Case+Study

Team Members: Claudine Simmons and Melinda Lopez

CASE STUDY

Executive Summary Asthma and allergies are considered to be chronic diseases that affect approximately 300 million people worldwide.This case study delves into the distribution patterns and trends of asthma specifically in the State of Florida, as it is an emerging public health concern.The prevalence of asthma within the State of Florida will be determined.Once determined, one will clearly see the reason for the concern and urgency to reduce the prevalence. The case study will specifically describe the asthma rates in Florida by providing statistical information regarding hospitalizations in Florida, as well as the amount of children and adults reported as having asthma in Florida.A breakdown in percentages of males and females with asthma, as well as the percentages of different ethnic backgrounds will also be provided. Risk factors associated with asthma include uncontrollable risks and controllable risks.Uncontrollable risks include genetics, age, gender, and ethnicity.Controllable risks include one’s choice in occupation, outdoor air pollutants, and indoor air pollutants.Each of these risks and triggers will be briefly described along with associated prevention strategies and life style modification options asthma sufferers can employ.If triggers are avoided, quality of life will improve. Finally, some of the available programs in Florida regarding asthma and allergy prevention and awareness will be listed and briefly described.Programs include the American Lung Association’s Asthma 101 and Open Airways, the Center’s for Disease Control and Prevention’s (CDC) National Asthma Control Program, and the Pediatric Health Care Alliance, P.A.’s Asthma Program.Each of these programs has the goal of reducing prevalence of asthma and allergies, which will ultimately lead to a decrease in the asthma and allergy rate in Florida. __Scenario__

One of the emerging public health concerns within the state of Florida is the prevalence of asthma. This can be seen through the hospitalization rate of asthma sufferers. Ms. Doe is a 37 year-old Hispanic female, who is admitted to the hospital as a result of having a severe asthma attack. The community and state program’s goal is to get to the root cause of the increase of hospitalization rates and decrease these rates. After the Doctor’s evaluation, it was determined that Ms. Doe had repeatedly been exposed to particle pollution. He recommends Ms. Doe taking the time to attend educational classes in order to prevent future attacks. Refer to the tables included in the appendix to answer the questions below.

Questions:

1. How prevalent is asthma and allergies within the state of Florida? 2. What are the risk factors and triggers associated with asthma and allergies? 3. Describe strategies for reducing the prevalence asthma and allergies?

Answers:

1. Within the state of Florida, more than 10% of the adults have reported having had asthma. Over 25,000 hospitalizations in 2002 are attributed to asthma. Of those hospitalized, the average age was 37. The average length of stay was 3.6 days, which resulted in an estimated $11,802 of hospital charges. In 2002, 232 people died of asthma in Florida. To put this into perspective, the asthma death toll for the U.S. in 2002 was 4,483 people. Asthma has also taken a toll on children. Between 2001 and 2002, a total of 97,386 children had asthma. This represents approximately 40 out of every 1,000 children, or 4% of the children attending public schools (Florida Department of Health, 2010). Both males and females attribute to 10.7% of those that suffer from asthma. Females have a rate of 11.7%, while males have a rate of 9.7%. According to the age breakdown, those 18-24 years of age account for 11.6%, those 25-34 years of age account for 11.7%, those 35-44 years of age account for 11.2%, those 45-54 years of age account for 10.4%, those 55-64 years of age account for 11.3%, and those 65 and over account for 9.1%. According to race and ethnicity, Whites account for 10.5%, Blacks account for 11.9%, Hispanics account for 10.7%, multi-racial account for 11.9%, and other races account for 9.3% (CDC, 2007).

2. Risk factors associated with asthma include controllable and uncontrollable risks. Uncontrollable risks include genetics, age, gender, and ethnicity. Genetics has been strongly associated with asthma. Those with immediate blood relatives with asthma have a higher likelihood of developing the condition. If asthma does not run in one’s family, and one develops the disease, it is attributed primarily to the environment. Asthma can affect all ages, however more than 50% of asthma sufferers are children between the ages of 2 and 17 (Badash, 2009). As far as gender is concerned, asthma is more common in boys during childhood years. Adolescent and young adult females have a greater rate of asthma. This age group exhibits boys as having higher rates of remission. Boys under the age of 12 have been found to have more severe asthma than girls, as well as higher rates of hospital admissions. After the age of 20, the rate of asthma has been found to be quite equal between men and women. However, adult females have more severe asthma than males, as well as more hospitalizations (Subbarao, Mandhane, & Sears, 2009). Ethnic background may also be a risk factor for asthma. It is found to be somewhat more frequent in Blacks and Hispanics than in Whites (Badash, 2009).

Controllable risks may also be considered triggers that may induce asthma attacks. These risks and triggers include one’s choice in occupation, outdoor air pollutants, and indoor air pollutants. Although these factors may not be completely controllable based on one’s environment, they are somewhat controllable, both by the asthma sufferer, as well as by the state.

3. Minimizing risk factors and triggers of asthma will reduce the prevalence of asthma within the state of Florida. There are several strategies the state can take to motivate and educate asthma sufferers to keep their chronic disease under control. For instance, in order to prevent outdoor air pollution as a trigger, it is beneficial to know the ozone is worse during the summer, especially afternoons and early evenings, and that particle pollution can be bad any time of the year. Particle pollution is worse when the airflow is calm. It is also bad near busy roads, during rush hour, and around factories. One should plan activities around these places and time frames. In the event one must be out, one should lower one’s activity level, so as to not breathe in as much pollution. It is also important to listen to one’s body. Thus, if symptoms arise during an outdoor activity, immediate cessation of that activity is advised. Finally, taking time to quickly view any available air quality forecast reports would alert one to the severity of the pollution, aiding in the decision to proceed or modify activities (EPA, 2010). Indoor air pollutants may be somewhat easier to control. Many preventative strategies can be implemented to reduce asthma triggers from indoor pollutants. Some of these strategies include removing pets from the house or from certain areas in the house, prohibiting smoking both indoors and near entryways or air intake systems, and utilizing fragrance-free products. Although more difficult to control, eliminating the presence of dust mites and cockroaches is also an important preventative strategy. Dust mites can be somewhat controlled through good cleaning and removal of habitat, such as putting dust covers on mattresses and removing carpet and stuffed animals. As for cockroaches, cleaning is good, but they can also live in clean houses. To control these, there should be structural seals within the house, and no food or water should ever be left out. Finally, indoor dampness and mold should be controlled through sealing the home, ensuring there are no plumbing leaks, and checking the ventilation to ensure dampness is being vented out of the house (Florida Department of Health, 2010). Finally, one’s occupational choice may also be a trigger for asthma. In cases where occupational triggers are part of the job description and duties, such as working with certain substances, fumes, vapors, or gases, one may need to modify job responsibilities. If this is not possible, asthma sufferers may have to consider removing themselves from the occupation. Implementing engineering controls, utilizing personal protective equipment, and educating employers and employees on preventative strategies can prevent some work related asthma (Washington State Department of Labor & Industries, 2010). Obviously, the asthma sufferer must take the initiative to follow these suggestions, which can be provided through State or community programs.

Programs offered by the State of Florida should include methods of monitoring health and provide services to improve the quality and expectancy of life. The programs should also include the creation of health data reports, provide preventative options, and offer educational programs about how to maintain good health (NSW, 2008). Available programs should concentrate on funding state, city, and school programs in order to monitor asthma, train healthcare workers, educate asthma sufferers along with their families, and create awareness and education regarding asthma to the public in general.

__References__

Badash, M. (2009). //Risk factors for asthma//. Retrieved July 2, 2010 from Aurora Health Care Web site: http://www.aurorahealthcare.org/yourhelath/healthgate/getcontent.asp?URLhelathgate=” 19115.html. Centers for Disease Control and Prevention (CDC). (2007). //National surveillance for asthma// //United States, 1980 – 2004 //. Retrieved July 3, 2010 from the CDC Web site: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5608a1.htm. Environmental Protection Agency (EPA). (2010). //Asthma and outdoor air pollution//. Retrieved June 9, 2010 from CDC Web site: http://www.epa.gov/airnow/health-prof/asthma_flyer?final.pdf Florida Department of Health. (2010). //Asthma Report//. Retrieved June 10, 2010 from Department of Health Web site: http://www.doh.state.fl.us/ENVIRONMENT/programs/Environmental_Public_Health_Tracking/EPHT_Asthma_Report.htm Pediatric Health Care Alliance, P.A. (2010). //Asthma Education Program Overview//. Retrieved July 20, 2010 from the Pediatric Health Care Alliance, P. A. Web site: http://www.pedialliance.com/index.cfm?action=articles&drill=subArticle&uid=0&sub=184 Subbarao, P., Mandhane, P., & Sears, M. (2009). Asthma: Epidemiology, etiology and risk factors. //Canadian Medical Association Journal//. 181(9). Washington State Department of Labor & Industries. (2010). //Asthma//. Retrieved July 10, 2010 from the Washington State Department of Labor & Industries Web site: [].

__Appendix__


 * Table 1.1 Florida Asthma Fast Facts **
 * Percentage of adults reporting having had asthma in 2007. || 10% ||
 * Asthma associated hospitalizations in 2002 || 25,000 ||
 * Average age of those hospitalized || 37 years ||
 * Average length of hospitalization || 3.6 days ||
 * Average cost of hospitalization || $11, 802 ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Amount of children with asthma between 2001 and 2002 || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">97,386 (40 out of every 1,000 children or 4% of children attending public schools) ||


 * <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Table 1.2 State of Florida Asthma Statistics **
 * **<span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Gender ** || **<span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Age ** || **<span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Race/Ethnicity ** ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Female: 11.7% || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">18-24 Years:11.6% || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">White:10.5% ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Male: 9.7% || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">25-34 Years:11.7% || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Black:11.9% ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Both Genders: 10.7% || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">35-44 Years:10.4% || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Multi-Racial:11.9% ||
 * || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">45-54 Years:11.3% || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Other Race:9.3% ||
 * || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">55-64 Years:9.1% ||  ||


 * <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Table 1.3 Risk Factors **
 * **<span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Controllable Risk Factors ** || **<span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Uncontrollable Risk Factors ** ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Choice of occupation || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Genetics ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Outdoor air pollutants || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Age ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Indoor air pollutants || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Gender ||
 * || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Ethnicity ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Table 1.4 Preventative Strategies **
 * **<span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Outdoor Air Pollution ** || **<span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Indoor Air Pollution ** || **<span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Occupation ** ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Know seasons and times of day when particle and ozone pollution are more prevalent || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Remove pets || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Modify job responsibilities which work with vapors, gases, and fumes ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Plan activities around peak pollution times. || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Prohibit smoking || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Consider changing occupations if modification of responsibility not possible ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">When outdoors lower activity levels during peak pollution times to limit exposure to pollutants || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Utilize fragrance free products || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Work site may implement engineering controls, personal protective equipment, and education regarding asthma prevention ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Cease outdoor activity if symptoms arise || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Eliminate dust mites and cockroaches ||  ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">View Air Quality Forecast Reports ||  ||   ||


 * <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Table 1.5 Available Programs for Asthma and Allergy Prevention in Florida and U.S. **
 * **<span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">American Lung Association (Asthma 101) ** || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Volunteers are trained to provide general information about asthma and allergies to educate parents, coaches and educators in the community. ||
 * **<span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">American Lung Association (Open Airways) ** || <span style="color: black; font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Program educates and empowers children through a fun and interactive approach to asthma self-management. It teaches children with asthma ages 8-11 how to detect the warning signs of asthma, avoid their triggers and make decisions about their health. ||
 * **<span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">CDC (National Asthma Control Program) ** || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Funds State, City and School Programs related to asthma awareness and prevention. ||
 * **<span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Pediatric Health Care Alliance, P.A. ** || <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 150%;">Educate parents and children on asthma and allergy prevention. ||