Augusta Asthma Control Program

Presentation to: Augusta University Respiratory Department

Presented by: Sadie Stockton
Date: February 14, 2018
Augusta Asthma Program History

BACKGROUND
• Four Asthma related Deaths reported between
September-November, 2006

– Adolescents, Ages 7-13

– 3 resided in Richmond County and 1 resided in Columbia
County
– All were African-American
– 3 Females, 1 Male
– All had history of allergies (3 had food allergies)
 Time Line
Deaths 2006:
• Case #1 September 17
• Case #2 October 6
• Case #3 October 31
• Case #4 November 15

December, 2006- January, 2007:

• School Nurses/Healthcare Providers convene meetings

January, 2007:
• CDC Conducts Investigation
 CDC Summary
• Richmond County:
 Case #1: 14 year old black male, died at home
 Care #2: 9 year old black female, died in ICU
 Case #3: 7 year old black female, died in ER

 Columbia County:
 Case #4: 13 year old black female, died in hospital in
Virginia (Patient traveled to Virginia prior to death to
attend grandmother’s funeral)
 CDC Summary Cont’
• Risk Factors at Time of Death:
 3 played outside within 12 hours prior to deaths
 1 exposed to cigarette smoke within 12 hours prior to death
 3 used jet nebulizer greater than 6 times in 24 hours prior to
death
 4 inconsistent compliance with inhaled steroids
 2 delay in seeking Medical Care
 Pollen counts were higher in September/October than in
previous 5 years
 Pets
 CDC Summary Cont’
• Risk Factors at Time of Death:
 3 played outside within 12 hours prior to deaths
 1 exposed to cigarette smoke within 12 hours prior to death
 3 used jet nebulizer greater than 6 times in 24 hours prior to
death
 4 inconsistent compliance with inhaled steroids
 2 delay in seeking Medical Care
 Pollen counts were higher in September/October than in
previous 5 years
CDC Summary Conclusions
• Underuse of inhaled steroids contributed to at least
3 of 4 deaths
• Delay in medical treatment contributed to at least 2
deaths
• At least 3 of the 4 cases were on Medicaid which
underwent insurance changes at the time the
deaths occurred
 CDC Recommendations
Public Health
• Asthma alert days when pollen counts are high and Air
Quality Index is poor
• Media Campaign discussing seriousness of asthma and
importance of controller meds/recognizing symptoms
• Formation of an asthma coalition between physicians,
asthma educators, respiratory therapist, parents, and
school nurses
 CDC Recommendations Cont’
Healthcare Providers
• Referrals to allergists/pulmonologist for high-risk
patients
• Emphasize importance of recognizing asthma symptoms
early and seek appropriate care
• Asthma action plan for every child with asthma
• Reinforcement of inhaled steroid compliance
• Care managers for children with multiple asthma
ER/hospitalizations
• Pharmacy automatic notification of PCP when patients
refill rescue medication
 CDC Recommendations Cont’
Schools
• Record whenever a child takes Metered Dose Inhaler
(MDI) or albuterol nebulizer at school Send a letter to
parents and/or PCP if child has unusual MDI/neb use
• Ensure that every known child with asthma has an
asthma action plan from PCP on file with school
• Establish a written protocol for handling asthma
emergencies what is available in all schools
• Asthma Clipboard Program for PE teachers and coaches
Public Health Development Process
• Recruit community leaders with an investment or
interest in Asthma (schools, healthcare, parents, worksites, CMOs,
faith-based)
• Facilitate one day symposium with community
leaders/partners
• Facilitate parent focus group
• With input from participants develop a five year Asthma
Community Action Plan
• Three work groups identified: School, Healthcare and
Community
 ECPHD Asthma Initiative
VISION: Asthma Community Based Initiative

GOAL: Develop a Community-Based Coalition

to improve Asthma Health Status and
asthma Patients’ Quality of Life
 Goals
• Improve the identification, diagnosis and treatment of
children with asthma
• Support patients and families in better managing the
disease
• Improve collaboration and coordination among
providers, schools, parents and community
• Identify system-wide and environmental changes that
can be implemented and sustained
 2008-2009 Accomplishments
• School Work Group:

– Richmond & Columbia Counties BOE adopted CDC Model 100%

Tobacco Free School Policies
– 100 % Tobacco Free School Signs were posted
– Richmond County BOE adopted “No Bus Idling Policy”
– School nurses receive ALA Asthma 101 Training
 2008-2009 Accomplishments
Healthcare Workgroup
• ALA Asthma 101 Training for Physicians’ staff
• Develop standardized Asthma Action Plan Format
• Request issues to hospitals to identify appropriate staff fro
asthma educator certification
• Develop list of local allergist/Immunologist and CMO Case
Managers
• Increase referrals to CMS
• CMS hire 3 Asthma Nurses
• Public Health receive $50,000 grant to pilot peer-base
community worker model program (50 families, 77 patients)
 2008-2009 Accomplishments
Community Workgroup
• Spring & Fall community event (education/screenings)
• GRU Respiratory Department received funding per Kohl’s
Department
• Developed list of available asthma resources
• 29 ALA Asthma 101 classes=529 participants
• 35 Healthcare Providers participated in Asthma Educator
Certification Course in May 2009
 Updates
• 2010 Augusta ranked #9 in The Top 10 Asthma Capitals
• 2015 Augusta ranked #6 in Challenging Cities to live with Asthma
• 2012---GA Legislators adopted “Self-administration of Asthma
Medications
• CMS Program still alive
• ECPHD received funds to implement Asthma Friendly Home
Inspection Initiative
• 2015 Augusta ranked #6 in The Most Challenging Places to Live
with Asthma
• EPI Pen