DefinitionPercentage of adults 18 years of age and older who responded "Yes" on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] to the questions: "Have you ever been told by a doctor, nurse, or other health professional that you had asthma?" and, if so, "Do you still have asthma?"
NumeratorWeighted number of adults (18+) who responded "Yes" on the BRFSS to the questions: "Have you ever been told by a doctor, nurse, or other health professional that you had asthma?" and, if so, "Do you still have asthma?"
DenominatorWeighted number of adults (18+) with complete and valid responses on the BRFSS to the two asthma questions, excluding those with missing, "Don't know/Not sure," or "Refused" responses.
Data Interpretation IssuesQuestions on lifetime asthma and current asthma have been asked on the Standard AK BRFSS survey continuously since 2000. Asthma questions have also appeared on the Supplemental AK BRFSS survey in 2004-2006 and 2008-2009, thereby doubling the responses for those years.
Post-stratification weights were used for Alaska prior to 2006; raking weights were used from 2007 onward. For more on this methodological change see: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/method.aspx].
Why Is This Important?In 2016, 8.9% of adults (18 years of age and older) in the United States had current asthma and 13.6% had asthma sometime during their life.^1^ In 2016, 3,518 Americans died from asthma (1.1 per 100,000).^2^ Asthma's impact on health, quality of life, and the economy is substantial.^3^ Asthma costs the United States more than $30 billion every year. The costs include the direct expenditure of treating asthma.^3^ There were 1.7 million emergency room visits in 2015 in which asthma was the primary diagnosis.^4^ [[br]]
1. U.S. Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System. Chronic health indicators: asthma, 2016. [https://www.cdc.gov/asthma/brfss/default.htm]. Accessed December 13, 2018.
2. U.S. Centers for Disease Control and Prevention (CDC). Deaths: final data for 2016. [https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_05_tables.pdf]. Published July 26, 2018. Accessed December 13, 2018.
3. U.S. Centers for Disease Control and Prevention (CDC). Asthma control: improving quality of life, and reducing deaths and costs. [http://www.cdc.gov/asthma/aag/2010/overview.html]. Accessed December 15, 2016.
4. Rui P, Kang K. National Hospital Ambulatory Medical Care Survey: 2015 Emergency Department Summary Tables. [https://www.cdc.gov/nchs/data/nhamcs/web_tables/2015_ed_web_tables.pdf]. Accessed December 13, 2018.
Healthy People Objective: Reduce activity limitations among persons with current asthmaU.S. Target: 10.2 percent
How Are We Doing?This indicator has been measured by the BRFSS since 2000. The percentage of Alaska adults who currently have asthma has increased slightly over that period, from 6.9% in 2000 to 9.2% in 2017. The occurrence of asthma at anytime during the lifetime has increased from 11.2% in 2000 to 14.3% in 2017. One-third (33.9%) of adults with current asthma said that they were limited in activities due to physical, mental, or emotional problems for the period of 2013-2017.
Since 2000, women have consistently reported higher prevalence of current asthma than men. In 2016, 13.0% of women reported currently having asthma compared to 5.7% of men. Those unable to work experienced significantly higher levels of current asthma than those who were employed (19.2% vs. 7.5%, respectively). Lower income was also associated with higher rates of current asthma.
Rates of asthma from the BRFSS are initially presented for all Alaskans and Alaska Native people. Subsequent analyses are reported by demographic subpopulations of sex, age, race/ethnicity, ethnicity, marital status, education, employment status, income, and poverty status.
Crosstabulations were also conducted for three-year averages by body mass index, current smoking, sexual orientation, disability, and number of Adverse Childhood Experiences. Significant differences occurred within each comparison.
Rates of asthma by regions of Alaska are presented for the most recent time period allowing reporting for all Alaskans and Alaska Native people: 1) single-year for the 7 Alaska Public Health Regions, 2) three-year averages by the 5 Metropolitan and Micropolitan Statistics Areas and rural remainder, 3) three-year averages for the 10 behavioral health assessment regions based upon aggregations of 20,000 population, 4) five-year averages for 29 boroughs and census areas, and 5) five-year averages for the 12 tribal health organization regions. These time intervals match those for the InstantAtlas health profiles for each of the geographic regionalizations of Alaska for those desiring longer time series.
How Do We Compare With the U.S.?Both Alaska and U.S. rates of current adult asthma were 9.1% in 2016.
What Is Being Done?The [http://www.asthmainalaska.org/coalition.php Alaska Asthma Coalition (AAC)] was established in 2003 and includes partners from the [http://dhss.alaska.gov/dph/Pages/default.aspx Alaska Division of Public Health], the [http://www.lung.org/about-us/local-associations/alaska.html American Lung Association in Alaska (ALAA)], and the [https://www.aafaalaska.com/ Asthma and Allergy Foundation of America (AAFA) Alaska Chapter], as well as asthma specialists, pediatricians, clinicians, school nurses, and environmental health experts. This partnership sponsored several statewide Asthma Summits and focused on the development of an Alaska State Asthma Plan.^5^ In 2006, an Asthma Burden Report was published by the Sections of Chronic Disease Prevention and Health Promotion and Women's, Children's, and Family Health.^6^ Coalition partners updated the Alaska Asthma plan in 2013, created a website [http://www.asthmainalaska.org/ Asthma in Alaska] to showcase new media spots and distribute new resources, including Asthma Data Improvement Recommendations 2013 prepared by McDowell Group. In 2016, two new reports were prepared by the McDowell group analyzing Emergency Department use in Mat-Su and the burden to Alaska's Medicaid System. The AAC continues to provide a variety of online trainings and public education events across the state.[[br]]
5. Alaska Asthma Coalition. Alaska asthma plan. [http://asthmainalaska.org/media/AK-Asthma-Plan-Update-2013-Final.pdf]. Published 2013. Accessed December 16, 2016.
6. Gessner B, Utermohle CJ. Asthma in Alaska: 2006 report.[http://dhss.alaska.gov/Documents/Publications/asthmaInAlaska.PDF]. Published 2006. Accessed December 16, 2016.
Evidence-based PracticesThe National Asthma Control Initiative (NACI), a program of the [https://www.nhlbi.nih.gov/about/org/naepp National Asthma Education and Prevention Program (NAEPP)], coordinated by the [https://www.nhlbi.nih.gov/ National Heart, Lung, and Blood Institute (NHLBI)], is a multi-component, mobilizing, and action-oriented initiative to engage diverse stakeholders who are concerned about or involved in improving asthma control. Its ultimate aim is to bring the asthma care that patients receive in line with evidence-based recommendations from two reports published by the NAEPP: the [https://www.nhlbi.nih.gov/health-pro/guidelines/current/asthma-guidelines Expert Panel Report 3-Guidelines for the Diagnosis and Management of Asthma (EPR-3)] and its companion [https://www.nhlbi.nih.gov/health-pro/guidelines/current/asthma-guidelines/implementation-panel-report-3 Guidelines Implementation Panel (GIP) Report-Partners Putting Guidelines Into Action]. The NACI is bringing together organizations from local, state, regional, and national levels so that they can share best practices, pool and direct resources, and identify new directions and learning opportunities.
The NACI focuses on three major efforts: [https://www.nhlbi.nih.gov/health-pro/resources/lung/naci/naci-in-action/demonstration-projects.htm NACI Demonstration Projects], the [https://www.nhlbi.nih.gov/health-pro/resources/lung/naci/naci-in-action/partners.htm NACI Strategic Partnership Program], and the [https://www.nhlbi.nih.gov/health-pro/resources/lung/naci/naci-in-action/champions.htm NACI Champions Program]. In communities across the country, these efforts are engaging health care professionals, patients and families, schools and childcare settings, professional associations, and many others to implement innovative, strategic interventions to overcome barriers to implementing clinical guidelines and reducing asthma disparities. Through such efforts, the NACI hopes to speed the adoption of these recommendations by clinicians and adherence to them by patients and their families and caregivers.
The NACI seeks to produce high-impact solutions and meaningful change in asthma control by:
[[br]]* Convening and energizing national, regional, state, and local leaders.
[[br]]* Developing a communication infrastructure for information sharing and accessing resources.
[[br]]* Mobilizing champion networks to implement and integrate clinical and community-based interventions with emphasis on sustainability.
[[br]]* Demonstrating evidence-based and best practice approaches for specific audiences in various settings with emphasis on closing the asthma disparity gap.
[[br]]* Monitoring and assessing NACI progress toward its goals by measuring outcomes and sharing lessons learned.
At the core of the NACI are six priority messages selected from the EPR-3 and detailed in the GIP Report. If practiced routinely and implemented widely, these action-oriented messages have the power to improve asthma control and transform the lives of people with asthma:
[[br]]* '''Use inhaled corticosteroids''' to control asthma.
[[br]]* '''Use written asthma action plans''' to guide patient self-management.
[[br]]* '''Assess asthma severity''' at the initial visit to determine initial treatment.
[[br]]* '''Assess and monitor asthma control''' and adjust treatment if needed.
[[br]]* '''Schedule follow-up visits''' at periodic intervals.
[[br]]* '''Control environmental exposures''' that worsen the patient's asthma.
Failure to control asthma diminishes physical, psychological, and social wellbeing and quality of life; increases health disparities, particularly among African American, Puerto Rican, and socioeconomically disadvantaged populations; and places added burden on families, schools, workplaces, and health care systems.