What is Asthma?
Asthma is a chronic respiratory illness. It is the most common chronic disease among children. Asthma causes repeated episodes of wheezing, breathlessness, and coughing, especially coughing in the night or early morning. There is no cure for asthma, but asthma attacks can be prevented by properly using medication and avoiding environmental triggers.
Effect of Asthma
Nearly 12% of the adult American population has asthma1. In 2002, asthma affected 25 million adults in the U.S, and 16 million reported having an asthma attack within the past year. In Montana, nearly 15% of the adult population has asthma. This corresponds to 130,000 adults with asthma in Montana. Of further concern, 80,000 adult Montanans (8.9%) reported having an asthma attack in the previous year1. Asthma is also prevalent among children, and is the most common chronic disease in childhood. More women than men report having asthma, and asthma rates tend to be higher in Native American populations than among the white population.
Asthma and Environmental Health
No one knows what causes asthma, but certain items in the environment can trigger asthma attacks. Second hand smoke, outdoor air pollution (including forest fires), mold, and cold weather have all been associated with asthma attacks.
Adapted from CDC's Basic Asthma Facts
1. 2002 Behavioral Risk Factor Surveillance Survey. www.cdc.gov/brfss
Related Links
American Academy of Allergy, Asthma, and Immunology
http://www.aaaai.org/
Asthma and Allergy Foundation of America
http://www.aafa.org
EPA - Asthma and Indoor Environments
http://www.epa.gov/asthma/index.html
CDC - National Asthma Control Program
http://www.cdc.gov/nceh/airpollution/asthma/default.htm
National Safety Council Asthma fact sheet
http://www.nsc.org/library/facts/asthma.htm
Montana Asthma Partner Activity Guide
(updated 3/30/04)
The EPHT project has become aware of many activities and interested parties working on asthma issues across the state. Below is a guide to some activities in Montana that were reported to us. We hope that this guide serves as a resource to connect interested parties doing similar work. If you would like to add information to this page please send information to: epht@state.mt.us
State of Montana Office of Public Instruction
The Office of Public Instruction has convened a Special Health Care Needs Advisory Committee for the purposes of providing recommendations regarding in-school care of students with chronic or special health care needs. The goal is to have a technical assistance document ready for distribution to schools by the fall of 2004 which will provide guidance, including sample health care plans, for diseases such as asthma and diabetes.
For more information, contact Cathy Kendall
Phone: (406) 444-0829
Email: cakendall@state.mt.us .
Missoula City-County Health Department
Missoula City-County Health Department has continued to identify the children with asthma in the community through referrals from WIC, homeless shelters, schools, and just by asking the question when other health issues are being addressed on home visits.
The RAP program materials are currently being used by Public Health Nurses in home visits and PHN's find the information very helpful and easy to use for families.
MCCHD also has been working with the Junior Pharmacy students from U of Montana school of Pharmacy. U of M students have developed a teaching module for 3 rd graders in the public school system that addresses the risks of asthma and the physiology of the disease. The Pharmacy students have received great evaluations in this partnership with schools.
For more information, contact Carol Regel
Phone: (406) 258-4293
Email: regelc@ho.missoula.mt.us
University of Montana, Center for Environmental Health Sciences
Pilot linking project
Environmental Public Health Tracking is the ongoing collection, integration, analysis and interpretation of data about environmental hazards, exposure to environmental hazards, and human health effects potentially related to exposure to environmental hazards. As part of the CDC planning and capacity building cooperative agreement with Montana DPHHS, the University of Montana's Center for Environmental Health Sciences will conduct a pilot linking project. The pilot project will explore linkages between existing health data from health care providers and ambient air monitoring data in three western Montana counties. Specifically, this study will examine the association of acute and chronic particulate matter (PM) exposure levels to the occurrence of hospitalizations, emergency visits, and clinic/outpatient visits for respiratory and cardiovascular disease.
Asthma Prevalence Study in Montana Health Planning Region 5
UM's Center for Environmental Health Sciences sponsored a telephone survey of residents in a multi-county area of western Montana to assess the prevalence of asthma. The survey included a two-stage sampling procedure, a brief screening instrument, and a detailed health questionnaire. Researchers are currently analyzing data collected from over 2,700 interviews with residents of Flathead, Lake, Lincoln, Mineral, Missoula, Ravalli, and Sanders counties. The intensive interview process was designed to collect information relating to numerous factors such as seasonality, medication use, symptom severity, and exacerbations due to wildfire events.
Laboratory-based research on asthma
Respiratory and immunotoxicology research is a major focus at the UM Center for Environmental Health Sciences. A team of investigators led by CEHS director Andrij Holian is conducting research on the mechanisms involved in chronic lung inflammation and immune system response to substances such as fine particulate matter and man made nanoparticles. This laboratory-based research program complements projects 1 and 2 shown above. Model systems of the role of regulatory T cells in inflammation are being applied to the development of immunotherapeutic approaches for the treatment of allergic disease in addition to lung fibrosis and mesothelioma.
Air and pollen sampling studies
CEHS has initiated a series of community-based studies and educational projects to better understand how local air quality and seasonal aeroallergen fluctuations influence human health.
- In an innovative science education partnership, CEHS and area high schools will conduct a real-world atmospheric chemistry research project focusing on certain air toxics (VOCs and SVOCs) present in both indoor and outdoor environments and their potential relationship with respiratory problems such as asthma.
- Bioaerosol sampling equipment installed by CEHS investigators will permit analysis of pollen and fungal aerobiology as a component of airborne particulate matter monitoring in the Missoula Valley
Source apportionment study in Libby, Montana
Libby's outdoor air quality has elevated levels of fine particulate matter less than 2.5 microns in diameter (PM 2.5 ). In fact, it is the only place in the western US outside of California that exceeds the annual PM 2.5 National Ambient Air Quality Standards. The Montana Department of Environmental Quality is sponsoring a CEHS study to identify sources of PM 2.5 by collecting air samples every six days over a four-month period during the winter of 2003-4. A chemical mass balance model to apportion sources of PM 2.5 will be applied to the data collected in this monitoring project.
For more information, contact Diana Vanek
Phone: (406) 243-4030
Email: dvanek@selway.umt.edu
Environmental Protection Agency, Region 8
EPA Region 8's Asthma Program
EPA Region 8's Asthma Program partners with sister federal agencies, state and local governments, and community groups to provide education and outreach to the public on environmental triggers of asthma, their mitigation, and steps to improve indoor air quality. For more information please visit Region 8's website at: http://www.epa.gov/region08/air/iaq/asthma/asthma.html
EPA also has numerous publications concerning asthma, second hand smoke, mold and moisture, and indoor air quality that can be accessed or ordered on line. Please visit the website at: http://www.epa.gov/iaq/pubs/index.html
The asthma program also offers opportunities for funding of regional asthma projects through grants and assistance agreements that are awarded on a competitive process. For more details on EPA Region 8's grants program please visit the website at: http://www.epa.gov/region08/community_resources/grants/grants.htm
Currently in Montana, Region 8 is working with the American Lung Association of the Northern Rockies to provide an integrated and expanded outreach of asthma education through such programs as Open Airways and public asthma awareness events (World Asthma Day). Much of this year's work will center on expanding services to low-income families, Native Americans, and children.
Region 8 has also been working closely with Indian Health Services at Ft Peck and recently signed an interagency agreement to assist with the Ft. Peck asthma clinic. This agreement is part of a larger EPA Region 8 asthma project called the Tribal Effective Asthma Management ( TEAM ) project. It is the focus of the TEAM project to:
- Assist IHS in educating health providers for the tribal communities within Region 8 about asthma prevalence.
- Encourage the use of established protocol systems so prevalence and patient education can be monitored.
- Develop a tribal capacity to raise awareness of asthma, its triggers, and how to effectively manage the disease.
For further information on the TEAM or other EPA Region 8 asthma activities contact Erin Collard
Phone: (303) 312-6361
Email: collard.erin@epa.gov
Montana's Pediatric Pulmonologist
Dr. Eichner is the only pediatric pulmonologist practicing in Montana. He cares for pediatric (and some adult) patients with asthma in the capacity as their asthma doctor, and as a consultant to their primary care physician. His practice is primarily located at the Great Falls Clinic, but has monthly clinics in Billings, Missoula, Helena and Havre.
Besides patient consultations and care, Dr. Eichner conducts pulmonary function testing, allergy testing, allergy desensitization, and provides asthma and allergy education at all levels. This includes basic information on asthma physiology, treatment, prevention, monitoring and treatment.
For more information, contact Dr. Eichner
Phone: (406) 454-2171
Email: Jerrold.Eichner@gfclinic.com
Healthy Child Care Montana
Healthy Child Care Montana is currently involved in the following asthma activities.
"An Orientation Manual for Child Care Health Consultants": a guide for public health child care consultants to familiarize them with this role and suggest policies and best practice in child care settings. This manual addresses health and safety issues in child care at a deeper level than the Montana Rules & Regulations for Child Care, but is not as comprehensive as "Caring for Our Children." It contains materials on Asthma and an Asthma Action Plan.
A two hour approved training on Childhood Asthma has been developed by Shelly Meyer, RN, for use in training child care providers about what asthma is, the triggers for asthma, the treatment options for asthma, and responding to asthma in the child care environment. Since it has been approved through the Career Development system, it can be offered by registered trainers anywhere in the state.
For more information, contact Shelly Meyer
Phone: (406) 258-4291
Email: meyers@ho.missoula.mt.us
Montana State University, Bozeman, MT
Montana State University Extension Service Housing Program is currently directing and coordinating a culturally specific asthma education program for reservation-based Native American adults and children. The title of the program is Native AIR (Asthma Intervention & Reduction).
The goals and objectives of this project focus on helping children understand asthma triggers and take action to prevent and/or control asthma. Children, on each of the seven reservations in Montana, will be provided a packet of asthma educational materials (logo-imprinted backpacks, patches, pencils, activity worksheets, etc.), in which children with their parents will assess their home for asthma triggers and opportunities to prevent and control the triggers. To assure asthma triggers are kept in check, children will be also be provided with a fun-to-complete journal to develop an asthma-reduction action plan and to record all daily aspects of their progress.
For more information about this project, contact Barbara Allen
Phone: (406) 994-3531
Email: blallen@montana.edu
Montana Department of Public Health and Human Services Childhood Asthma Program
Montana's Childhood Asthma Program is located in the Child and Community Health Bureau of the Department of Public Health and Human Services. This program promotes community awareness about the serious, increasing problem of asthma in children through education and outreach to public health nurses and other public health professionals, school nurses, and day care providers.
Adults in Montana have the same reported asthma prevalence as the rest of the U.S., but there was no information on asthma prevalence among Montana's children. DPHHS conducted a survey in 2002 to establish a baseline asthma prevalence in children 2 through 17 years of age in three community health centers in Montana for the time period of June 1, 2000 to May 31, 2002. Pediatric asthma prevalence in the 3 centers combined was 5.0% and varied from 3.9% to 6.0% among the health centers. Asthma prevalence varied according to ethnicity, with African Americans (23.5%; 95% confidence interval (CI), 6.8%-49.9%) and Native Americans (12.1%; 95% CI, 6.9%-21.5%) having a higher prevalence than Caucasians (4.9%; 95% CI, 4.2%-5.5%) while Hispanics had a similar prevalence (4.1 %; 95% CI, 0.8%-11.5%). There was no difference in prevalence based on gender or age.
A brochure titled "Asthma and Child Care: What You Need to Know" was developed and distributed to approximately 2,500 child care providers through their annual enrollment packets. This brochure remains available for distribution on an as needed basis.
Working in collaboration with the Montana Medicaid program, a case management program for Medicaid children with asthma was developed and implemented in 5 counties who provided Targeted Case Management services. Called "Montana's RAP" (Relief from Asthma Project), a public health nurse made three visits to the home to make sure that parents and their child understood how to manage the asthma. Although "RAP" is no longer "officially" supported by DPHHS, a few counties continue to provide the services.
Additional information about the DPHHS Childhood Asthma Program may be obtained by contacting Wilda McGraw, RN
Phone: (406) 444-3394
Email: wmcgraw@state.mt.us
Little Lungs Asthma Program
St. Patrick Hospital Respiratory Therapy department offers an interactive asthma awareness program for children in the Missoula area. The purpose of the program is to teach children and the community how to:
- Recognize and manage asthma.
- Understand and avoid asthma triggers.
- Use daily medication for asthma.
For more information about the Little Lungs program, call St. Patrick Respiratory Therapy Education Department in Missoula
Phone: (406) 329-5845
Email: RespLead@saintpatrick.org
