National Asthma Education and Prevention Program

PROGRAM DESCRIPTION

Purpose

The National Asthma Education and Prevention Program (NAEPP) was initiated in March 1989 to address the growing problem of asthma in the United States. The goals of the NAEPP are to:

Raise awareness of patients, health professionals, and the public that asthma is a serious chronic disease.
Ensure the recognition of the symptoms of asthma by patients, families, and the public and the appropriate diagnosis by health professionals.
Ensure effective control of asthma by encouraging a partnership among patients, physicians, and other health professionals through modern treatment and education programs.

To accomplish these broad program goals, the NAEPP works with intermediaries including major medical associations, voluntary health organizations, and community programs to educate patients, health professionals, and the public. The ultimate goal of the NAEPP is to enhance the quality of life for patients with asthma and decrease asthma-related morbidity and mortality.

Background

Asthma is a major public health problem in the United States. The disease affects approximately 15 million people, nearly 5 million of whom are under the age of 18. People with asthma experience well over 100 million days of restricted activity annually, and the total annual costs of the disease are estimated at $11.3 billion.

Although asthma mortality in the United States is among the lowest in the world, approximately 5,000 asthma-related deaths still occur each year in this country. Moreover, the asthma mortality rate has risen over the past 20 years or so, especially in African Americans and individuals age 85 and older. This increase is of particular concern because it comes at a time when mortality rates from most natural causes in the United States are on the decline.

Rising asthma prevalence, especially among children, is another cause for concern. Between 1980 and 1994, the prevalence of asthma in the United States increased 75 percent overall and 74 percent among those between the ages of 5 and 14. It is estimated that more than 7 percent of children now have the disease.

Also disturbing are the number and rate of asthma-related hospitalizations in this country. In 1994, 466,000 hospitalizations were directly related to the disease. The hospitalization rates since 1979 have increased disproportionately among children and African Americans. The rate of hospitalizations among African Americans was nearly triple that of whites in 1993-1994.

Percent Increase in Asthma Prevalence, Death, and Hospitalization Rates: Prevalence Rate: 75% Increase; Death Rate: 56% Increase; Hospitalization Rates; Total Population: 3% Increase; Children, 0-4 years: 45% Increase; Children, 5-14 years: 13% Increase; African Americans: 37% Increase

The reasons for the increases in morbidity seen with asthma are not clear. However, certain factors indicate that many asthma-related hospitalizations and deaths are preventable. For example, the patient may fail to avoid environmental factors that make asthma worse, recognize early warning signs of worsening asthma, appreciate the severity of an exacerbation, take appropriate medication, or get prompt medical help when problems occur. The clinician may fail to diagnose asthma, initiate appropriate therapy, adequately monitor the patient's condition, recognize serious exacerbations, or educate the patient to prevent symptoms and develop a crisis plan for emergencies.

These issues indicate the need for asthma education—for both patients and health professionals. Such was the conclusion at a 1988 NHLBI-sponsored workshop titled “Asthma Education: A National Strategy,” which involved representatives for a number of lay and professional organizations interested in asthma. The recommendations made at this workshop, combined with the results of research demonstrating the benefits of asthma education on disease outcome, became the impetus for the development of the NAEPP and helped define the program's objectives.

NAEPP Objectives

For Patients and the Public

Increase public awareness of asthma as a significant public health problem.
Increase public awareness of the signs and symptoms of asthma
Improve the knowledge, attitudes, and skills of patients regarding the detection, treatment, and control of asthma, particularly in high-risk populations.
Define guidelines for effective asthma education programs.
Promote development, dissemination, and use of patient and family education materials.

For Health Professionals

Increase knowledge, attitudes, and skills of all health professionals regarding signs, symptoms, and management strategies for asthma.
Encourage health professionals treating patients with asthma to adequately track and monitor patient status and to use objective measures of lung function.
Assist and encourage health professional schools and continuing education programs to include up-to-date and accurate information on diagnosis, pathogenesis, and treatment of patients with asthma.
Promote and encourage the concept of active patient participation with the physician in the management of asthma.
Develop resources and materials for use by health professionals.
Promote research to answer unresolved questions about underlying causes of asthma and appropriate asthma treatment and management practices.

Program Achievements

Since 1989, when the NAEPP began, much has been accomplished to meet the program's objectives. The first significant achievement was the development and wide distribution of the “Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma.” This report changed common perceptions about asthma and its treatment by emphasizing the role of inflammation in disease development, noting the importance of objective monitoring of lung function, and stressing the need for establishing partnerships between patients and health care providers through patient education.

Hundreds of thousands of copies of the report have since been distributed to physicians, medical schools, and other health professionals and organizations, as well as to patients with asthma. In 1992, the NAEPP sponsored the First National Conference on Asthma Management to encourage implementation of the recommendations in the report. The guidelines continue to be promoted at national health and medical association meetings and in a variety of journals.

A number of companion documents also have been developed for health professionals and patients. A practical guide with patient handouts was produced to facilitate patient education by clinicians. An easy-to-read booklet instructs patients how to control their asthma in collaboration with their health care providers. Separate guides have been prepared for emergency department personnel, pharmacists, and nurses. Specialized reports on asthma in pregnancy and asthma in the elderly were also developed. These materials and others are continually distributed through the NHLBI Information Network and a variety of other channels.

In 1997, an updated version of the guidelines was released. It builds upon the recommendations in the original report and, based on more recent scientific findings, adds recommendations for clinicians and patients about such important issues as the appropriate medications for controlling asthma and for relieving asthma symptoms, the use of allergy testing to identify perennial indoor allergens for some patients, the importance of reducing patient exposures to tobacco smoke, the need to treat suspected asthma in infants aggressively, and the value of using spirometry and peak flow monitoring in diagnosing and monitoring asthma.

Because children are significantly affected by asthma, a separate initiative is targeted to schools. A variety of materials have been produced not only to teach children with asthma and their parents about the disease, but also to educate school personnel about the important role they can play in children's ability to manage their disease at school.

In 1998, the NAEPP expanded its activities with intermediary organizations to focus on collaborative activities with the many community-based asthma coalitions that are growing up across the country. More than 40 local asthma coalitions were invited to a workshop in Washington in the fall to promote networking among these groups and to identify opportunities for the NAAEPP to support some of them. It is currently working to develop innovative performance-based interventions through selected local asthma coalitions to improve the way physicians manage asthma, to ensure that patients are taught effective self-management skills, and to promote programs and policies that support asthma-friendly environments.

The NAEPP also launched a Web site in December 1998 to provide a focal point through which local asthma coalitions can learn about each other's and the NAEPP's activities and exchange information. The Web site also provides virtually all the scientific literature on chronic asthma that has ever been published for physicians who want to provide the most up-to-date diagnostic and treatment methods for their asthma patients. It is located at .

Complementing all of these efforts has been a number of media campaigns to promote asthma awareness among the general public and to encourage undiagnosed patients to seek care. These messages have been targeted to African Americans and to Hispanics, who are at increased risk of asthma-related hospitalizations and deaths.

In addition to conducting asthma education and prevention activities, the NAEPP also contracts with other organizations to develop educational programs for minority populations.

NAEPP Coordinating Committee

Key to the success of the NAEPP is the participation of representatives from the major scientific, professional, governmental, and voluntary organizations interested in asthma. Members of the NAEPP Coordinating Committee not only provide input on program strategies and materials development, but also implement many activities through their organizations.

Member Organizations of the NAEPP Coordinating Committee

Allergy and Asthma Network/Mothers of Asthmatics, Inc.
American Academy of Allergy, Asthma, and Immunology
American Academy of Family Physicians
American Academy of Pediatrics
American Academy of Physician Assistants
American Association for Respiratory Care
American Association of Occupational Health Nurses
American College of Allergy, Asthma and Immunology
American College of Chest Physicians
American College of Emergency Physicians
American Lung Association
American Medical Association
American Nurses Association
American Pharmaceutical Association
American Public Health Association
American School Health Association
American Society of Health-System Pharmacists
American Thoracic Society
Association of State and Territorial Directors of Public Health Education
Asthma and Allergy Foundation of America
National Association of School Nurses
National Black Nurses' Association, Inc.
National Medical Association
Society for Academic Emergency Medicine
Society for Public Health Education

Federal Agencies

Agency for Healthcare Research and Quality
National Center for Chronic Disease Prevention
National Center for Environmental Health
National Center for Health Statistics
National Heart, Lung, and Blood Institute
NHLBI Ad Hoc Committee on Minority Populations
National Institute for Occupational Safety and Health
National Institute of Allergy and Infectious Diseases
National Institute of Environmental Health Sciences
U.S. Department of Education
U.S. Environment Protection Agency
U.S. Food and Drug Administration
U.S. Public Health Service

Additional Representatives to the NAEPP School Asthma Subcommittee

American Association for Physical and Health Education, Recreation, and Dance
National Association of Elementary School Principals
National Education Association Health Information Network
National School Boards Association

For more information on the NAEPP, contact:

National Asthma Education and Prevention Program
NHLBI Health Information Network
P.O. Box 30105
Bethesda, Maryland 20824-0105
(301) 592-8573 phone
(301) 592-8563 fax
www.nhlbi.nih.gov