near future.
 Home Visit – the home visit committee is working on a limited implementation proposal and will plan to use
nurse case managers with community health workers going into homes. Since this is a complex process that
will likely involve a number of agencies in a community to partner for this to happen, the committee is
working to smooth out those details prior to implementation. However, they plan to begin a limited
implementation in the fall.
 Clinical Initiative – the clinical committee has decided to implement an Asthma Patient Centered Medical
Home model for family and internal medicine practices. The model is to be integrated into existing medical
home models that have electronic medical record capabilities. It is likely that the limited implementation of
the model will take place in at least one federally qualified healthcare center because of their familiarity with
the chronic care model from which the Patient Centered Medical Home is derived. Committee members will
be determining what policies, tools and other elements will be provided to practices and how to most
effectively replicate the model being used by the Ohio Chapter of the American Academy of Pediatrics.
OAC Webinar Now Archived and Available
The February Webinar presented by Dr. Shalini Forbis on “Incorporation of Asthma into Clinical Practice” is now
archived on Ohio Train for those who were not able to attend the live Webinar or for those who wish to view it
again. To access the course register or log in to Ohio Train: http://oh.train.org.
To access the course once you are logged in, go to “Course Search” in the gray row at the top of the page. In
“Course Search” go to the left side list and search by “Course ID”. The Course ID number is 1025764. Follow
directions for logging into the course. When you have completed the Webcast you will have access to the Post
Test, called an Assessment in Ohio Train, and to the course evaluation. When you have completed those, go to
the home page and click on “Certificates”. You will be able to print the certificate from this page.
Continuing Education:
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the
Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Wright State
University (WSU) and Ohio Asthma Coalition. WSU designated this Live Activity for a maximum of 1 AMA PRA
Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation
in the activity.
Nurses and Respiratory Therapists in Ohio may use AMA PRA Category 1 Credit™ as one-to-one credit for
nursing and respiratory therapy continuing education requirements.
If you have any difficulty with Ohio Train please contact Barbara Hickcox, at [email protected] or
614-644-8286, or Tonya Congdon at [email protected] or 614-728-7062.
National Asthma Educators Certification Board News
In March this year the Steering Committee of the OAC and the ODH Asthma Program decided to endorse a letter
being sent from the Wisconsin Asthma Coalition to the NAECB. The letter reported: “A survey completed by the
Wisconsin Asthma Coalition (WAC) shows 42% of current certified asthma educators (AE-C) in Wisconsin do not
intend to take the exam upon expiration. The three primary reasons for not retaking the exam included no longer
working in the field, no benefit from being an AE-C and exam cost. The survey results were shared at the Association of Asthma Educators conference as a poster and published online in the Journal of Asthma and Allergy Educators, 27 September 2010.”
On April 28, this update on this issue was received:
“I just heard back from Karen Meyerson, chair of the National Asthma Educator Certification Board (NAECB),
about their discussion regarding the letter (attached) we sent a few weeks ago regarding recertification of AE-C’s.
NAECB met earlier this month in Phoenix.
The NAECB agreed to appoint an exploratory committee to gather more information about CEUs for potential
recertification. This group is to bring recommendations to their next face-to-face meeting in August. The NAECB
also plans to create and disseminate their own survey of AE-C’s nationwide regarding their opinions about
recertification.
NAECB will send a formal response once a decision has been made.”
ANYTHING ASTHMA:
Everyone Breathe™ recognizes the challenges parents or guardians of children with asthma face in preparing for
their child's future and managing their child's asthma while he or she is at school. That's why we've created the
Everyone Breathe Asthma Education Grants program, where parents of children with asthma are invited to apply
to win a $2,500 savings bond for their child's continued education and a $5,000 grant for their child's school to
help improve the quality of asthma care and educate students about asthma. Deadline for submission is July 29,
2011, so we encourage you to submit your application today. To apply go to:
http://www.everyonebreathe.com/asthmaGrants/asthma-education-grants.html
Asthma Rate Rises Sharply in U.S., Government Says
Americans are suffering from asthma in record numbers, according to a study released Tuesday by the Centers
for Disease Control and Prevention. Nearly one in 10 children and almost one in 12 Americans of all ages now has
asthma, government researchers said. NY Times (5/3/11)
High-Dose Inhaled Steroids Reduce Cold-Related Asthma Attacks
NEW YORK (Reuters Health) Apr 28 - The most effective ways to reduce cold-related asthma exacerbations are
budesonide/formoterol maintenance and reliever therapy, or treatment approaches using higher dose inhaled
corticosteroids (ICS), according to a new report published online March 15 in the European Respiratory Journal.
Respiratory infections account for 50% to 75% of asthma exacerbations in adults, Dr. Helen K. Reddel of the
Woolcock Institute of Medical Research in Sydney, Australia and her colleagues note. (Medscape)
May is National Asthma Awareness Month and World Asthma Day will be observed on Tuesday, May 3, 2011.
Several resources that may be helpful for your asthma activities are available on the National Environmental
Education Foundation’s website http://neefusa.org/health/asthma/index.htm :
 EPA’s Asthma Awareness Month Event Planning Kit- provides ideas and strategies for hosting asthma awareness events, guidance on partnership development, resources for kids, and media relations outreach activities.
 CDC’s asthma website and public health tracking network.
 CDC’s Vital Signs- the asthma edition will be released on May 3, along with an accompanying MMWR, Fact
Sheet, and press release.
 NEEF’s Pediatric Asthma tools and resources.
Asthma more likely in children from poor, rural areas, study finds
A study of 117,080 Medicaid-covered children in Tennessee found that 13% of children in rural areas suffer from
asthma compared with only 11% of those in urban places, but only 31% of rural children received inhaled
corticosteroids compared with 35% of urban counterparts. The study in the Annals of Allergy, Asthma &
Immunology found a higher percentage of rural children who had bronchiolitis as infants or mothers who smoke,
which researchers speculated to account for the findings. Reuters (4/28)
New very large study on Long Acting Beta Agonist’s may contradict SMART study.
They found that the SAE hazard ratio for patients who had received a LABA either with or without concomitant
inhaled corticosteroid was significantly lower than that for patients who received only a short-acting beta
agonist. Principal risk factors for SAEs were black race, alcohol abuse, and pregnancy. The results were similar in
patients with newly diagnosed and preexisting asthma. Relative to short-acting beta agonist only, LABA use was
associated with a lower risk for an SAE, such as an emergency department visit. (Excerpt from Medscape
Pulmonary Medicine Viewpoints, The Safety of Long-Acting Beta-Agonists in Asthma, Nicholas Gross, MD, PhD,
Posted: 04/08/2011, can be found at: http://www.medscape.com/viewarticle/740017?src=nl_topic
Abstract of the research article Risk of Serious Asthma Exacerbations Associated with Long-Acting Beta Agonists
Among Patients With Asthma: A Retrospective Cohort Study, Guo JJ, Tsai K, Kelton CM, Bian B, Wigle PR
Ann Allergy Asthma Immunol. 2011;106:214-222.e2 can be found at: http://www.annallergy.org/article/S10811206(10)01171-3/abstract
Asthma Drug Added to Standard Therapy Effective in Inner-City Children CME/CE
News Author: Emma Hitt, PhD, CME Author: Penny Murata, MD
Authors and Disclosures CME/CE Released: 03/22/2011; Valid for credit through 03/22/2012
March 22, 2011 — The humanized monoclonal anti-immunoglobulin E (IgE) antibody omalizumab, when added to
standard asthma treatment, appears to improve control, reduce seasonal peaks in exacerbations, and decrease
the need for other medications, according to the findings of a randomized trial.
http://www.medscape.org/viewarticle/739410?src=cmemp
NIH STUDY FINDS OMALIZUMAB RELIEVES SEASONAL ASTHMA ATTACKS IN YOUTH Symptoms reduced in
children and young people with moderate to severe disease
A drug that targets the antibody immunoglobulin E (IgE), a key player in asthma, nearly eliminated seasonal
increases in asthma attacks and decreased asthma symptoms among young people living in inner city
environments, a clinical trial sponsored by the National Institutes of Health has found.
The findings appeared in the March 17 issue of the New England Journal of Medicine.
This investigational use of the drug omalizumab, sold under the brand name Xolair, was conducted in eight U.S.
cities by the Inner City Asthma Consortium (ICAC), a nationwide clinical trials network supported by the National
Institute of Allergy and Infectious Diseases (NIAID), part of NIH. Additional support for this research was provided
by the NIH National Center for Research Resources and Novartis Pharmaceuticals Corporation.
http://www.nih.gov/news/health/mar2011/niaid-16.htm
The NIH Guidelines for the Diagnosis and Management of Asthma can be viewed or downloaded at
<www.nhlbi.nih.gov/guidelines/asthma/>.
FDA delays a decision on Novartis' COPD drug until July
The FDA extended for three months a review of Novartis' application for indacaterol, a drug candidate for chronic
obstructive pulmonary disease. Novartis said the agency does not need additional data. FDA advisers previously
endorsed the drug's 75-microgram strength but rejected its 150-microgram dose. Reuters (3/23)
Paediatric asthma outpatient care by asthma nurse, paediatrician or general practitioner: randomised controlled trial with two-year follow-up.
Prim Care Respir J. 2011; 20(1):84-91 (ISSN: 1475-1534)
Kuethe M ; Vaessen-Verberne A ; Mulder P ; Bindels P ; van Aalderen W, Department of Paediatrics, Amphia Hospital, Breda, Noord Brabant, The Netherlands.
For children with stable asthma, to test non-inferiority of care provided by a hospital-based specialised asthma
nurse versus a general practitioner (GP) or paediatrician.
PreMedline Identifier:21311842 From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
http://www.ncbi.nlm.nih.gov/pubmed/21311842.
Extreme Prematurity Linked to Asthma Risk in Young Adults CME
News Author: Laurie Barclay, MD, CME Author: Penny Murata, MD
CME Released: 03/22/2011; Valid for credit through 03/22/2012
March 22, 2011 — Extreme preterm birth (23 - 27 weeks' gestation), but not later preterm birth, is associated
with an increased risk for asthma at least into young adulthood, according to the results of a Swedish national
cohort study reported online March 21 and in the April print issue of Pediatrics.
http://www.medscape.com/viewarticle/739412
COPD Drug Test of Questionable Diagnostic Value CME
News Author: Neil Osterweil, CME Author: Désirée Lie, MD, MSEd
CME Released: 03/23/2011; Valid for credit through 03/23/2012
March 23, 2011 — A 14-day oral prednisolone test does not appear to be helpful for diagnosing or excluding
chronic obstructive pulmonary disease (COPD), investigators from The Netherlands assert in the March/April issue of the Annals of Family Medicine. http://www.medscape.com/viewarticle/739135
Asthma in the Primary Care Practice
As a companion to the NYS Consensus Asthma Guideline decision support tool and pocket guide , this step-by
step tutorial is intended to assist you, the clinician, in applying the key concepts of the updated
recommendations of the National Asthma Education Program (NAEPP), Expert Panel Report -3 (EPR-3) into your
practice.
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The problem-based learning format of this activity will help you:
Apply key changes of the NAEPP, EPR-3;
Incorporate communication strategies to promote self management;
Integrate trigger reduction recommendations into clinical practice;
Adopt specific high leverage changes for greatest need and opportunity.
This activity has been reviewed and is acceptable for up to 3.0 Prescribed Credits by the American Academy of
Family Physicians (AAFP). Of these credits, 1.5 conforms to the AAFP criteria for evidence-based CME clinical
content. CME credit has been increased to reflect 2 for 1 credit for only the EB CME portion. When reporting
AAFP credit, report total Prescribed and Elective credit for this activity. It is not necessary to label credit as
evidence-based CME for reporting purposes.
The EB CME credit awarded for this activity was based on practice recommendations that were the most current
with the strongest level of evidence available at the time this activity was approved. Since clinical research is
ongoing, AAFP recommends that learners verify sources and review these and other recommendations prior to
implementation into practice. http://jeny.ipro.org/files/Asthma/
Study questions benefits of acid-suppressing drugs in children
A review of 12 clinical trials, published in Pediatrics, found no solid proof that proton-pump inhibitors such as
Prilosec and Prevacid reduce symptoms of gastroesophageal reflux disease in infants, and that there's not enough
evidence that the benefits seen in older children will last in the long run. The lead researcher, Dr. Rachel van der
Pol, and American College of Gastroenterology expert Dr. Steven Czinn said there's a need to have well-designed
studies on the effectiveness and safety of such acid-suppressing medications. Reuters (4/5)
Tiotropium: A Safe Solution for Long-Acting Asthma Control?
Charles P. Vega, MD Posted: 03/28/2011
Asthma is one of the most common chronic illnesses seen in physicians' offices, yet in a study from 29 pediatric
centers in the United States, the prevalence of uncontrolled asthma was 46%.[1] Children with uncontrolled
asthma were more likely than their peers with controlled asthma to have recently missed school, even if these
children did not have any respiratory complaints.
The results of this study are encouraging. Based on these data, tiotropium appears similar to salmeterol with regard to improving asthma control among patients requiring step-up therapy. Tiotropium was superior to highdose beclomethasone alone.
However, tiotropium is not approved for the treatment of asthma by the US Food and Drug Administration, and
this one trial of 210 adults who were treated for only 14-week intervals should not convince anyone that tiotropium is currently a first-line option for step-up therapy. Larger trials should address efficacy and, particularly,
safety issues. http://www.medscape.com/viewarticle/739453
PPIs Not Recommended for Routine Treatment of Adult Asthma
April 11, 2011 — Proton pump inhibitor (PPI) therapy in adults with asthma shows a small, statistically, but not
clinically, significant improvement in the morning peak expiratory flow (PEF) rate, according to the results of a
meta-analysis reported in the April 11 issue of the Archives of Internal Medicine.
http://www.medscape.com/viewarticle/740639?src=mp&spon=13
Lung Defects More Common in Girls Than in Boys at Risk for Asthma
This conclusion is from a paper presented at the American Academy of Allergy, Asthma and Immunology (AAAAI)
2011 Annual Meeting from researchers who looked at and scored defects on the helium-3 MRIs of lungs in a
cohort of 9- and 10-year-old girls and boys from the Childhood Origins of Asthma Study (COAST), which seeks to
provide insights into the development of allergies and asthma. Scores were based on the size and number of lung
defects seen on the images. Although those with asthma had higher defect scores than those who had not been
diagnosed with the disease, the researchers found that there were also clear sex differences. They hope that such
sex differences will provide clues as to why asthma symptoms are more common in boys than in girls, but why
women are more prone to asthma as adults than men. Medscape 3/20/11
Resource for asthma research and presentations: Clinical Directors Network
The Clinical Directors Network (CDN) is dedicated to providing and improving comprehensive and accessible
community-oriented primary and preventive health care services for poor, minority, and underserved
populations. CDN is the only practice-based research network in the country devoted to providing primary care
research opportunities to medically underserved populations. Research, webinars and past presentations on
asthma and a variety of other topics are available. CDN's overall goal is the translation of clinical research into
clinical practice Click Here for CDN Website.
*To access the Webcast replay, you will need to use Macromedia Flash player. If you need to download the free
Macromedia Flash player go to: http://www.macromedia.com/go/getflashplayer .
* To play the audio recording (MP3 format), you will need a browser plug-in or a program such as QuickTime® ,
Windows® Media Player® , or Real Player® . Links to non-Federal organizations are provided solely as a service
to our users, and do not constitute endorsements of the organizations by AHRQ or the Federal Government.
Why Are Asthma Rates Soaring? Researchers once blamed a cleaner world. Now they are not so sure
Veronique Greenwood, Scientific American
April 14, 2011
Asthma rates have been surging around the globe over the past three decades, and for a long time researchers
thought they had a good idea of what might be fueling the increase: the world we live in is just a little too clean.
According to this notion-known as the hygiene hypothesis-exposure in early childhood to infectious agents
programs the immune system to mount differing highly effective defenses against disease-causing viruses,
bacteria and parasites. Better sanitary conditions deprive the immune system of this training, so that for reasons
that are still unclear, the body pounces on harmless particles-such as dust and ragweed-as if they were deadly
threats. The resulting allergic reaction leads to the classic signs of asthma: chronic inflammation or swelling of the
airways and acute spasms of those passageways.
National Healthy Schools Day: EPA Administrator, Parent Speak out on need to improve indoor air quality in
schools, academic performance April 11, 2011
WASHINGTON, DC-Environmental Protection Agency Administrator Lisa P. Jackson, Claire Barnett, Founder of
Healthy Schools Network, Montgomery County Public Schools officials and a parent of children who formerly
attended Maryland public schools marked National Healthy Schools Day by speaking out on the importance of
improving indoor air quality in schools. Montgomery County school officials are undertaking some of the most
effective steps to improve their schools' indoor air quality in the nation.
VACCINATIONS AND ASTHMA:
H275Y Mutant Pandemic (H1N1) 2009 Virus in Immunocompromised Patients CME
Christian Renaud, MD, MSc; Alexandre A. Boudreault; Jane Kuypers, PhD; Kathryn H. Lofy, MD; Lawrence Corey,
MD; Michael J. Boeckh, MD; Janet A. Englund, MD
CME Released: 03/23/2011; Valid for credit through 03/23/2012
Most oseltamivir-resistant pandemic (H1N1) 2009 viruses have been isolated from immunocompromised
patients. To describe the clinical features, treatment, outcomes, and virologic data associated with infection from
pandemic (H1N1) 2009 virus with H275Y mutation in immunocompromised patients, we retrospectively
identified 49 hematology–oncology patients infected with pandemic (H1N1) 2009 virus. Samples from 33 of those
patients were tested for H275Y genotype by allele-specific real-time PCR.
http://www.medscape.org/viewarticle/739332?src=cmemp
FDA approves shingles vaccine Zostavax for those in their 50s
The FDA approved Merck & Co.'s vaccine Zostavax to prevent shingles in patients ages 50 to 59. The expanded
approval is based on clinical data indicating that Zostavax reduces this age group's risk by 70%. The drug was
initially approved in 2006 for patients age 60 and older. Reuters (3/24)
MEDICATIONS:
Experts look at ways to boost medication adherence
Failure to take prescription drugs as directed -- or at all -- not only costs the medical system billions of dollars
each year, it costs thousands of lives as well. Refill reminders, generic substitutions, physician communications
and pharmacist interventions may boost adherence, experts say. The Wall Street Journal (3/28)
FDA Orders Safety Studies for Some Asthma Drugs
* Trials to test the safety of Long-Acting Beta-Agonists
* Results expected in 2017
* Covers drugs by AstraZeneca, Glaxo, Merck and Novartis
* Will involve total of 53,000 patients
WASHINGTON (Reuters) Apr 15 - U.S. health regulators have ordered drugmakers to conduct clinical trials involving a total of 53,000 patients to test the safety of a controversial class of inhaled asthma drugs that are already
on the market.
The trials are being required to demonstrate the safety of long-acting beta-agonists (LABAs) when used in combination with inhaled steroids, the U.S. Food and Drug Administration said on Friday.
The FDA expects to receive results in 2017 for the studies that will begin later this year.
LABAs to be studied are AstraZeneca's Symbicort, GlaxoSmithKline's Advair Diskus, Merck & Co's Dulera, and Novartis AG's Foradil.
In four of the trials sought by the FDA, each of the LABAs plus a corticosteroid will be compared with the steroid
alone in patients 12 years of age and older. Those studies are expected to include a total of 46,800 patients.
The agency has also asked for a trial of 6,200 younger patients, aged 4 to 11, using Advair Diskus. Reuters Health
Information © 2011 http://www.nlm.nih.gov/medlineplus/news/fullstory_111064.html
CHANGING PRACTICES
Practitioners stress comprehensivist approach in patient care
Health experts proposed establishing comprehensive care physicians to help eliminate potential
miscommunication between specialists and hospital doctors on patients' health and hospitalization risks. The
proposal, called the comprehensivist approach, is now being done in countries including Canada and Great
Britain, a researcher added. United Press International (4/30)
CDC to poll providers on chronic disease management
The CDC is seeking to enlist 900 doctors in an online survey meant to gather data on primary care providers' use
of evidence-based strategies in handling patients with chronic conditions. The survey also will include data on
how providers utilize electronic health records and other systems set up for patient follow-up care. Modern
Healthcare (free registration) (4/29
ED visits are on the rise, survey finds
A survey by the American College of Emergency Physicians found that 80% of 1,768 emergency doctors reported
seeing an increase in emergency department visits and 89% think the health care legislation will spur more ED
visits. Ninety-seven percent of respondents said they treat patients referred by primary care physicians every day
and 97% also said they had daily encounters with Medicaid patients who could not find another doctor to accept
their health insurance, according to the poll. BeckersHospitalReview.com (4/28)
"Evidence-based health" model could improve patient care
Evidence-based medicine often fails to aid in chronic disease treatment because doctors overlook the effect of a
patient's home environment, according to a perspective piece by two primary care doctors in The Journal of
General Internal Medicine. They said an "evidence-based health" model is needed that would coordinate care
among physicians, community health workers and patients and extend care from the doctor's office to the home.
NYTimes.com/Well Blog (3/10)
Patients have growing influence in medical care, health industry
Participatory medicine in which patients play a bigger role in their care, medical research and the health industry
in general will have a big effect on providers, experts told the Massachusetts Biotechnology Council. The Boston
Globe report said patients are inspired by the growth of personalized medicine and are using social media as well
as gated online discussions to organize and share information and personal experiences. The Boston Globe (free
registration) (3/22
Hydrocortisone may curb hospital-acquired pneumonia, study finds
A French study found 36% of hospitalized trauma patients who were given the steroid hydrocortisone acquired
pneumonia by the 28th day of their admission, compared with 51% of patients who received placebo. Those who
took hydrocortisone were less likely to require mechanical ventilation, had shorter intensive care unit stays and
were less likely to have acute lung injury or acute respiratory distress syndrome, the study in the Journal of the
American Medical Association found. HealthDay News (3/22)
Transition to medical home model has challenges, study finds
Physician practices that switch to a medical home model face challenges, such as establishing a teamwork
mentality among staff and obtaining expensive technology needed to make the system work, according to a study
in Health Affairs. Data from the first National Demonstration Project on medical homes found while the patientcentered approach to care improved quality and controlled costs, the transition was time-consuming and
disruptive. The New York Times (free registration)/Prescriptions blog (3/8)
Study projects 83% of providers may qualify for EHR incentives
Almost 83% of physician practices are likely to receive bonuses from one of the federal EHR incentive programs,
but the estimated eligibility rates vary by program and specialty, according to a study in Health Affairs. Among
eligible pediatricians, only 14% are expected to receive Medicare EHR reimbursements, with 47% who might
qualify through Medicaid, the study notes. Modern Healthcare (free registration) (3/8)
Review: Health literacy affects quality, outcomes
Patients with low health literacy are more likely to be hospitalized and elderly patients with low health literacy
had a higher risk of mortality and were less likely to comply with medication regimens than those who had a
better understanding of medical information, according to a review of data by the Agency for Healthcare Research
and Quality. "Ensuring that people understand health care information is critical to a high-quality, safe health care
system," AHRQ Director Carolyn Clancy said. National Journal (3/28)
Study: Most U.S. patients seek online access to physicians
A survey of 1,000 U.S. adults found that 73% would want to adopt secure Web portals for easier access to lab test
results, appointments scheduling, medical bills payment and communication with physician practices. The survey
echoes earlier research demonstrating that U.S. patients increasingly are tapping the Internet for better health
management. InformationWeek (3/4
Community Health Centers are medical homes by necessity
Community health centers provide an increasingly important part of the U.S. health care safety net and have
become, by necessity, medical homes that offer a wide range of services for many people who otherwise would
not have access to care. While the Affordable Care Act contains incentives for community centers, that funding
could shrink under Republican deficit reduction plans. The Washington Post/Kaiser Health News (4/11)
Performance Measurement and Public Reporting: Lessons Learned: Lessons Learned About Measuring and
Reporting Physician Performance
The Robert Wood Johnson Foundation’s Aligning Forces for Quality (AF4Q) initiative is releasing two new issue
briefs to share “Lessons Learned” from its work in 17 communities around the country to improve the quality of
health care. In Lessons Learned in Public Reporting: Physician Buy-In is Key to Success and Lessons Learned in
Public Reporting: Deciding What to Report, representatives from AF4Q communities share the obstacles and
successes they have experienced in the movement towards transparency in health care.
Public reports on the performance of physicians and hospitals can lead to higher quality health care as patients
become informed and as physicians, nurses and other professionals identify areas for quality improvement.
Payers can benefit as well; they learn about the value of the care they are purchasing. But measuring
performance and publicly reporting the information is no easy feat. Deciding how to measure requires
participation from all stakeholders, including physicians, and gathering information requires making decisions
about what measures make the most sense for a particular locale. Community organizations need to make
difficult choices and forge hard-won relationships from the start of their public reporting endeavors.
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Read Lessons Learned in Public Reporting: Physician Buy-In is Key to Success.
Read Lessons Learned in Public Reporting: Deciding What to Report.
Learn more about Aligning Forces for Quality
Health industry taps IT to boost patient care education
The health industry is leveraging IT tools to better educate patients about their care. A drug reconciliation
program at the Mayo Clinic has allowed the facility to cut discrepancies in drug documentation by more than half,
while a program from Healthwise gives clinicians direct access to patient education tools from within an
electronic medical record. InformationWeek (4/20)
Hospital benefits from chronic care management technology
A bidirectional chronic condition management system is helping providers at Denver Health Medical Center
better manage care for chronically ill patients and lower the costs related to hospital readmissions for patients
with diabetes. The technology "may be an effective method to provide care for chronic conditions beyond the
traditional clinic setting," said Dr. Andy Steele, the hospital's director of medical informatics. Healthcare IT News
(4/20), InformationWeek (4/20)
TOBACCO ISSUES
U.S. sees a decline in the prevalence of heavy smoking
A report in the Journal of the American Medical Association found 2.6% of Californians and 7.2% of people from
other states smoked at least one pack of cigarettes per day in 2007 -- a big drop from 23.2% of smokers from
California and 22.9% from the rest of U.S. in 1965. The researchers also found a decline in the prevalence of
moderate-intensity smoking of 10 or more cigarettes per day. WebMD (3/15)
Smoking Cessation Before Surgery May Not Increase Post-Op Complications CME
News Author: Laurie Barclay, MD, CME Author: Charles P. Vega, MD
CME Released: 03/22/2011; Valid for credit through 03/22/2012
March 22, 2011 — Stopping smoking a few days before surgery is not associated with increased postoperative
complications, according to the results of a systematic review and meta-analysis reported online March 14 in the
Archives of Internal Medicine. http://www.medscape.org/viewarticle/739409.
A Nationwide Analysis of US Racial/Ethnic Disparities in Smoking Behaviors, Smoking Cessation, and CessationRelated Factors. Am J Public Health. 2011; 101(4):699-706 (ISSN: 1541-0048)
Compared with non-Hispanic Whites, smaller proportions of African Americans, Asian Americans/Pacific
Islanders, and Hispanics/Latinos had ever smoked. Significantly fewer African Americans reported long-term
quitting. Racial/ethnic minorities were more likely to be light and intermittent smokers and less likely to smoke
within 30 minutes of waking. Adjusted models revealed that racial/ethnic minorities were not less likely to
receive advice from health professionals to quit smoking, but they were less likely to use nicotine replacement
therapy. Reprint of Article.
Moderate Levels of Secondhand Smoke Deliver Nicotine to the Brain NIH-funded study shows how secondhand
smoke may increase vulnerability to nicotine addiction.
Exposure to secondhand smoke, such as a person can get by riding in an enclosed car while someone else
smokes, has a direct, measurable impact on the brain-and the effect is similar to what happens in the brain of the
person doing the smoking. In fact, exposure to this secondhand smoke evokes cravings among smokers,
according to a study funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of
Health.
The study, published today in Archives of General Psychiatry, used positron emission tomography (PET) to
demonstrate that one hour of secondhand smoke in an enclosed space results in enough nicotine reaching the
brain to bind receptors that are normally targeted by direct exposure to tobacco smoke. This happens in the
brain of both smokers and non-smokers.
Previous research has shown that exposure to secondhand smoke increases the likelihood that children will
become teenage smokers and makes it more difficult for adult smokers to quit. Such associations suggest that
secondhand smoke acts on the brain to promote smoking behavior.
"These results show that even limited secondhand smoke exposure delivers enough nicotine to the brain to alter
its function," said NIDA Director Nora D. Volkow, M.D. "Chronic or severe exposure could result in even higher
brain nicotine levels, which may explain why secondhand smoke exposure increases vulnerability to nicotine
addiction."
"This study gives concrete evidence to support policies that ban smoking in public places, particularly enclosed
spaces and around children," said Arthur Brody, M.D., of the UCLA Department of Psychiatry & Biobehavioral
Sciences and corresponding author for the article.
The Surgeon General's Report concluded in 2006 that secondhand smoke causes heart disease and lung cancer in
nonsmoking adults and many serious health conditions in children, including sudden infant death syndrome,
respiratory infections, and more severe asthma. According to the CDC, almost 50,000 deaths per year can be
attributed to secondhand smoke. For more information or for resources to help quit smoking, go to
<http://www.nida.nih.gov/DrugPages/Nicotine.html>.
The study can be found online at: <http://archpsyc.ama-assn.org/>.
WEBINARS:
Announcing the May 2011 CDC Asthma Webinar
Date/Time: Tuesday, May 10, 2011 3:15 p.m. – 4:15 p.m. EST
Presenter: David M. Mannino, MD – Professor, University of Kentucky, College of Public Health
Presentation Title: The Overlap of Asthma and Chronic Obstructive Pulmonary Disease (COPD)
David Mannino, MD, is a Professor in Department of Preventive Medicine and Environmental Health at the
University of Kentucky College of Public Health in Lexington, Kentucky. He also has an appointment in the
Department of Epidemiology in the College of Public Health and the Division of Pulmonary and Critical Care
Medicine in the Department of Medicine at the University of Kentucky College of Medicine. He is the Director of
the Pulmonary Epidemiology Research Laboratory.
Having obtained his medical degree from Jefferson Medical College in 1981, Dr Mannino went on to complete his
internship and residency at Lankenau Hospital, both in Philadelphia, Pennsylvania. A fellowship in pulmonary
medicine at West Virginia University School of Medicine/National Institute for Occupational Safety and Health in
Morgantown, West Virginia, followed. Dr Mannino served as the chief science officer for the Centers for Disease
Control and Prevention’s Air Pollution and Respiratory Health branch following his fellowship. His research
interests there included the epidemiology of asthma and COPD and the effects of air pollution exposure on
respiratory function and lung diseases.
He retired as a Captain with twenty years of service with the United States Public Health Service in 2004, prior to
joining the University of Kentucky faculty. While with the USPHS, he was awarded numerous medals and
commendations. Other awards that he has received include the Soffer Research Award from the American
College of Chest Physicians and the Advocate of the Year Award from the American Lung Association.
Dr Mannino has authored over 180 articles for peer-reviewed journals, in addition to book chapters, editorials,
and book reviews. He is an associate editor for Thorax, International Journal of Tuberculosis and Lung Disease,
and The Clinical Respiratory Journal. He is also a member of the editorial boards of Chest, American Journal of
Respiratory and Critical Care Medicine, and Therapeutic Advances in Respiratory Disease. He is an active member
of several professional organizations including the COPD Foundation, the US COPD Coalition, and the Alpha-1
Foundation.
Join the meeting.
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Please Note: There are only 50 conference lines and 50 webinar spaces available each month, so to
ensure that there is space for everyone we encourage you to share conference lines and webinar
space. If you have any questions prior to the webinar please contact Velma Julius at 770-488-3700
([email protected]).
Using Consumer Assessment of Healthcare Providers and Systems (CAHPS) Item Sets that Address Cultural
Competence and Health Literacy: April 5, 2011
Results from the CAHPS Clinician & Group Survey indicate that doctor-patient communication is the most
significant driver of patients’ overall experiences with ambulatory care. One useful way to determine how to
improve your performance on the communication measure is to take a closer look at the specific factors that
affect how providers and patients talk with one another.
This webcast offered information on how to get the most out of using two CAHPS supplemental item sets for the
Clinician & Group Survey:
 Questions about providers' efforts to address health literacy and
 New questions to assess the cultural competence of providers.
Cindy Brach, MPP, of the Agency for Healthcare Research and Quality (AHRQ) discussed the importance of health
literacy and cultural competence in delivering quality health care and achieving objectives related to prevention,
chronic care management, and reducing health care disparities. She also provided a context for measuring
patient experience in these areas. She was joined by Robert Weech-Maldonado, PhD, of the University of
Alabama at Birmingham and Beverly Weidmer, PhD, of RAND.
Mr. Weech-Maldonado discussed how to use the CAHPS Cultural Competence Item Set to assess how well
clinicians bridge barriers to communication and understanding that stem from racial, ethnical, cultural, and
linguistic differences.
Ms. Weidmer discussed how to use the CAHPS Item Set for Addressing Health Literacy to assess providers’
activities to foster and improve the health literacy of patients, the role of the item set as part of the Health
Literacy Universal Precautions Toolkit, and how to link results from the item set to improvement strategies in the
American Medical Association's Health Literacy Toolkit (2nd edition).
To access the recorded Webinar or to access slides from this Webinar go to:
https://www.cahps.ahrq.gov/content/community/events/COMM_EVENTS_webcast2011-4-5.asp
DISPARITIES:
Webcast: Today's Topics In Health Disparities: HHS' Action Plan to Reduce Health Disparities
On Monday, April 25, 2011 Today's Topics in Health Disparities webcast examined the new Department of Health
and Human Services’ Action Plan to Reduce Racial and Ethnic Health Disparities.
The program addressed the contents of the strategy and its timeline for implementation as well as its implications for providers. The panelists also discussed how the new strategy relates to other recently released HHS
strategies including the National Strategy for Quality Improvement in Health Care, the National Prevention and
Health Promotion Strategy, the Healthy People 2020 initiative and the National HIV/AIDS Strategy for the United
States. Panelists also considered what the strategy’s role as it relates to health reform implementation.
A video of the Webcast is available at: http://www.kff.org/minorityhealth/todaystopics_hhs_042111.cfm. The
transcript will be published shortly.
Webinar: Looking Upstream: How Income, Education and Racial Inequalities Shape Health
On April 26th the Robert Wood Johnson Foundation will host a webinar on the effects that income, education
and race have on health. Published: Apr 13, 2011
The path to a healthy or unhealthy life depends on many factors outside the health care system. To fully
understand why some Americans are healthy and others are not, we need to look “upstream” –at the places
where we live, the education we receive, the stress we experience at home and at work, and whether we have
safe places to be active and healthy foods in our neighborhoods and communities–in other words, the factors
that shape our experiences where we live, learn, work and play.
In the second of three webinars to examine the non-medical factors that shape health, panelists will present key
findings from three issue briefs being released on April 26th. The webinar will also highlight the County Health
Calculator, a new interactive app that explores the impact that education and income have on health at the U.S.,
state and county level.
The webinar will address such questions as: How do income and wealth influence health beyond the ability to
afford health care? How do experiences based on a person’s race or ethnic group affect their health? Can a few
additional years of education meaningfully improve well-being?
James Marks, M.D., M.P.H., senior vice president and director of the Health Group at the Robert Wood Johnson
Foundation, will kick off the discussion with an expert panel that includes:
 Paula Braveman, M.D., M.P.H., University of California, San Francisco
 David Williams, Ph.D., M.P.H Harvard School of Public Health and Harvard University
 Steven Woolf, M.D., M.P.H., Virginia Commonwealth University
When: Tuesday, April 26, 2011, from 12:30 p.m. – 2:00 p.m. ET
Webinar Series: This webinar is the second in a three-part series exploring how conditions where we live, learn,
work and play affect our health. Mark your calendar for the third and final segment of the series:
 Wednesday, May 11, 2011: Place and Health: How Living and Working Conditions Shape Health
 Register at: http://www.rwjf.org/vulnerablepopulations/product.jsp?id=72204 or view the April 26
recording.
Ohio Department of Health Asthma Program
This newsletter was supported by Grant/Cooperative Agreement Number EH09-901- 1U59EH000511-01from
Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do
not necessarily represent the official views of the CDC.