The strategic plan for addressing asthma in Georgia, 2004

THE STRATEGIC PLAN FOR ADDRESSING
ASTHMA
in GEORGIA 2004
DR
GEORGIA DEPARTMENT OF HUMAN RESOURCES

The Georgia Department of Human Resources is proud to present The Strategic Plan for Addressing Asthma in Georgia. This plan conveys the magnitude and severity of the asthma problem in Georgia and sets forth a framework and strategy that will guide the future direction of statewide efforts to address asthma in Georgia.
Thoroughly researched and carefully crafted, this plan provides sound recommendations based on solid information to alleviate the burden of asthma in our state. Partnerships, prevention, quality care, education, communication, and surveillance are all key components of the plan. It provides a coordinated, collaborative strategy that utilizes our resources to create a healthier Georgia.
Sincerely,

Kathleen E. Toomey, M.D., M.P.H. Director, Division of Public Health Georgia Department of Human Resources
Acknowledgements
Georgia Department of Human Resources B.J. Walker, Commissioner
Division of Public Health Kathleen E. Toomey, M.D., M.P.H., Director
Chronic Disease Prevention and Health Promotion Branch Carol B. Steiner, B.N., M.N., Acting Director
Health Promotion Section Carolyn Williams, Asthma Program Manager Susan H. Enete, M.Ed., Media Coordinator
Epidemiology Branch Paul Blake, M.D., M.P.H., Director
Chronic Disease, Injury, and Epidemiology Section Kenneth E. Powell, M.D., M.P.H., Chief Angela Blackwell, Epidemiologist

Contact information
Georgia Addressing Asthma from a State Perspective 2 Peachtree Street NW, Suite 16-472 Atlanta, GA 30303-3142 Phone: 404-657-6638 Fax: 404-657-6631 E-mail: healthmatters@dhr.state.ga.us
Suggested citation
Williams CW. The Strategic Plan for Addressing Asthma in Georgia 2004. Georgia Department of Human Resources. November 2004. Publication number DPH04-000305HW.
Publication support
This publication was supported by Grant/Cooperative Agreement Number U59/CCU420871 from the 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.

TABLE OF CONTENTS
Highlights ....................................................................1 Introduction .................................................................2
Table 1. Prevalence of lifetime and current asthma Table 2. Healthy People 2010 National Goals for Asthma
Background .................................................................5 Structure of GAASP .....................................................6 Goals and Values of GAASP ......................................7 Strategic Plan Recommendations .............................8
Internal Management Surveillance Work Healthcare Provider Education Community Awareness Patients/Families Education Public Policy
Other Considerations ...............................................19 Conclusion..................................................................20 References .................................................................21 Acknowledgements ..................................................22 GAASP Membership .................................................23 Resources in Georgia ...............................................25 Related Web Sites.....................................................28 Glossary .....................................................................29

HIGHLIGHTS

Georgia ranks 17th in the prevalence of lifetime
asthma and 17th in the prevalence of current asthma.
Despite the fact that smoking may trigger asthma attacks, 26.3% of adults with asthma, 24.7% of high school students with asthma, and 11.6% of middle school students with
asthma currently smoke.
Quality-of-Life Issues Uncontrolled asthma has a major impact on the lives of sufferers. Asthma can cause
much stress, including:
Missed days of work or school
A need for unplanned childcare
Emergency room visits
Sleep disturbances and fatigue
Physical limitations
Depression
With proper education and treatment, people with asthma can lead full, active lives with little disruption to work, school, family, and social activities.
1 Strategic Plan for Addressing Asthma in Georgia

Approximately 9,400 hospitalizations occur annually from asthma.
Approximately 120 Georgians die from asthma each year.
13.1% of public middle school students and 10.7% of public high school students have asthma.
Hospital charges total approximately $59 million annually.
Blacks are more likely than whites, and women are more likely than men to be hospitalized or die because of their asthma.
Georgians over 65 and under 20, especially toddlers, are more likely to be hospitalized with asthma.
Senate Bill 472, passed in 2001 by the Georgia House of Representatives, allows school-aged children with asthma to self-administer asthma medication at school. Named in memory of a student who died after suffering an acute asthma attack at school, the Kellen Edwin Bolden Act provides that any student who has asthma and is authorized to self-administer his or her medication may possess and use asthma medication while in school or involved in a schoolsponsored activity without asking permission from a teacher or nurse.

INTRODUCTION

At present, the public health community and other asthma experts have very limited information about the precise causes of asthma and how to prevent it. This limited information makes it especially challenging for the public health and medical communities to provide high quality care and culturally appropriate education, information, and peer/family support to individuals with asthma and their families from various communities.

Clearly a major public health problem in Georgia and in the United States as a whole, asthma has become more prevalent in the last 20 years. Despite recent medical advances, the prevalence of asthma in the United States increased among all age, sex, and racial groups from 1980-1996. Unfortunately, this trend has not yet been reversed in the new millennium (Table 1). Fundamental to addressing this issue is an understanding of asthma as a disease and the Healthy People 2010 objectives related to asthma (Table 2).

The purpose of this strategic plan is to provide direction and guidance for public health officials, physicians, healthcare professionals, public policy experts, and other members of the education, health, and medical community who are concerned about asthma in Georgia. Reducing the burden of asthma in Georgia will require a coordinated, multidisciplinary approach in order to provide highquality care for individuals with asthma. No single institution or organization can solve the problem of asthma alone. It will take statewide coordination and collaboration to decrease the financial, emotional, and physical burdens that currently affect people with asthma, their families, and their communities.

There have been a number of barriers to implementing a successful
public health program which will address the burden of asthma in Georgia:
Physician non-adherence to National Asthma Education and Prevention Program guidelines Perception of asthma as an acute rather than a
chronic disease Patient non-adherence to asthma management plan
Cost of asthma drugs Lack of attention to adult asthma
Cultural issues Lack of insurance Low literacy levels Data limitations Lack of a coordinated, collaborative statewide plan Inconsistent and insufficient funding Inadequate number of staff

Strategic Plan for Addressing Asthma in Georgia

2

I N T R O D U C T I O N (continued)

Table 1. Prevalence of lifetime and current asthma among survey respondents, by area

Behavioral Risk Factor Surveillance System, United States, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands, 2001. Source: Self-Reported Asthma Prevalance/Control Among U.S. Adults, 2001.

Lifetime Asthma

Current Asthma

Area

No.* (%)

(95% Cl)

No.*

(%)

(95% Cl)

Alabama

2,792

9.7

Alaska

2,871

11.5

Arizona

3,261

12.4

Arkansas

2,927

10.6

California

4,170

12.4

Colorado

2,030

12.1

Connecticut

7,745

12.3

Delaware

3,510

12.0

District of Columbia

1,886

12.0

Florida

4,675

9.9

GEORGIA

4,530

11.0

Hawaii

4,492

12.2

Idaho

4,830

11.7

Illinois

4,007

11.3

Indiana

3,991

11.3

Iowa

3,629

9.7

Kansas

4593

11.7

Kentucky

7,518

10.9

Louisiana

4,999

9.1

Maine

2,413

12.6

Maryland

4,464

11.1

Massachusetts

8,614

13.1

Michigan

3,823

12.4

Minnesota

3,958

10.1

Mississippi

3,040

9.2

Missouri

4,175

12.0

Montana

3,334

11.8

Nebraska

3,696

8.4

Nevada

2,571

13.3

New Hampshire

4,063

12.5

New Jersey

6,009

9.4

New Mexico

3,618

10.8

New York

3,894

11.1

North Carolina

6,201

10.1

North Dakota

2,509

9.1

Ohio

3,431

9.8

Oklahoma

4,545

10.1

Oregon

2,529

13.0

Pennsylvania

3,658

10.7

Rhode Island

4,109

12.1

South Carolina

3,196

10.8

South Dakota

5,109

7.7

Tennessee

2,921

9.3

Texas

5,911

9.6

Utah

3,649

10.7

Vermont

4,292

12.1

Virginia

2,937

11.4

Washington

4,193

12.0

West Virginia

3,091

12.5

Wisconsin

3,350

10.9

Wyoming

3,038

11.6

Total**

204,797

11.0

(8.5-10.9) (9.7-13.3) (10.7-14.1) (9.3-11.9) (11.3-13.6) (10.6-13.7) (11.4-13.2) (10.5-13.5) (10.3-13.7) (8.9-10.8) (9.8-12.2) (10.8-13.5) (10.6-12.8) (10.2-12.4) (10.2-12.4) (8.6-10.8) (10.6-12.8) (9.9-11.9) (8.2-10.0) (11.1-14.2) (9.8-12.4) (12.2-13.9) (11.1-13.7) (9.1-11.2) (8.0-10.4) (10.6-13.3) (10.3-13.3) (7.3-9.6) (11.5-15.1) (11.3-13.7) (8.5-10.3) (9.6-12.0) (9.9-12.3) (8.8-11.3) (7.9-10.3) (8.7-10.9) (9.0-11.2) (11.6-14.4) (9.5-11.9) (10.9.13.3) (9.5-12.0) (6.9-8.6) (8.1-10.5) (8.8-10.5) (9.4-12.0) (11.0-13.2) (10.0-12.7) (10.9-13.1) (11.2-13.8) (9.6-12.2) (10.3-12.9) (10.8-11.2)

2,788 2,866 3,249 2,922 4,162 2,019 7,719 3,505 1,881 4,666 4,516 4,483 4,821 4,001 3,985 3,623 4,583 7,503 4,994 2,413 4,450 8,589 3,814 3,942 3,034 4,167 3,329 3,693 2,566 4,051 5,998 3,605 3,884 6,191 2,505 3,424 4,538 2,524 3,652 4,099 3,192 5,101 2,919 5,904 3,646 4,285 2,924 4,177 3,086 3,336 3,035 204,359

6.3

(5.4-7.3)

7.3

(5.8-8.8)

8.3

(6.8-9.8)

7.0

(5.9-8.1)

7.2

(6.3-8.0)

8.0

(6.7-9.3)

7.9

(7.1-8.6)

7.5

(6.3-8.8)

7.4

(6.0-8.8)

5.8

(5.0-6.5)

7.2

(6.2-8.3)

7.3

(6.2-8.4)

8.0

(7.1-8.8)

7.9

(6.9-8.8)

7.5

(6.7-8.4)

6.7

(5.8-7.7)

8.1

(7.1-9.1)

8.3

(7.5-9.2)

5.3

(4.6-6-0)

9.4

(8.1-10.7)

7.1

(5.9-8.2)

9.5

(8.7-10.3)

9.0

(7.9-10.2)

6.6

(5.8-7.4)

5.5

(4.6-6.5)

8.2

(7.0-9.3)

8.0

(6.7-9.3)

5.8

(4.8-6.7)

8.3

(6.8-9.7)

8.4

(7.4-9.4)

8.2

(5.5-7.0)

8.9

(5.9-7.9)

7.3

(6.4-8.3)

6.4

(5.4-7.4)

6.8

(5.8-7.9)

7.3

(6.3-8.2)

6.9

(6.1-7.8)

8.1

(7.0-9.2)

7.3

(6.4-8.3)

9.4

(8.3-10.5)

6.5

(5.5-7.6)

5.3

(4.6-6.0)

6.9

(5.8-7.9)

6.1

(5.4-6.8)

7.0

(5.9-8.1)

8.8

(7.8-9.8)

6.4

(5.5-7.4)

7.7

(6.8-8.5)

9.3

(8.2-10.4)

7.8

(6.7-8.9)

8.3

(7.1-9.4)

7.2

(7.0-7.4)

Guam Puerto Rico Virgin Islands

871

7.5

4,234

19.6

2,263

9.2

(5.6-9.4) (17.8-21.4) (7.5-10.8)

870 4,234 2,260

3.5

(2.2-4.9)

9.5

(8.3-10.8)

4.9

(3.7-6.1)

* Persons who answered "yes" to the question, "Have you ever been told by a doctor, nurse, or other health professional that you had asthma?" Persons who answered "yes" to the questions, "Have you ever been told by a doctor, nurse, or other health professional that you had asthma?" and "Do you still have asthma?" ** 50 states and the District of Columbia CI=Confidence Interval

3 Strategic Plan for Addressing Asthma in Georgia

I N T R O D U C T I O N (continued)

Table 2. Healthy People 2010 National Goals for Asthma

Healthy People 2010 is designed to achieve two over-arching goals: 1) to increase quality and years of life, and 2) to eliminate health disparities. Progress toward the goals will be monitored through specific objectives in 28 focus areas. Respiratory diseases, including asthma, are covered in Focus Area #24. The asthma objectives are:

24.1 Reduce asthma deaths
Rate per million
a. Children under age 5 years b. Children aged 5 to 14 years c. Adolescents and adults aged 15 to 34 years d. Adults aged 35 to 64 years e. Adults aged 65 years and older

1998 (baseline)
1.7 3.2 5.9 17.0 87.5

2010 Target
1.0 1.0 3.0 9.0 60.0

24.2 Reduce hospitalizations for asthma
Rate per 10,000
a. Children under age 5 years b. Children and adults aged 5 to 64 years c. Adults aged 65 years and older

1998 (baseline)
60.9 13.8 19.3

2010 Target
25 8 10

24.3 Reduce hospital emergency department visits for asthma
Rate per 10,000
a. Children under age 5 years b. Children and adults aged 5 to 64 years c. Adults aged 65 years and older

1995-97 (baseline)
150.0 71.1 29.5

2010 Target
80 50 15

24.4 Reduce activity limitations among persons with asthma Target: 10% Baseline: 19.5 percent of persons with asthma in 1994-96.

24.5 (Developmental) Reduce the number of school or workdays missed by persons with asthma due to asthma.

24.6 Increase the proportion of persons with asthma who receive formal patient education, including information about community and self-help resources, as an essential part of the management of their condition. Target: 30% Baseline: 6.4 percent of persons with asthma received formal patient education in 1998 (preliminary data).

24.7 (Developmental) Increase the proportion of persons with asthma who receive appropriate asthma care according to the National Asthma Education and Prevention Program guidelines.

24.8 (Developmental) Establish in at least 15 states a surveillance system for tracking asthma death, illness, disability, impact of occupational and environmental factors on asthma, access to medical care, and asthma management.

Strategic Plan for Addressing Asthma in Georgia

4

BACKGROUND
Until recently, little had been done to address asthma in Georgia from a public health standpoint. In 1999, a needs assessment funded by a Title V Maternal and Child Health (MCH) Block Grant identified asthma as the leading cause of childhood hospitalization in Georgia. Subsequently, the rate of pediatric asthma hospitalizations was chosen as a state MCH performance measure. Around the same time, the Georgia Department of Human Resources and the American Lung Association jointly published a report which provided insight into the problem of asthma in Georgia. The report, Asthma in Georgia 2000, highlighted barriers to controlling asthma, including inadequate education for young patients and their families. The report also identified populations that were particularly susceptible to asthma, including African Americans and the elderly. Findings highlighted in the report made it clear that a statewide, systemic approach was needed to address the problem of asthma in Georgia.
In 2001, the Centers for Disease Control and Prevention awarded a grant to the Georgia Department of Human Resources to create and implement a statewide strategic plan to address asthma which would be based on a systemic rather than activity-oriented approach. Recognizing that a multi-disciplinary group was needed to create the statewide plan, the Georgia Department of Human Resources formed the Internal Management Team to determine what resources were necessary to address asthma in Georgia. The Internal Management Team then assembled a steering committee, which included representatives from state and local government, academia, medical associations, healthcarerelated nonprofit organizations and other groups. The committee, known as the Stakeholder Steering Committee, was tasked with developing a detailed, comprehensive strategy for reducing the burden of asthma in Georgia.
Essential to the creation of a comprehensive plan were: an understanding of asthma as a disease; familiarity with the Healthy People 2010 objectives related to asthma; and knowledge of the planning, surveillance and intervention efforts outlined in Asthma in Georgia 2000. The plan also needed to address barriers and challenges that would be faced as the plan was implemented.
The Stakeholder Steering Committee created four work teams: Surveillance, Healthcare Provider Education, Community Awareness, and Patients/Families Education. The work teams were tasked with identifying current asthma-related activities and programs in Georgia; identifying problems, barriers, and challenges; assessing gaps; and providing recommendations for each of the priority/issue areas. Once this was accomplished, the strategic planning process could begin.
5 Strategic Plan for Addressing Asthma in Georgia

STRUCTURE OF GAASP

The Internal Management Team, the Stakeholder Steering Committee, and the four work teams are known collectively as Georgia Addressing Asthma from a State Perspective (GAASP).
er Steering
Internal Management
Team

Stakehold

Committee

Surveillance Work Team

AwEapriedneemssiology

Healthcare Provider Education
Work Team

Epidemiology Awareness

Community Awareness Work Team

Patients/Families

Education

EpideAmwiaorloegnyess

Work Team

The Internal Management Team sets the policy, programmatic, and management direction for GAASP.
The Stakeholder Steering Committee determines the priority areas and oversees the work teams.
The Surveillance Work Team provides epidemiological support. Epidemiology and sur veillance activities are vital to the development, implementation and evaluation of a strategic plan to combat asthma.
The Healthcare Provider Education Work Team addresses professional education and standards. Healthcare providers must develop the skills to accurately diagnose and treat asthma.
The Community Awareness Work Team raises awareness about asthma and related issues. Once the public is more aware of the burden of asthma, it will become easier to find the resources needed to manage the disease.
The Patients/Families Education Work Team identifies and develops educational materials for patients and families that focus on recognizing triggers and creating an asthma management plan. Education should begin at diagnosis and be incorporated into all phases of patient care.

Strategic Plan for Addressing Asthma in Georgia

6

GOALS AND VALUES OF GAASP

The primary goal of GAASP is to improve the quality of life of Georgians with asthma and reduce the burden of asthma throughout the state. To reach this goal, GAASP
has three areas of focus:
1.
Track the disease to determine whom, where, and when asthma occurs.
This will provide the cornerstone for planning and evaluating programs and directing resources to
alleviate this problem
2.
Ensure interventions are based on sound science.
3.
Help partners develop, implement and evaluate
local programs.
7 Strategic Plan for Addressing Asthma in Georgia

The foundation of the strategic plan includes the following values:
Prevention
Prevention reduces the burden of asthma and helps
individuals with asthma enjoy a good quality of life.
Partnerships
Collaboration helps address the problem of asthma
more efficiently and effectively.
Quality Care
All providers should know and practice the standards of care.
Education
Public and professional education is critical to controlling asthma.
Communication
Scientific data and facts must be communicated to healthcare
professionals and to the public. Provider-to-provider and provider-to-patient/family
communications are most effective.
Epidemiology and Surveillance
Epidemiology and surveillance are essential in planning
and evaluating the program.

INTERNAL MANAGEMENT
OBJECTIVES AND ACTION STEPS

Guiding Principle: Objective 1:
ACTION STEPS:
Performance Measures:

Through coordinated, careful management, GAASP will maximize the potential available partnerships and resources.
Maintain an internal management structure to oversee, direct, and coordinate GAASP.
- Meet semi-monthly to review status and needs of GAASP. - Disseminate GAASP reports and other related documents. - Facilitate the implementation of GAASP initiatives.
- Internal management team meets semi-monthly. - Keep a record of the distribution of GAASP reports and related documents. - Maintain a functional collaborative partnership structure to address asthma and related issues.

Objective 2:

Maintain and expand the on-going Steering Committee to support local efforts and facilitate sharing of information and resources at the state level.

ACTION STEPS: Performance Measures:

- Add professionals and advocates interested in clean air initiatives, rural health, and worksite wellness.
- Add clinical representatives from allergy and immunology specialty groups. - Within the Steering Committee, develop work teams, bringing in additional partners
as appropriate to address the following specific issues: - Surveillance - Healthcare provider education - Community awareness - Patient and family education - Work-related asthma - Environmental
- Composition of Steering Committee includes a broad base of stakeholders. - Steering Committee members select a work team. - Work teams develop interventions and plans.

Strategic Plan for Addressing Asthma in Georgia 8

SURVEILLANCE
OBJECTIVES AND ACTION STEPS

Guiding Principle: Objective:
ACTION STEPS:
Performance Measures:

Epidemiology and surveillance are vital to the development, implementation, and evaluation of the GAASP Strategic Plan.
Develop and maintain a comprehensive Georgia surveillance system with data on patterns and trends related to prevalence, burden and risks of asthma and asthma attacks.
- Ensure adequate personnel, expertise, and other resources to provide infrastructure for asthma surveillance program.
- Identify components of the Burden of Asthma report; identify users and data providers. - Determine which tables will be included in the report and qualify to what level data will
be reported. - Obtain data on morbidity, mortality, hospitalizations, asthma-related costs, and quality of
care indicators from Georgia Medical Care Foundation, Medicare, Medicaid, hospital data, and county emergency medical services. - Perform statistical analysis and interpret results. - Expand the surveillance system to incorporate emergency room data, emergency medical services, hospital outpatient/ambulatory care data, and occupational-related asthma. - Produce and disseminate the Burden of Asthma in Georgia surveillance update report to target audience; track number of copies requested and distributed. - Repeat the Childhood Asthma Survey to assess prevalence of asthma in children; missed school for children and missed work for their parents; and management plans for children with asthma. - Add questions to subsequent asthma-related surveys to assess prevalence. - Apply to CDC for implementation grant to sustain surveillance. - Collaborate with other states in regional and national efforts to maximize the utility of surveillance in Georgia and elsewhere.
- Personnel hired and resources identified and utilized. - Data providers and components of report identified. - Tables identified for inclusion in report. - Data collected. - Data analyzed; statistical report generated. - Emergency medical service data added to cur rent surveillance efforts. - Burden of Asthma in Georgia report pr oduced and disseminated, number of requested and distributed
copies tracked. - Childhood Asthma Survey and related surveillance ar ticles completed; report produced and distributed. - Asthma-related questions included in prevalence surveys. - Submission of implementation grant. - Successful collaboration with partners on surveillance-related issues.

9 Strategic Plan for Addressing Asthma in Georgia

HEALTHCARE PROVIDER EDUCATION
OBJECTIVES AND ACTION STEPS

Guiding Principle: Education of healthcare providers is critical in controlling asthma.

Objective 1: ACTION STEPS:

Conduct trainings and provide opportunities to improve healthcare providers' knowledge, attitudes, and practice.
- Perform training needs assessment for healthcare providers. - Encourage institutions to self-assess present state of asthma practices in relation to
usage of National Asthma Education and Prevention Program guidelines. - Partner with health care providers to coordinate continuing education needs and
professional programs that include asthma as a topic. - Partner with established agencies that offer training on asthma management for
healthcare providers. - Provide a clearinghouse for offerings of continuing education that include asthma. - Collaborate with professional organizations and health organizations to produce
articles for publication in journals, newsletters and other media which focus on asthma. - Partner with agencies to develop multidisciplinary symposium on asthma management. - Work with school health nurses and parent/teacher associations statewide to improve
the implementation of recommended standards of care in the school setting for the assessment, support and self-management of asthma. - Identify funding sources, including government, public, and private sources.

Performance Measures:

- Training needs assessment completed. - Institutions perform self-assessment in relation to NAEPP guidelines. - Partnerships established and professional training opportunities identified. - Clearinghouse developed and shared with partners. - Articles and reports published. - Multidisciplinary professional symposium completed. - School nurses and parent/teacher associations use recommended standards of care for students. - Funding sources are identified and secured.

Strategic Plan for Addressing Asthma in Georgia 10

HEALTHCARE PROVIDER EDUCATION
OBJECTIVES AND ACTION STEPS (continued)

Objective 2:

Incorporate asthma services and education into public health districts and county health departments to provide culturally competent care to their patients with asthma.

ACTION STEPS:

- Build relationship with health district directors. - Assess district capacity to address asthma - Assist health districts with organizing partnerships and developing asthma plans. - Develop training programs specific for health districts. - Disseminate materials to health districts and area agencies for target populations. - Promote case management to coordinate asthma care and patient/family education. - Collaborate with partners to deliver asthma curriculum for health professionals. - Provide grant-in-aid funding to public health districts for asthma interventions.

Performance Measures:

- Partnerships developed with district health directors. - Assessment of district capacity completed. - Districts develop and expand partnerships with local organizations. - Asthma training developed and implemented in districts. - Appropriate educational materials disseminated to target populations. - Asthma case management courses delivered to diverse populations. - Asthma curriculum developed and utilized by health prof essionals. - Funding provided to health districts.

11 Strategic Plan for Addressing Asthma in Georgia

HEALTHCARE PROVIDER EDUCATION
OBJECTIVES AND ACTION STEPS (continued)

Objective 3:

Identify health care delivery system and policy barriers related to diagnosis, treatment and medications that impact asthma management and related health outcomes.

ACTION STEPS:

- Perform assessment of healthcare delivery system. - Build relationships with health plan providers and pharmaceutical companies. - Support asthma case management through Area Health Education Centers (AHEC)
and health clinics targeting children and adults. - Partner with American Lung Association (ALA) to advocate for policy changes and
programmatic resources. - Disseminate Resource Guide for services and education. - Disseminate statistical reports to health plan providers. - Support a system approach to identify and address barriers to delivery of
appropriate asthma management. - Include schools, childcare facilities, and health professionals in the proactive
management of asthma patients via an Asthma Action Plan. - Promote and encourage the early and appropriate diagnosis, treatment and self-
management of asthma. - Determine and minimize identified barriers to following prescribed guidelines by
patients. - Determine and minimize identified barriers to use of National Asthma Education
and Prevention Program (NAEPP) guidelines by providers.

Performance Measures:

- Assessment of healthcare delivery systems completed. - Relationships developed with health plan providers and pharmaceutical companies. - Interventions for children and adults implemented through AHEC and health clinics. - Partnerships developed to advocate for policy changes and programmatic resources. - Resource Guide disseminated to general public and persons with asthma. - Statistical reports disseminated. - Systems approach is applied to support asthma management. - Schools, childcare facilities, and health professionals utilize and adhere to an Asthma Action Plan. - Healthcare organizations practice appropriate car e of asthma. - Persons with asthma follow appropriate care according to National Asthma Education and
Prevention Program (NAEPP) and utilize Asthma Action Plans prescribed by physician. - Providers utilize National Asthma Education and Prevention Program (NAEPP) guidelines.

Strategic Plan for Addressing Asthma in Georgia 12

COMMUNITY AWARENESS
OBJECTIVES AND ACTION STEPS

Guiding Principle: Objective 1:

Public awareness and understanding of asthma are essential to alleviating the burden of asthma in Georgia.
Increase awareness and knowledge of the public and community about asthma, including asthma triggers, early identification, and the importance of having regular asthma care.

ACTION STEPS:

- Solicit proposals for media contract and select media contractor. - Identify key media messages for selected target audiences. - Work with media contractor to develop comprehensive media campaign. - Identify and disseminate educational materials and approaches for diverse populations. - Enlist the support of coalitions and agencies to provide education within communities. - Promote asthma awareness activities, events, and other learning opportunities for the
public throughout the year. (i.e. World Asthma Day). - Educate local decision makers and communities about air-borne pollutants and
secondhand smoke policies. - Identify and disseminate resources available to families that address environmental risk
factors in the home. - Expand and support existing and pilot projects that identify children who are at
increased risk for asthma. - Partner and support organizations that implement environmental and educational
interventions that may reduce the onset of asthma. - Support and provide information on existence of established asthma programs, such
as Open Airways, Tools for Schools, and Camp Breathe Easy. - Maintain updated resource list and disseminate to public and partners. - Work with employers to encourage asthma management plans which may result in
fewer employee sick days. - Address unique problems faced by elderly in asthma management.

Performance Measures:

- Media contractor selected. - Messages identified for target audience. - Media campaign developed. - Educational materials reviewed for usability and compliance with NAEPP guidelines before
dissemination to target populations. - Local coalitions assisted with asthma awareness and management. - Statewide activities planned and conducted for World Asthma Day. - Local decision makers educated on asthma-related risks. - Resource information disseminated to those affected by asthma. - Support provided to identified asthma awareness and prevention agencies. - Partnership developed with environmental and educational agencies. - Increase in the number of persons who receive information about asthma. - Successful collaboration and partnership with employers. - Elderly asthma management issues are addressed.

13 Strategic Plan for Addressing Asthma in Georgia

COMMUNITY AWARENESS
OBJECTIVES AND ACTION STEPS (continued)

Objective 2: Identify and decrease exposure to environmental asthma triggers.

ACTION STEPS: Performance Measures:

- Develop approach for addressing indoor air quality. - Compile and review existing materials and resources. - Determine and/or develop consistent training materials for diverse groups. - Increase awareness of environmental triggers for asthma in diverse domains. - Support state pollution prevention programs. - Increase focus on indoor air quality in public and private buildings. - Collaborate and coordinate with groups applying a healthy-home, healthy-
community approach to environmental triggers of asthma. - Support efforts at identifying and managing environmental exposures that cause or
trigger asthma events. - Support efforts at continuous improvement in ambient air quality, such as the
Georgia Clean Air Campaign. - Support efforts to address smoking cessation and smoking prevention. - Support pollution prevention activities, including recycling and materials
replacement efforts, as well as promote air monitoring.
- Compilation of asthma materials and resources. - Training materials identified. - Diverse populations receive asthma triggers and management infor mation. - Georgia improves adherence success with National Ambient Air Quality Standards. - Individuals in public and private buildings are aware of indoor air quality issues. - Successful collaboration with healthy community groups. - Successful promotion of efforts identifying molds, and other naturally occurring asthma triggers. - Successful efforts of the Georgia Clean Air Campaign. - Successful efforts to address smoking cessation and smoking prevention. - Increase in the number of prevention activities related to re placement and recycling efforts.

Strategic Plan for Addressing Asthma in Georgia 14

COMMUNITY AWARENESS
OBJECTIVES AND ACTION STEPS (continued)

Objective 3:

Maximize management of asthma in the school setting to enhance health and learning of students with asthma, within the context of coordinated school health programs as recommended by the Centers for Disease Control and Prevention.

ACTION STEPS: Performance Measures:

- Promote the use of guidelines for individual health education and counseling and strategies using support groups that reinforce self-management skills and that includes at least health education, environmental controls and behavior modification.
- Support asthma education and awareness programs for students and school staff. - Increase communication among parents, healthcare provider and school personnel. - Support safe and healthy school environments to reduce asthma triggers. - Support safe, enjoyable physical education and activity opportunities for students
with asthma. - Coordinate school, family healthcare provider and community efforts to better
manage asthma symptoms and reduce school absences among students with asthma.
- Increased use of guidelines for individual health education by school health staff. - An increase in the number of persons who receive patient education, including information about
community and self-help resources. - Hospital-based or clinic-based programs sharing consistent information with school personnel. - Increased number of school staff/students receiving asthma trig gers education and training. - Increased number of school staff/students receiving asthma management education in relation to
physical education. - Primary care providers, community and schools are working together to establish goals for self-
management.

Objective 4: Reduce workplace exposures to known occupational asthma-causing agents.

ACTION STEPS:

- Partner and support healthcare providers with focus on work-related asthma. - Enlist the support of healthcare providers to ask adults with asthma about their
workplaces, and report work-related asthma cases to the Department of Public Health and the Department of Labor. - Collect and develop comprehensive materials/brochures to educate employers regarding work-related asthma. - Provide education materials through ethnic support organizations, district public health departments, religious organizations, and to farmers and other agricultural groups. - Develop and administer work-related asthma questionnaire to individuals who are seen in asthma clinics. - Collect work-related asthma data, analyze data, and disseminate results.

Performance Measures:

- Successful partnership with work-related asthma healthcare providers. - Successful support of healthcare providers and Department of Labor. - Brochures developed and disseminated about work-related asthma. - Work-related asthma information will be made available to diverse occupational groups. - Work-related asthma questionnaire delivered to asthma clinics. - Collection and data analysis complete; development and dissemination of report.

15 Strategic Plan for Addressing Asthma in Georgia

PATIENTS/FAMILIES EDUCATION
OBJECTIVES AND ACTION STEPS

Guiding Principle: Objective:
ACTION STEPS:

Education for individuals with asthma and their families is essential to managing asthma.
Increase knowledge and improve the ability of patients of all ages and families in the self-management of asthma.
- Conduct needs assessment of patients and families. - Conduct inventory of asthma resources, programs, and activities in Georgia. - Establish quality criteria measures for materials. - Define the target audiences. - Develop communication strategies. - Conduct focus groups to obtain input from patients/parents of children with
asthma, representing all age groups, to determine what assistance would be useful in improving their asthma care. - Design and disseminate effective messages, materials, and models to promote prevention and self-management to patients/families. - Revise materials based on feedback. - Work with school health nurses, occupational health nurses, and local coalitions and agencies to identify and provide materials that focus on identifying triggers and creating and maintaining a written asthma management plan. - Coordinate with schools, hospitals, public health officials, local governments, and community groups in planning specific activities in Georgia to increase awareness. - Develop and provide learning opportunities for individuals, such as school staff (e.g. coaches, teachers, school aids, building and maintenance staff, etc), community youth workers, faith groups, and others who interact with people with asthma. - Encourage case management for patients with poorly controlled asthma. - Collaborate with groups addressing environmental justice issues.

Performance Measures:

- Needs assessment conducted. - Inventory conducted. - Measures for quality materials established. - Target audience defined. - Communication strategies drafted and revised. - Focus groups conducted with specific groups. - Number of messages, materials and models developed and disseminated. - Number of materials revised based on consumer feedback. - Number of materials identified and disseminated to asthma agencies. - Number of successful collaboration with asthma agencies. - Number of successful asthma interventions and activities implemented. - Number of educational opportunities provided to communities, schools and other groups. - Increased number of patients utilizing case management. - Successful collaboration with environmental justice groups.

Strategic Plan for Addressing Asthma in Georgia 16

PUBLIC POLICY
OBJECTIVES AND ACTION STEPS

Guiding Principle: Objective 1:

In order to implement policy change, awareness and understanding of asthma among public officials and high-level decision-makers is essential.
Increase the proportion of schools in compliance with Senate Bill 472 (known as the Kellen Bolden Act) that allows children to possess and self-administer asthma medication in accordance with local school system policy

ACTION STEPS:
Performance Measures:
Objective 2: ACTION STEPS:

- Conduct survey to identify compliance of school and school districts - Create survey instrument - Obtain list of schools and/or school districts - Compile results - Create report packet of information - Disseminate asthma education/compliance materials to schools
- Initial compliance survey complete. - Final draft of survey instrument. - School and/or school district list obtained. - Analysis of results completed. - Compliance report developed. - Dissemination of compliance report and asthma education materials disseminated to schools and
policymakers.
Increase the number of asthma patients with asthma-related insurance coverage.
- Support the clarification, publication and dissemination of multi-lingual specific asthma benefits coverage and Medicaid coverage information.
- Work with insurers to promote appropriate coverage in accordance with model benefit packages for essential asthma services, including age-appropriate medications, delivery services, and self-management education.
- Support funding for professional education and provide education reimbursement to professionals providing asthma education to patients.
- Partner with pharmaceutical companies for best practices, education and provision of funding for patient, provider, and pharmacist education efforts.
- Support GAASP workgroup efforts to review current federal funding applicable to education programs and conferences on health and community issues.

Performance Measures:

- Number of multi-lingual asthma benefits information disseminated to target audiences. - Successful partnerships and activities with health insurers. - Providers receive reimbursement for patient education. - Partnership developed with pharmaceutical companies. - Federal funding obtained.

17 Strategic Plan for Addressing Asthma in Georgia

PUBLIC POLICY
OBJECTIVES AND ACTION STEPS (continued)

Objective 3:

Increase awareness and understanding of asthma among policy-makers and high-level decision-makers

ACTION STEPS:

- Promote Governor's Proclamation and/or Legislative Resolution creating "Asthma Awareness Day or Month."
- Identify educational materials to be shared with high-level decision makers. - Disseminate packet of information for policymakers, i.e. Burden of Asthma in
Georgia Report, key facts, current relevant statutes, asthma statistics, costs associated with asthma, etc. - Build relationships with identified groups and their leaders, along with "champions" of the community. - Serve as asthma resource for policymakers. - Offer training and technical assistance to grassroots networks.

Performance Measures:

- Resolution and/or proclamation drafted and promoted during World Asthma month events. - Information identified. - Packet of information disseminated to policymakers. - Successful partnerships with identified groups and leaders. - Policymakers are made aware of state asthma resources. - Trainings held.

Strategic Plan for Addressing Asthma in Georgia 18

OTHER CONSIDERATIONS
Throughout the strategic planning process, a number of asthma-related issues emerged. While efforts to address these issues are being led by other groups, it is important to emphasize the connection between these issues and asthma.
One of the most significant issues is housing. The lack of clean, decent housing has reached a crisis level in many parts of the state. As a result, many people are forced to live in substandard housing where asthma triggers, such as mold and cockroaches, are common. Individuals and families often do not have the financial resources needed to leave unhealthy environments. Because of the limited availability of affordable housing, even apartments and homes with unhealthy environments rent easily, and landlords have little financial incentive to improve housing conditions. Because there are no enforceable statewide codes addressing asthma triggers, they also have no legal incentive to do so.
Furthermore, individuals and families with limited financial resources have difficulty obtaining the asthma medications which are needed to control asthma and prevent asthma episodes. In addition, individuals with asthma and families are often unable to purchase basic household equipment and supplies (e.g. vacuum cleaners, cleaning solutions, etc.), which could help decrease the indoor environmental triggers.
Finally, consideration should be given to integrating asthma-related initiatives with other chronic disease initiatives such as those involving diabetes, arthritis, hypertension, obesity, nutrition, cardiovascular disease, and physical activity.
19 Strategic Plan for Addressing Asthma in Georgia

CONCLUSION
Asthma continues to be a major public health issue in the United States and Georgia. Untreated or inadequately treated, it results in excessive hospitalizations, elevated rates of school and work absenteeism, lost productivity, disability, and increased healthcare costs. Because it is treatable and manageable, successful public health education and prevention efforts could improve the emotional, financial, and physical quality of life for individuals with asthma and their families. This strategic plan addresses these education and prevention efforts and offers solutions to help reduce the burden of asthma in Georgia. Implementation of the strategic plan will require collaboration with communities, agencies, organizations, schools, places of worship, businesses, and Georgia's nineteen public health districts. GAASP will continue to address issues requiring planning and development at the state level while at the same time supporting activities, programs, and events at the regional and local level. Working at the regional and local level will allow GAASP to share the strategic plan with local communities; provide a forum for sharing information regarding existing asthma activities; facilitate collaboration between asthma groups; and facilitate the development of local coalitions. The strength of Georgia Addressing Asthma from a State Perspective is in its partnerships. Working together, these partners can leverage their collective knowledge, expertise and resources to give Georgians with asthma a better quality of life and reduce the burden of this disease on the state.
Strategic Plan for Addressing Asthma in Georgia 20

REFERENCES
Mortality and Morbidity Weekly Report. May 2, 2003. "Self-Reported Asthma Prevalence and Control Among Adults." National Heart, Lung and Blood Institute. Asthma Statistics Data Fact Sheet. Available at: http://www.nhlbi.nih.gov. Georgia Department of Human Resources, Division of Public Health. The Burden of Asthma in Georgia 2003. American Lung Association of Georgia, Inc., and Georgia Department of Human Resources, Asthma in Georgia 2000. Georgia Department of Human Resources, Division of Public Health, Office of Infant & Child Health Services, Asthma 101: "Understanding Asthma, 2001." Clearing the Air: Asthma and Indoor Air Exposures (2000) Institute of Medicine (IOM) National Academies Press 2000. American Lung Association. Children with asthma and the elderly at risk from ozone air pollution, two new studies show. Available at: http://www.lungusa.org/press/medical/medfebaf.html. Reference ID: 172. Anderson SD, Daviskas E. The mechanism of exercise-induced asthma. J Allergy Clin Immunol. 2000;106(3):453-459. US Department of Health and Human Services. "Action against Asthma: A Strategic Plan for the Department of Health and Human Services," Washington, D.C., May 2000. National Heart, Lung and Blood Institute. Asthma Statistics Data Fact Sheet. Available at: http://www.nhlbi.nih.gov. Asthma and Allergy Foundation of America. Costs of Asthma in America. Available at: http://www.aafa.org. Center for Disease Control and Prevention, National Center for Health Statistics. Asthma Prevalence, Health Care Use and Mortality, 2000-2001. Available at: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/asthma/asthma.htm. U.S. Department of Health and Human Services, "Healthy People 2010, Understanding and Improving Health," Volumes I and II, Boston: Jones and Bartlett Publishers, November 2000. National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program, Guidelines for the Diagnosis and Management of Asthma, 1997. Plaut, Thomas, M.D., One-Minute Asthma-What You Need to Know, Amherst, MA: Pedipress, 2001. National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. Guidelines for the Diagnosis and Management of Asthma. Expert Panel Report 2. Bethesda: National Institutes of Health. 1997. Health Advisory: Outdoor Physical Activity During the Smog Season Prepared by the Clean Air Campaign, Technical Advisory Board, Smog and Physical Activity Advisory Sub-Committee; W. Gerald Teague, M.D. et.al. 2001.
21 Strategic Plan for Addressing Asthma in Georgia

ACKNOWLEDGEMENTS

Special thanks to the many individuals, agencies, and organizations who gave their time, dedication, and commitment to develop this strategic plan.

American Academy of Pediatrics American Lung Association of Georgia Breathe Georgia Children's Healthcare of Atlanta The Clean Air Campaign DeKalb County Board of Health The Edison Group Emory University School of Medicine Environmental Protection Agency Georgia Association of School Nurses Georgia Department of Community Health Georgia Department of Human Resources, Division of Aging Services Georgia Department of Human Resources, Chronic Disease Prevention and Health Promotion Branch Georgia Department of Human Resources, Family Health Branch Georgia Department of Human Resources, Environmental Health Unit

Georgia Department of Human Resources, Epidemiology Branch Georgia Hospital Association Georgia Medical Care Foundation Georgia Paternity Acknowledgement Program Georgia State University, Clinical Education Georgia Thoracic Society Georgia Tobacco Use Prevention Program Grady Health System HP & G Associates Hughes Spalding Children's Hospital Medical Association of Georgia The National Center for Primary Care, Morehouse School of Medicine Office of Emergency Medical Services University of Georgia, Survey Research Center University of Georgia, School of Pharmacy ZAP Asthma

Strategic Plan for Addressing Asthma in Georgia 22

GAASP MEMBERSHIP

Larry Aull, Phar m.D.
School of Phar macy University of Georgia
Rosalyn K. Bacon, M.P.H.
Family Health Branch Division of Public Health Georgia Department of Human Resources
Jim Bason, Ph.D.
Survey Research Center University of Georgia
Brenda Batts, M.P.H., R.R.T.
Hughes Spalding Children's Hospital
Jennifer Beane, M.P.H.
Georgia Paternity Acknowledgement Program
Angela Blackwell, M.P.H.
Epidemiology Branch Division of Public Health Georgia Department of Human Resources
Robert Blake, M.P.H., R.E.H.S.
Environmental Health DeKalb County Board of Health
Jeane Borkenhagen
Clean Air Campaign Georgia Environmental Protection Agency
Pamela Collins, M.S.A.
American Lung Association of Georgia
Gloria Chen, R.N., M.B.A.
Family Health Branch Division of Public Health Georgia Department of Human Resources
Allison Ellison, R.N., P.N.P.
Children's Healthcare of Atlanta
Yvonne Fry, M.D.
National Center for Primary Care Morehouse University School of Medicine
Allan Goldman, M.P.H.
Division of Aging Ser vices Georgia Department of Human Resources
Lynda Thomas Goodfellow, Ed.D., R.R.T.
Department of Cardiopulmonary Care Sciences Georgia State University
23 Strategic Plan for Addressing Asthma in Georgia

Leroy M. Graham, M.D., F.C.C.P.
HP&G Associates
Cam Grayson
The Medical Association of Georgia
Kevin Holloway, M.D.
Grady Health Systems
Marlon Hunter
Planning and Partnership Development DeKalb County Board of Health
Sandra Leonard, R.N., M.S., F.N.P.
Family Health Branch Division of Public Health Georgia Department of Human Resources
William M. McClellan, M.D.
Georgia Medical Care Foundation
Kathy McGowan, M.P.H.
Georgia Hospital Association
Mark Moncino, M.D.
Breathe Georgia
Betty Neal, R.N.
DeKalb Health Center DeKalb County Board of Health
James P. O'Neal, M.D.
Emergency Medical Services
Kenneth E. Powell, M.D., M.P.H.
Epidemiology Branch Division of Public Health Georgia Department of Human Resources
Maurice Redmond, R.E.H.S.
Environmental Health and Injury Prevention Branch Division of Public Health Georgia Department of Human Resources
Joyce Reid
Georgia Hospital Association
George Rust, M.D.
National Center for Primary Health Care Morehouse University School of Medicine

G A A S P M E M B E R S H I P (continued)

Katherine Sheriff, R.N.
The Georgia Association of School Nurses
Monica Sutherland, M.S., AE-C
Children's Healthcare of Atlanta
Gerald Teague, M.D.
Emory University School of Medicine
Linda Thomas
Environmental Protection Agency
Paul Weisner, M.D.
DeKalb Health District
Lucretia Washington, M.P.H.
Chronic Disease Prevention and Health Promotion Branch Division of Public Health Georgia Department of Human Resources
Charles White
American Lung Association of Georgia
Michele White, Pharm.D., R.Ph.
Royal Family of God Community Project
Carolyn Williams. B.S.
Chronic Disease Prevention and Health Promotion Branch Division of Public Health Georgia Department of Human Resources
Manxia Wu, M.D., M.P.H.
Epidemiology Branch Division of Public Health Georgia Department of Human Resources

GAASP Program Staff and DHR Internal Management Team
Angela Blackwell, M.P.H.
Epidemiology Branch Division of Public Health Georgia Department of Human Resources
Gloria Chen, R.N., M.B.A.
Family Health Branch Division of Public Health Georgia Department of Human Resources
Kenneth E. Powell, M.D., M.P.H.
Epidemiology Branch Division of Public Health Georgia Department of Human Resources
Maurice Redmond, R.E.H.S.
Environmental Health and Injury Prevention Branch Division of Public Health Georgia Department of Human Resources
Carol Steiner, R.N., M.N.
Chronic Disease Prevention and Health Promotion Branch Division of Public Health Georgia Department of Human Resources
Carolyn Williams, B.S.
Chronic Disease Prevention and Health Promotion Branch Division of Public Health Georgia Department of Human Resources

Strategic Plan for Addressing Asthma in Georgia 24

RESOURCES IN GEORGIA

American Lung Association of Georgia
www.alaga.org 770-434-5864 1-800-LUNG-USA
The American Lung Association of Georgia provides information on asthma to the general public. It also offers professional education programs to physicians, nurses, respiratory therapists, and other allied health professionals. ALAG also funds clinical research in Georgia to find the causes and cures for lung diseases. To reach children with asthma, the American Lung Association of Georgia offers Open Airways for Schools, an elementary school-based program which helps children manage their asthma. Another program is A is for Asthma, a bilingual, multi-media program that builds awareness of childhood asthma in preschoolers, their families, health and child-care providers. The American Lung Association of Georgia also offers Asthma 101, a one-hour program designed to present basic asthma education for K-12 faculty, staff, and parent groups.
Breathe Georgia
www.breathegeorgia.org 404-885-9789
Breathe Georgia is a physician-driven, not-for-profit organization whose mission is to educate healthcare providers and the public about the appropriate diagnosis and treatment of childhood asthma. Breathe Georgia is a statewide educational program.
Children's Healthcare of Atlanta
www.choa.org 404-256-5252
The Children's Healthcare of Atlanta Asthma Center for Education provides education for asthma patients. Several education programs are offered, each designed for patients of differing age and developmental levels. Patients and families can learn about basic asthma principles, such as triggers identification, early warning signs and signs of distress. The Asthma Center of Education provides instruction on the correct use of equipment, such as a nebulizer, metered dose inhaler, and peak flow meter. The Center's team includes physicians, pediatric nurse practitioners, nurses and respiratory therapists.

Camp Breathe Easy
www.alaga.com 770-434-5864
Camp Breathe Easy is a week-long, sleep-over camp held in June for children who are 7-13 years old and have severe asthma and require daily medications. The goal is to promote self-confidence and self-management of a chronic disease through education while enjoying traditional camp activities. The American Lung Association also offers summer day camp programs with similar goals for children in Albany, Augusta and Columbus.
Camp Easy Air
www.archbold.org 229-228-8053
Sponsored by Archbold Memorial Hospital, Camp Easy Air is a week-long day camp held in June for children with asthma who are 8-12 years old. This camp provides many recreational activities, including swimming and basketball. Additionally, it provides information about how children with asthma can maintain an active lifestyle.
Clean Air Campaign
www.cleanaircampaign.com 1-877-CLEANAIR
The Clean Air Campaign is a not-for-profit organization formed in 1996 that works to reduce traffic congestion and improve air quality by facilitating voluntary changes in driving and other actions related to smog formation. The mission of The Clean Air Campaign is to motivate Georgians to take action to improve air quality and reduce traffic congestion. As part of its role as the region's clearinghouse for information and solutions to air pollution and traffic congestion, The Clean Air Campaign offers employers free assistance in the design and implementation of commute options and other smogreducing programs. Other services include a children's education program, distribution of Smog Alert notifications, air quality education through speaker's bureau, public relations and community outreach, and financial incentives to promote alternative commuting behavior. The Clean Air Campaign provides year-round monitoring of air quality levels in metro Atlanta.

25 Strategic Plan for Addressing Asthma in Georgia

R E S O U R C E S I N G E O R G I A (continued)

DeKalb County Board of Health
www.dekalbhealth.net
The DeKalb County Board of Health seeks the highest possible health status for the people who live, work, and play in DeKalb County. The health of the community is influenced, indeed determined, by the conditions that contribute to health. It is the individual and collective responsibility of DeKalb residents to help create positive health conditions. The Board of Health par tners with the community to work toward our mission of promoting and providing quality preventive and primary care. The prevention of disease, injury, disability and premature death is the primary purpose of the Board of Health.
Environmental Protection Agency
www.epa.gov/iaq/asthma/iedasthmaprog.html 404-562-9900
Environmental Protection Agency's Indoor Environments Division has launched a national public education and prevention program in response to the asthma epidemic in the United States. The goal of the outreach program is to raise public awareness of indoor environmental asthma triggers (e.g., secondhand smoke, dust mites, mold, pet dander, and cockroaches) and actions that can be taken to reduce children's exposure to them in homes, schools and child care settings. The EPA is working to insure that environmental management is fully incorporated into all asthma education and disease management programs.
Fulton County Department of Health and Wellness
www.myfultoncountyga.com/departments/health.html 404-730-1211
The mission of the Department of Health and Wellness is to protect and promote the health of all the people of Fulton County and to assure the conditions under which people can be healthy. In addition to operating 13 health centers in Fulton County, the Department plans for facility improvements, ensures community awareness of healthrelated illness through health education and promotion, disseminates public information, and works with other departments to respond to health emergencies.

Georgia Association of School Nurses
www.gasn.org 770-732-5884
The Georgia Association of School Nurses (GASN) was organized in 1991 to unite school nurses committed to providing quality health care services to children. GASN remains dedicated to promoting excellence in school health through its continuedadvocacy and education programs. The mission of GASN is to promote the development of professional school nurses and improve the quality of health education and health services provided to students with the ultimate result being the enhancement of educational achievement.
Georgia Hospital Association
www.gha.org 770-249-4500
The Georgia Hospital Association is a non-profit trade association made up of member hospitals and individuals in administrative and decision-making positions within those institutions. Founded in 1929, GHA serves approximately 190 hospitals in Georgia. The purpose of GHA is to promote the health and welfare of the public through the development of better hospital care for all of Georgia's citizens. GHA members are committed to improving institutional health care services and, in turn, patient care. The association provides information and education on issues ranging from access to health care and clinical care updates, to effective hospital management and compliance with high-level accreditation standards.
Georgia Medical Care Foundation
www.gmcf.org 404-982-0411
Georgia Medical Care Foundation provides a wide range of healthcare related services we provide that include the Medicare Quality Improvement Initiatives in Georgia. The Foundation has a membership of over 1,700 actively practicing Georgia physicians, located throughout the state, who represent all specialties and all settings. They respond to more than 250,000 consumer inquiries and routinely handle more than 100,000 recertification reviews a year.

Strategic Plan for Addressing Asthma in Georgia 26

R E S O U R C E S I N G E O R G I A (continued)

Georgia Thoracic Society
www.thoracicga.org 770-434-5864
The Georgia Thoracic Society is a professional and scientific society whose members are devoted to the discovery, dissemination, and application of new knowledge of the respiratory system. The long-range objective of the Society is to prevent and diminish death and disability from diseases of the lungs and respiratory system.
Grady Health System
www.gradyhealthsystem.org 404-616-4307
The Grady Health System is a comprehensive health services delivery system whose goal is to provide high quality, cost-effective, and customer-focused healthcare to residents of metropolitan Atlanta and citizens of the state of Georgia. The Grady Health System is committed to offering medical services to the underserved in a compassionate, respectful and dignified manner.
Medical Association of Georgia
www.mag.org 404-876-7535 The mission of the Medical Association of Georgia is to enhance patient care and the health of the public by advancing the art and science of medicine and by representing physicians and patients in policy-making processes.
National Center for Primary Care
www.msm.edu/ncpc/ncpc.htm 404-756-5740
The National Center for Primary Care is an organization which encourages doctors to pursue primary care careers, works to make primary care practice more effective, and supports primary care professionals serving in underser ved areas. The NCPC team provides training for primary care practitioners, conducts practice-based research to improve health outcomes, creates protocols and tools for improving primary care effectiveness, and undertakes policy analyses focused on how to make primary care more accessible and more effective.

Southeast Pediatric Environmental Health Specialty Unit
www.sph.emory.edu/PEHSU 770-956-9636
The Southeast Pediatric Environmental Health Specialty Unit is an established resource for pediatricians, healthcare providers, agencies, and the general public. PEHSU is the region's most comprehensive source of information and referrals on children's environmental health. The goal of PEHSU is to improve the health of children by reducing environmental health hazards and improving access to expertise in pediatric environmental medicine. The Unit also works to inform families, communities, agencies, and healthcare providers regarding environmental hazards, their effects, and practical ways to protect children's health.

27 Strategic Plan for Addressing Asthma in Georgia

RELATED WEB SITES

Allergy and Asthma Network/Mothers of Asthmatics, Inc. www.aanma.org
American Academy of Allergy, Asthma and Immunology www.aaaai.org
American Academy of Pediatrics www.aap.org
American Cancer Society www.cancer.org
American College of Emergency Physicians www.acep.org
American College of Physicians www.acponline.org
American Heart Association www.americanheart.org
American Lung Association www.lungusa.org
Asthma and Allergy Foundation of America www.aafa.org
Asthma and Allergy Foundation of America www.aafa.org/asthmaandallergyinformation
Asthma and Schools www.asthmaandschools.org
Asthma Moms www.asthmamoms.com
Centers for Medicare and Medicaid Services www.cms.hhs.gov
Centers for Disease Control and Prevention www.cdc.gov/nceh/airpollution/asthma/default.htm
Children's Healthcare of Atlanta www.choa.org/library/conditions/asthma.shtml

Children's Hospitals and Clinics www.childrenshc.org
Clean Air Campaign www.cleanaircampaign.com
Department of Housing and Urban Development www.hud.gov
Environmental Protection Agency www.epa.gov/iaq/asthma
Healthfinder www.healthfinder.gov
Healthy Learners Asthma Initiative www.healthylearners.org
Institute of Inspection, Cleaning and Restoration www.iicrc.org
Mayo Clinic Allergy and Asthma Center www.mayohealth.org
National Jewish Medical and Research Center www.nationaljewish.org
No Attacks www.noattacks.org
Rebuild America www.eren.doe.gov/buildings/rebuild
Smoke-Free Coalition www.smokefreecoalition.org
The ABCs of Secondhand Smoke: A Training Module for Child Care Providers www.nsc.org/ehc/chldhlth.htm
The National Institutes of Health National Heart, Lung, and Blood Institute www.nhlbi.nih.gov/nhlbi/nhlbi.htm

Strategic Plan for Addressing Asthma in Georgia 28

GLOSSARY

Action plan A written plan which specifies when to increase medications, when to see a doctor, or when to go to the hospital.
Acute Brief; usually implies relatively high intensity.
Airway reactivity The constriction of the airways after exposure to irritants or triggers. Also called airway hyperresponsiveness.
Allergies An exaggerated reaction of the immune system to substances that, in the majority of people, cause no symptoms. Allgergies are caused by food, chemicals, dust, pollen, or other substances.
Asthma attack Asthma symptoms which get worse either suddenly or over a short period of time.
Breathlessness A sensation of not being able to breathe. One of the main symptoms of asthma. Described as 'gasping for breath', 'feeling suffocated' or 'feeling strangled'.
Bronchospasm The tightening of muscle in the airways that leads to narrowing of the airways. Associated with an asthma attack.
Bronchodilator Medication which relieves and helps prevent constriction of airways in the lungs. There are two types of bronchodilators. Fast-acting bronchodilators are used to help relieve sudden asthma symptoms. Long-acting bronchodilators are used to prevent the airways from narrowing in the first place.
Chronic illness A condition which is long-lasting and which needs to be managed on a long-term basis. Asthma is an example of a chronic illness.
Corticosteroid A medication which reduces the swelling in airways, making it easier to breathe. Takes longer to work than a bronchodilator. Corticosteriods are also called steroids, though they should not be confused with anabolic steroids that people use to increase muscle mass.

Dander Very small flakes of skin from pets such as dogs or cats. Dander is a common trigger for people with asthma.
Dust mites Very tiny creatures which live in the dust in people's homes. They are present both in visible dust (under the bed or behind the couch, for example) and in items such as pillows, mattresses, blankets, and stuffed animals.
Exercise-induced asthma Asthma symptoms which are caused or worsened by exercise.
Extrinsic asthma Asthma symptoms which are triggered by one or more external factors such as pollen or dust. Extrinsic asthma is more common in people who develop asthma in childhood.
Fast-acting inhaler Asthma medication which helps provide immediate relief of sudden asthma symptoms such as wheezing, chest tightness, and shortness of breath. Also known as a rescue or quick-relief medication.
Home monitoring A continual process of testing how open your airways are; involves using a peak flow meter.
Inflammation Swelling of tissues. As it pertains to asthma, this swelling occurs in the airways, making them narrower. This narrowing leads to difficulty with breathing.
Intrinsic asthma Asthma symptoms which are not triggered by external factors. Also known non-allergic asthma. Intrinsic asthma is more common in people who develop asthma for the first time in adulthood.
Mold A type of fungus. Mold is a common trigger for people with asthma.
Mucus A thick substance produced by cells. Cells which line the airways produce more mucus when the airways are inflamed. Mucus can contribute to the narrowing of the airways and make asthma symptoms worse.

29 Strategic Plan for Addressing Asthma in Georgia

G L O S S A RY (continued)

Nebulizer A machine which breaks up a liquid form of asthma medication into a fine mist which is inhaled through a mask or mouthpiece.
Preventers Medications which are taken over a long period of time to reduce the number and severity of attacks.
Relievers Medications which relax the muscles around the airways; used to treat asthma symptoms.
Self-management plan A plan which provides guidance on how to manage asthma; usually created in collaboration with a medical professional.
Spacer A chamber which fits on to the end of an aerosol inhaler. Spacers come in different shapes and sizes, some with masks and others with mouthpieces. A spacer increases the amount of medication which reaches the lungs and helps reduce the risk of side effects.
Spirometer An instrument used to measure amount of air that is exhaled; similar to a peak flow meter. Can be used as a tool to diagnose asthma.
Steroid A strong, anti-inflammatory drug used to control asthma.
Support group A group of people all sharing a certain problem or concern (such as having asthma, or having a child with asthma) who meet to discuss how they are dealing with it. Support groups provide emotional support by decreasing a person's sense of isolation and can also provide practical advice, since other members of the group have experience confronting similar challenges.
Symptoms of asthma Asthma has five main symptoms: coughing, wheezing, chest tightness, shortness of breath, and mucus production.

Trigger Anything which causes or worsens the symptoms of asthma. Most people with asthma have more than one trigger. Examples of common triggers are pollen, exercise, dust mites, and upper respiratory infections.
Wheeze A whistling sound that is made during an asthma attack. Produced when air passes through constricted airways.

Strategic Plan for Addressing Asthma in Georgia 30

NOTES

Effectively deliver compassionate, innovative, and accountable services to individuals, families and communities.
Mission of the Georgia Department of Human Resources Promote and protect the health of people in Georgia.
Mission of the Division of Public Health Encourage Georgians to achieve healthy lifestyles, create healthful environments, and prevent chronic disease, disability, and premature death.
Mission of the Chronic Disease Prevention and Health Promotion Branch
This publication was supported by Grant/Cooperative Agreement Number U59/CCU420871 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. Further information about this plan may be obtained by contacting: Georgia Addressing Asthma from a State Perspective Program 2 Peachtree Street NW, Suite 16.472 Atlanta, GA 30303-3142 Phone: 404-657-6638 Fax: 404-657-6631 E-mail: healthmatters@dhr.state.ga.us Webpage: http://health.state.ga.us Printed November 2004

DR
GEORGIA
DEPARTMENT OF
HUMAN RESOURCES