Persisting Racial Disparities Among Chicago Children with Asthma

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Background

One of the more vexing public health issues facing Chicago is the existence of significant racial/ethnic disparities in asthma. Chicago has been identified as an epicenter for asthma, with higher prevalence in minority communities on the city’s west and south sides. The 2016 Healthy Chicago Survey estimated that 216,000 adults in Chicago have asthma, with the rate among African Americans nearly 75% higher than among Whites and almost 85% greater than the rate among Hispanic adults.i The most recently available data on youth suggests that 22.3% of Chicago high school students have been diagnosed with asthma, including 15% of White students and 27% of African American students.ii 

In the absence of a comprehensive source of surveillance data for childhood asthma in Chicago, less traditional public health sources have been used to better understand the scope of the problem. For this report, we examined hospital discharge data, specifically asthma-related emergency department (ED) visits. Asthma is one of the leading causes of ED visits for children ages 0-17. 

To better understand the impact of asthma in Chicago, we looked at three types of indicators: (1) the number of pediatric asthma ED visits, over time, which we stratified by age group and race/ethnicity; (2) the rates of these visits per 10,000 population, also demographically stratified, and; (3) racial and ethnic disparities in these rates over time. The data revealed that between 2009 and 2015 the number of annual asthma-related ED visits among Chicago children declined, however, the racial and ethnic disparities in rates of visits showed only modest decreases. 

Date of Publication: May 2018

Home-Based Asthma Education and Environmental Interventions in Illinois: The Case for Sustainable Financing

Download report: RHA-SUHI-IDPH_Business Case_Asthma Care_ Final

Asthma education and environmental management are evidence-based strategies that reduce asthma-related emergency department (ED) visits and hospitalizations and reduce health care costs. Despite the economic benefits, reimbursement for these strategies tends to be lower and/or less comprehensive than other recommended asthma management approaches.

Our goal is to expand access to evidence-based, home-based asthma education and environmental interventions for Illinois residents living with asthma through sustainable financing mechanisms. While there are a number of mechanisms described in this report that are available to accomplish this, we recommend the following for immediate exploration:

 

  • Expand reimbursement for asthma educators, community health workers (CHW) and others currently outside of Illinois’ clinical licensure system;
  • Establish a Health Homes Program that incorporates asthma care best practices;
  • Apply for Section 1115 Research and Demonstration Waiver that includes home-based asthma education and environmental interventions;
  • Utilize reimbursement through existing Medicaid channels such as early and periodic screening, diagnostic, and treatment and administrative costs;
  • Amend contracts between state Medicaid and Medicaid Managed Care Organizations (MCO) to enable and provide guidance for the use of CHWs, and;

 

Encourage Medicaid MCOs to expand in-home asthma education and environmental interventions, by providing these services or reimbursing other providers.

Stock Asthma Rescue Medication in Schools

Download the Issue Brief – Stock Asthma Rescue Medication in Schools.

Stock asthma rescue medication in schools is a viable policy solution to help prevent the poor health outcomes that can result when a child experiences an asthma emergency at school, but does not have access to medication. After years of studying this critical policy gap, Respiratory Health Association (RHA) and Legal Council for Health Justice came together in 2017 to actively explore pursuing a stock asthma rescue medication policy in Illinois. In furtherance of that end, we are now proud to present this issue brief assessing the fit and feasibility of stock asthma rescue medication in Illinois schools.

This issue brief explores the burden of asthma and the asthma policy landscape in Illinois and outlines elements of stock asthma rescue medication policies and lessons learned from other states. It concludes with recommendations for adoption of a stock asthma rescue medication in schools policy for Illinois. It is our conclusion that a stock asthma rescue medication policy for Illinois schools could achieve a safer school environment for those living with asthma, and that the most appropriate framework for adoption ofsuch a policy would be via the state’s existing stockundesignated epinephrine auto-injector law in the School Code (105 ILCS 5/22-30). RHA and Legal Council for Health Justice hope this paper will serve as a useful educational tool for asthma policy stakeholders statewide to better understand the need for a stock asthma rescue medication policy and how one could be best implemented in Illinois.

Date of Publication: March 2018

Issue Brief – ACA is Good for Lung Health

Download the Issue Brief – Affordable Care Act is Good for Lung Health PDF.

 

Executive Summary

In March 2010, the Patient Protection and Affordable Care Act (ACA) was signed into law. Since that time, more than one million Illinois residents gained insurance coverage through either the Health Insurance Marketplace or the Medicaid Expansion, and the uninsured rate in Illinois has fallen by 49 percent.

With ongoing threats to the ACA from Congress, advocates are taking a close look at how its possible repeal will impact vulnerable populations, both locally and nationally, with a particular focus on the numbers who will lose their health care coverage.

With this brief, the Respiratory Health Association (RHA) focused on why a repeal of the ACA would be bad for lung health. Several provisions of the ACA have been particularly valuable to efforts to prevent and improve health outcomes for people living with asthma and other respiratory conditions; we highlight four of those:

  • Dependent Coverage for Young Adults: Reducing Asthma Emergency Room Visits
  • Medicaid Expansion: Improving Quality of Asthma Care
  • The Prevention and Public Health Fund: Supporting Tobacco Control
  • Requiring Coverage for Pre-Existing Condition: Making Treatment Affordable

Date of Publication: May 2017

 

If you have questions or would like additional information about the Affordable Care Act and lung health, please contact Erica Salem via email [email protected] or by phone (312) 628-0235.

Nebulizers

Download the Nebulizers – What You Need to Know PDF.

 

Nebulizers are small air compressors used to administer medicine. Users put a nebulizer mask on their face or use a mouthpiece to breathe in mists of air mixed with medicine. Nebulizers do not require oxygen tanks; they use the air in the room.

Who should use a nebulizer?

A health care provider may recommend a nebulizer for a variety of reasons. Nebulizers are often prescribed for infants and children who are not coordinated enough to use an inhaler. Also, the liquid vials of medicine used with nebulizers can be less expensive than purchasing the same medicine in an inhaler.

However, nebulizers are not always the best option for someone with asthma. They are not as portable as inhalers, so someone who only has a nebulizer may not have easy access to their medicine if their asthma acts up away from home. Some asthma medicines are also not available for nebulizers.

How do I use a nebulizer?

If you are prescribed a nebulizer, follow these steps carefully:

  1. Wash your hands.
  2. Open the medication cup and fill it with medication as prescribed by your health care provider.
  3. Secure the cap.
  4. Attach either a mouthpiece or mask to the end of the medication cup.
  5. Hook one end of the tubing to the medication cup and the other end to the nebulizer.
  6. If using a mouthpiece, seal lips tightly around the mouthpiece. If using a mask, place mask firmly on the face.
  7. Turn on the nebulizer. Breathe normally through the mouthpiece or mask. Continue until you no longer see the medication mist (about 10 minutes).

Care and cleaning of a nebulizer

It is very important to clean your nebulizer to prevent infections.

  • Always wash your hands prior to touching medicine.
  • After each use, remove the medication cup and rinse with warm water. Place on a paper towel and allow to air dry.
  • Once a week, clean medication cup in mild soapy water or one part vinegar and two parts water. Rinse well and place on a paper towel to air dry.
  • Replace the nebulizer cup and tubing every six months.
  • Change the filter in your nebulizer when it becomes discolored.
  • Never wash or clean the tubing because mold can grow inside.

Dry Powder Inhalers

Download the Using a Dry Power Inhaler – What You Need to Know PDF.

 

Using a Dry Powder Inhaler (DPI or Diskus®)

Dry powder inhalers (DPIs) are a type of long-term controller medicine. This type of medicine can be prescribed to help reduce the frequency of asthma symptoms. It works slowly to reduce swelling in the airways, which is an underlying cause of asthma symptoms.

Directions on how to use your dry powder inhaler:

  1. Remove all candy, food or gum from your mouth.
  2. Stand up straight.
  3. Hold the inhaler level to the floor.
  4. Open the inhaler with the mouthpiece facing you.
  5. Slide the lever away from you until you hear it click. This means the medicine has been released. Be careful not to tip the inhaler or slide the lever again; the medicine will fall out and it will be wasted.
  6. Take a deep breath in and breathe out.
  7. Place the inhaler in your mouth, seal your lips tightly around it and take a quick, deep breath in.
  8. Hold your breath for 10 seconds, and then breathe out.
  9. Rinse your mouth with water and spit water out.

Helpful tips for use:

Because this medicine is a dry powder, moisture can ruin the medicine and cause it to clump.

  • When preparing to take a dry powder inhaler, be sure not to breathe into the inhaler.
  • Do not store in the bathroom.

Metered Dose Inhalers

Download the Using a Metered Dose Inhaler – What You Need to Know PDF.

 

Metered dose inhalers (MDIs) can contain long-term controller medicine or quick-relief medicine. It is important to know which medicine your inhaler contains because the two types of medicines work on different parts of asthma.

Spacers (holding chambers)

Whenever possible, use a spacer (also known as a “holding chamber”) with your metered dose inhaler. A spacer is a plastic tube that connects to the mouthpiece of an inhaler and helps get medicine deeper into the lungs and airways.

A spacer helps direct the medicine to the airways so that each dose of medicine is more effective and less medicine is wasted.

Using a metered dose inhaler with a spacer:

  1. Remove any candy, food or gum from your mouth.
  2. Stand up straight.
  3. Remove the cap of the inhaler and attach it to the spacer. Make sure to clean out any dust or fuzz so that there is nothing inside either one.
  4. Shake the inhaler and spacer for five seconds.
  5. Take a deep breath in and breathe out slowly to empty your lungs completely.
  6. Put the spacer in your mouth and seal your lips around the mouthpiece.
  7. Press down on the inhaler and take a slow deep breath in.
  8. Hold your breath for 10 seconds and then breathe out.
  9. If using a controller medicine, rinse your mouth with water and spit water out.

Using a metered dose inhaler without a spacer:

  1. Remove any candy, food or gum from your mouth.
  2. Stand up straight.
  3. Remove the cap of the inhaler and attach it to the spacer. Make sure to clean out any dust or fuzz so that there is nothing inside either one.
  4. Shake the inhaler and spacer for five seconds.
  5. Take a deep breath in and breathe out slowly to empty your lungs completely.
  6. Place the inhaler mouthpiece inside your mouth and seal your lips tightly around the mouthpiece.
  7. Take a slow breath in, press down on the inhaler and breathe in the medicine.
  8. Hold your breath for 10 seconds and then breathe out.
  9. If using a controller medicine, rinse your mouth with water and spit water out.

Asthma Warning Signs

Download the Asthma Warning Signs – What You Need to Know PDF.

Asthma warning signs are the symptoms you feel when your airways are narrowing and your body is receiving less oxygen. Asthma warning signs are different for everyone. It is important to know your warning signs so you can take the right steps to stop the asthma episode from getting worse. Your asthma warning signs and how to respond to them are included in your Asthma Action Plan.

    LEVEL 1

Early Warning Signs

  • Shortness of breath
  • Coughing
  • Feeling tired or weak
  • Watery eyes
  • Stomachache

How to Respond

  • Move away from any triggers
  • Take your quick-relief medication
  • Monitor your warning signs

 

    LEVEL 2

More Serious Warning Signs

  • Medications are not working or do not last
  • Increase in coughing or chest tightness
  • Wheezing
  • Inability to do normal activities

How to Respond

  • Take the same steps as Level 1: move away from triggers, take quick-relief medication and monitor your warning signs
  • If signs get worse or are not better within 15 minutes of using medication, follow your Asthma Action Plan and call 911

 

    LEVEL 3

Severe Warning Signs

  • Severe shortness of breath
  • Difficulty walking or talking
  • Skin sucking in at ribs and neck
  • Paling, blue or gray lips and nail beds

How to Respond

  • Call 911! Any ONE of these symptoms needs immediate medical help
  • If you have not already, take your quick-relief medication

Preparándose para la Escuela

Descargar Preparándose para la Escuela – Lo Que Usted Necesita Saber PDF o en inglés Preparing for School with Asthma – What You Need to Know PDF,

 

Es importante prepararse con tiempo para la escuela, en especial si su hijo padece de una enfermedad crónica como el asma. En Illinois, todos aquellos niños que padecen de asma y que pueden administrarse sus medicamentos sin ayuda, tienen permitido llevar consigo en todo momento, su medicamento de alivio.

Es importante dejar que sus niños comiencen a cuidar de su asma ellos mismos al menos 6 meses antes de iniciar el kindergarten o la escuela. Esto le permitirá saber si su hijo está usando sus medicamentos correctamente antes de que comience la escuela. Seguramente cometerá errores pero es mejor que estos sucedan cuando usted esté ahí para corregirlos.

A continuación se presentan algunos consejos que harán esta transición más fácil para ambos.

  • Comience a enseñar a sus hijos a reconocer signos y síntomas de su asma.
  • Enséñeles como usar su medicamento de alivio con un espaciador.
  • Enséñeles como usar un medidor de flujo máximo (del inglés peak flow meter).
  • Asegúrese que comprendan la importancia de llevar su medicamento siempre con ellos.
  • Asegúrese que sepan qué cosas desencadenan su asma y como evitarlas en la escuela.
  • Haga que su hijo practique administrarse su medicamento enfrente de usted.
  • Asegúrese que sepan como avisarle a un adulto cuando comiencen a tener síntomas de asma.

Después de haber preparado a su hijo/a, es importante estar seguro que la escuela está preparada para recibir a él/ella.

  • Llame a la escuela y asegúrese de obtener y firmar todos los formularios requeridos por usted, de manera que su hijo pueda llevar consigo sus medicamentos.
  • Haga una cita para conocer a la enfermera de la escuela y asegúrese de explicarle cuáles son los síntomas de asma de su hijo, qué cosas pueden provocarle síntomas y qué medicamentos utiliza.
  • Proporcione a la escuela un plan de acción para el asma y póngase de acuerdo con los encargados en cuanto a los lugares en donde se mantendrá dicho plan.
  • Asegúrese que la escuela tenga todos los teléfonos de emergencia necesarios para poder contactarla a usted o a cualquier otra persona que tenga conocimiento del asma de su hijo/a.
  • Al inicio de cada año escolar, reúnase con el maestro encargado de su hijo/a para explicarle e informarle acerca del asma de su niño/a.
  • Los niños con asma tienen el derecho de estar a salvo mientras estén en la escuela. Por favor asegúrese que la escuela sepa de cualquier cambio, arreglo o ajuste que necesite realizar para que esto sea possible.

Preparing for School with Asthma

Download the Preparing for School with Asthma – What You Need to Know PDF or en español, Preparándose para la Escuela – Lo Que Usted Necesita Saber PDF.

 

If your child has asthma, it is important to start preparing for school early. All children in Illinois with asthma are allowed to carry and use their quick-relief asthma inhaler while at school, so you’ll want to make sure your child knows how to use his or her inhaler during the school day.

Begin letting your child use his or her quick-reliever at least six months before starting school. By practicing together, you can ensure your child is using the inhaler correctly and does not have your help. There will be mistakes, so it is best that you are there to correct them.

Be sure to teach your child:

  • That it is important to always keep his or her asthma medicine nearby.
  • What triggers his or her asthma and how to avoid these triggers at school.
  • How to recognize his or her asthma signs and symptoms.
  • How to tell an adult when asthma symptoms start.
  • When to use quick-reliever medicine.
  • How to use quick-reliever medicine with a spacer.

Ensure that your school has the necessary materials:

As of August 2010, in accordance with Illinois Public Act 096-1460, your child does not need a doctor’s note to carry and use a quick-relief asthma inhaler at school.

The school does need:

  • You to fill out and promptly return all required forms, including documentation of an asthma diagnosis.
  • A note signed by you explaining that your child can carry and use his or her quick-relief inhaler.
  • The prescription label off of your child’s medication box.

Make sure the school is ready for your child:

  • Call and meet with school staff to file an Individualized Health Care Plan (504 plan), a legal document that provides modifications to your child while at school.
  • Ensure that the nurse and teacher have an asthma action plan. An asthma action plan is a written document that explains your child’s asthma triggers, symptoms, medicines and actions to take during an asthma episode.
  • Provide two inhalers whenever possible. Your child should carry one with him/her, and the school staff should keep a backup.
  • Provide the school with emergency contact information so you or someone else can be reached in an emergency.