National Medical Association
Asthma and Allergy Rescue Project
Putting Guidelines Implementation Panel (GIP) Messages into Practice
---INSERT NAME HERE--– NMA Asthma Champion INSERT DATE
Objective #1: NMA Asthma and Allergy Rescue Project
The NMA Asthma and
Allergy Rescue Project Funded in part by the National
Asthma Control Initiative of the
National Heart, Lung, and
Blood Institute (NHLBI),
National Institutes of Health
(NIH).
Legacy, Mission and Values of the NMA
NMA Legacy
For over a century, the National Medical Association
has boldly shaped, “the conscience,”
as well as the art and science of medicine.
Legacy
Since its inception in 1895:

The NMA has represented 30,000 African American
physicians.

The NMA still stands as one of the original supporters of
Medicare.

The NMA has trained and retained hundreds of African
American physicians.

Most physician leaders within communities across the United
States of America, have been NMA members.
Mission
To advance the art and science of medicine for people of
African descent, through education, advocacy and health
policy, promoting health and wellness, eliminating health
disparities and sustaining physician viability.
NMA Values
The NMA has consistently held true to the following
Values:






Integrity
Empowerment
Excellence
Accountability
Commitment
Compassion
Presentation
Objectives
Objectives
At the end of the presentation, participants will
1.
Become aware of the NMA Asthma and Allergy Rescue Project
2.
Understand the impact of asthma on the African American community.
3.
Understand the importance of asthma control.
4.
Become knowledgeable about the Guidelines Implementation Panel
(GIP) six messages.
5.
Be encouraged to utilize ACT Test more.
6.
Understand measuring Albuterol usage measures control of asthma
Objective #1
NMA Asthma and
Allergy Rescue Project
Objective #1: NMA Asthma and Allergy Rescue Project
The objectives of the program are to:
1.
To develop a physician training program comprised of six minimodules and accompanying toolkit based on the six GIP messages.
The NMA will pilot the training program at regional meetings, the
NMA annual convention, and in the cities of Washington D.C., and
Detroit, Michigan.
2.
To establish a core group of NMA champions to promote the GIP
messages as being an essential part of quality asthma care. A total of
500 physicians will receive training on six GIP mini-modules and the
accompanying toolkit over the course of one year.
NMA Asthma and Allergy Rescue Project
3.
The NMA will designate an NMA National Asthma Control Initiative
(NACI) champion for each of its six regions and within 50 of the
largest local affiliates.
4.
To provide physicians who see African American patients with asthma
with training on the necessary knowledge and skills to: 1) implement
the EPR-3 clinical practice recommendations and six GIP messages;
and, 2) tailor the delivery of the educational messages to the specific
needs, literacy level, and cultural relevancies of their patients.
5.
Each of the 500 physicians receiving training will disseminate Asthma
Control Tests™ (ACTs) to their asthma patients, and office/clinic staff
will score the tests as part of routine care.
NMA Asthma and Allergy Rescue Project
6.
To incorporate one or more GIP messages into a consumer media
health education campaign called Take Control of Your Asthma. This
campaign uses local television, radio and print ads, Public Service
Announcements (PSAs) and video news releases with spokesperson to
promote use of the ACT and the NMA Website.
NMA Asthma and Allergy Rescue Project
Accomplishments to date:
Over a three month period the NMA has reached over
6,000 people through E-blasts and educated 200 health
professionals about Guidelines Implementation Panel (GIP)
messages.
Objective #2: Asthma Prevalence
Asthma Prevalence
per 1000 Population
120
100
80
White
Black
Hispanic
60
40
20
0
Males
Females
Objective #2
Asthma Prevalence
&
Asthma’s Impact on
African Americans
Objective #2: Asthma Prevalence
25 million Americans with a diagnosis of asthma in
their lifetime
4 million Americans with a current diagnosis of asthma
African American women have the highest asthma mortality
rate out of all racial groups
African-American children are three times more
likely than Caucasians to die from asthma.
11 people die of asthma
each day
CDC 2009
Asthma & African Americans
1. African Americans are hospitalized because of asthma three and
on-half times more than whites.
2. 20% more likely to have ever been diagnosed with asthma
3. ER visit rate for African Americans were 350% higher
4. African Americans had an asthma death rate 200%. They are three
times more likely than Caucasians to die from asthma.
5. In 2003, the asthma death rate of African American patients
was more than double that of the general population, and
was highest among African American women1
American lung Association, , Annual Report 2003 & Summary health statistics for U.S.
Children: National Health Interview Survey 2009
Objective #3
Importance of Asthma
Control
Objective #3: Importance of Asthma Control
• Asthma is a characterized by chronic inflammation in the lung which
can lead to loss of lung function.
• Just like hypertension and diabetes, patients with asthma must be
followed and good control validated by some type of measurement.
• Most asthma patients are not in control.
• Patients in urban inner cites are the least controlled patients with
asthma.
41% of Patients With Asthma Were
“Not Well Controlled”
“Not well controlled asthma” was based on a score of ≤19
on the Asthma Control Test™ in a Community-Based Survey
70
59%
% of Patients
60
50
41%
40
30
20
10
0
Controlled
Uncontrolled
Of those uncontrolled:
• 64% were on a controller and 25% were using only a short-acting beta2-agonist
Asthma Control Test is a trademark of QualityMetric Incorporated.
Data on file, GlaxoSmithKline (Asthma USA Study – Summer 2007).
Nearly Half of Patients Visiting a PCP for a
Nonrespiratory Reason Had Uncontrolled Asthma
100%
80%
60%
72%
58%
48%
40%
20%
0%
Total
Respiratory
Nonrespiratory
Results from cross-sectional epidemiological survey in PCP offices to patients, regardless of reason for visit.
Data for 2238 adults with a self-reported physician diagnosis of asthma who completed the Asthma Control
Test™. Uncontrolled asthma defined as Asthma Control Test™ ≤19.
Asthma Control Test is a trademark of QualityMetric Incorporated.
Data on file, GlaxoSmithKline.
Measuring Asthma Control
Inflammation?
Direct or indirect?
Exacerbations:
Asthma-related ER
visits, OCS use, and
hospital admissions
Functional
status?
Limitations
of activities
Lung
function?
Daytime
symptoms?
Nighttime
awakenings?
Asthma
Control
Missed work
and/or school?
Use of “quick
relief” inhaler
and/or
nebulizer?
Patient self-report
of control?
Measuring Asthma Control
• IN THE LABORATORY
•
– Nitrous Oxide
– Airway Hyper-responsiveness
– Sputum Eosinophilia
IN THE OFFICE
– Spirometry
– Validated Questionnaires
– Albuterol Usage
Objective #4
KNOW & IMPLEMENT
G.I.P. Messages
Objective #4: Guidelines Implementation Panel (GIP) messages
What is the GIP report?
The Guidelines Implementation Panel (GIP) Report presents
recommendations and strategies for overcoming barriers to the
acceptance and utilization of the updated NHLBI clinical practice
guidelines for asthma.
Who comprises the GIP?
The National Asthma Education & Prevention Program (NAEPP)
selected experts from American Board of Medical Specialists; CDC;
Connecticut Children’s Medical Center; Family Medicine of
Albermarle: Certified Asthma Educator; Research Development
Corporation ; and School of Medicine at UCLA. (See handout)
Source: NHLBI – Guidelines Implementation Panel Report for Expert Panel Report 3 - Guidelines for the Diagnosis and
Management of Asthma - http://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.htm
Objective #4: Guidelines Implementation Panel (GIP) messages
What are the GIP messages?
 At the heart of the GIP Report are six key messages to address
those issues considered to be the most likely ones to result in
significant impact on asthma care processes and outcomes if the
broader asthma community were to focus its attention and
resources on them.
 The GIP Report is a call to action by the full range of guideline
end-users, including medical professionals, office support staff,
educators, administrators, policy makers, purchasers and payors
of healthcare services in both the private and public sectors.
Source: NHLBI – Guidelines Implementation Panel Report for Expert Panel Report 3 - Guidelines for the Diagnosis and
Management of Asthma - http://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.htm
Guidelines Implementation Panel (GIP) messages
What are the six GIP messages?
The six clinical practice recommendations that could reduce both the
individual and societal burden of asthma if implemented broadly are:
1)
2)
3)
4)
Use inhaled corticosteroids to control asthma
Use written asthma action plans to guide patient self-management
Assess asthma severity at the first visit to determine initial treatment
Assess and monitor asthma control at each follow-up visit and adjust
treatment if needed
5) Schedule follow-up visits at periodic intervals
6) Control exposure to allergens and irritants that worsen the patient’s
asthma
Source: NHLBI – Health Care Professionals - http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/audiences/healthcare-professionals.htm
Guidelines Implementation Panel (GIP) messages
GIP Message #1 - Use inhaled corticosteroids to control asthma
Use inhaled corticosteroids for better asthma control and fewer flare-ups

Inhaled corticosteroids are the most effective medications for
long-term management of persistent asthma and should be
utilized by patients and clinicians.

Inhaled corticosteroids (ICS) are the most effective long-term
therapy available for mild, moderate, or severe persistent asthma.
ICS are anti-inflammatory medications that:
A.
B.
C.
reduce airway hyper-responsiveness
inhibit inflammatory cell migration and activation,
block late phase reaction to allergen.
In general, ICS are well tolerated and safe at the recommended dosages.
Source: NHLBI – Inhaled Corticosteriods: Keep Airways Open - http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/discover/corticosteriods.htm
Guidelines Implementation Panel (GIP) messages
GIP Message #1 - Use inhaled corticosteroids to control asthma (CONTINUED)
Educate patients on the role of ICS in long-term asthma management
Communicating the effectiveness, safety, and importance of ICS for asthma control
and addressing concerns about their long-term use should occur at all levels of
health care.
1. It is also important for clinicians and educators to
2. Tailor their communications based the patient’s health literacy level.
3. Develop a heightened awareness of health disparities and cultural barriers
that facilitate more effective communication with minority (ethnic or racial) or
economically disadvantaged patients regarding the use of asthma
medications that may improve asthma outcomes.
Source: NHLBI – Inhaled Corticosteriods: Keep Airways Open - http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/discover/corticosteriods.htm
Guidelines Implementation Panel (GIP) messages
GIP Message #2 - Use Written Asthma Action Plans

All patients with asthma should receive a written asthma
action plan to guide their self-management efforts.
Many patients have difficulty recalling instructions for care that are
given by their health care provider.
A written asthma action plan provides patients with instruction
and information on how to:
1. Self-manage one’s asthma daily
2. Take medications appropriately
3. Identifying and avoiding exposure to allergens and irritants
that can bring about asthma symptoms.
Source: NHLBI – Asthma Action Plans: Help Patients Take Control - http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/discover/action-plans.htm
Guidelines Implementation Panel (GIP) messages
GIP Message #2 - Use Written Asthma Action Plans (Continued)

Physicians should encourage patients' adherence to the
written asthma action plan
1. Choose treatment that achieves outcomes and addresses
preferences that are important to the patient, and remind
patients that adherence will help them achieve the outcomes
they want.
2. Review with the patient at each visit the success of the
treatment plan in achieving asthma control and make
adjustments as needed.
3. Review patients' concerns about their asthma or treatment at
every visit. Inquire about any difficulties encountered in
adhering to the written asthma action plan.
Source: NHLBI – Asthma Action Plans: Help Patients Take Control - http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/discover/action-plans.htm
Guidelines Implementation Panel (GIP) messages
GIP Message #2 - Use Written Asthma Action Plans (Continued)

Physicians should encourage patients' adherence to the
written asthma action plan
4. Assess the patient's and family's level of social support, and
encourage family involvement.
5. Tailor the self-management approach to the needs and literacy
levels of the patient, and maintain sensitivity to cultural beliefs
and ethnocultural practices.
6. Observe skills for self-management, for example, inhaler
technique, use of a valved holding chamber or spacer, and selfmonitoring.
Source: NHLBI – Asthma Action Plans: Help Patients Take Control - http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/discover/action-plans.htm
Guidelines Implementation Panel (GIP) messages
GIP Message #3 - Assess Asthma Severity

Information gathered in the assessment of asthma severity is
used to characterize the patient’s asthma in order to guide
decisions for initiating therapy, after which the focus shifts to how
well the patient is able to control his or her asthma by following
the treatment plan.

A severity assessment ensures the appropriate use of
pharmacologic agents.
Source: NHLBI – Asthma Severity Know Where to Start - http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/discover/asthma-severity.htm
Guidelines Implementation Panel (GIP) messages
GIP Message #3 - Assess Asthma Severity
Both asthma severity and asthma control are determined by the same
measures in two domains:
1) Current impairment – i.e. frequency and intensity of symptoms
2) Future risk - i.e. asthma exacerbations, progressive decline in lung
function (or, for children, reduced lung growth), or risk of adverse
effects from medication
Monitoring the level of asthma control is used to adjust medication as
needed.
Source: NHLBI – Asthma Severity Know Where to Start - http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/discover/asthma-severity.htm
Guidelines Implementation Panel (GIP) messages
GIP Message #4 - Assess and Monitor Asthma Control
NUTSHELL:
At each follow-up visit, adjust treatment if needed.
1. The treatment goal is asthma control
2. Monitor asthma control and adjust therapy if needed
3. Educate patients on how to recognize inadequate asthma control
Source: NHLBI – Asthma Control: Keep it Going - http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/discover/asthma-control.htm
Guidelines Implementation Panel (GIP) messages
GIP Message #5 - Schedule Follow-up Visits
Monitor asthma control at follow-up visits & Communicate its importance

Asthma is highly variable. It can change over time, vary by season or
situation, and differ from person to person.
In general, patient visits should be scheduled at:

2- to 6-week intervals while initiating therapy or stepping up
therapy to achieve control

1- to 6-month intervals after asthma control is achieved in order to
monitor if asthma control is maintained

3-month intervals if a step-down in therapy is anticipated.
Source: NHLBI – Follow Up Visits: Stay on Track - http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/discover/follow-up-visits.htm
Guidelines Implementation Panel (GIP) messages
GIP Message #6 - Control Environmental Exposures & Control
Triggers
Clinicians should review each patient’s exposure to allergens and irritants
and provide a multipronged strategy to reduce exposure to those
allergens and irritants which make a patient’s asthma worse.
1.
Begin with an environmental assessment
2.
Provide education and resources to reduce environmental
exposures
Source: NHLBI – Environmental Exposures: Avoid Asthma Triggers - http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/discover/environmental-exposure.htm
Guidelines Implementation Panel (GIP) messages
RECAP of six (6) GIP Messages
1. Use inhaled corticosteroids to control asthma.
2. Use written asthma action plans to guide patient self-management.
3. Assess asthma severity at the first visit to determine initial treatment.
4. Assess and monitor asthma control at each follow-up visit and adjust treatment
if needed.
5. Schedule follow-up visits at periodic intervals.
6. Control exposure to allergens and irritants that worsen the patient’s asthma.
Source: NHLBI – Health Care Professionals - http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/audiences/healthcare-professionals.htm
Objective #4
Utilization of ACT Test
Objective #5: Utilization of ACT Tests
The Asthma Control Test provides a score that can help a physician and
patient determine if the current asthma treatment plan is working or if it
might need to be changed.
Review Handouts
ACT for people 12 years and older
ACT for children 4 to 11 years
A score of ≤19 means your patient’s asthma may not be under control.
Asthma Control Test™ (ACT)
1. In the past 4 weeks, how much of the time did your asthma keep you from getting
as much done at work, school or at home?
Score
1. During the past 4 weeks, how often have you had shortness of breath?
1. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness
of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning?
1. During the past 4 weeks, how often have you used your rescue inhaler or nebulizer
medication (such as albuterol)?
1. How would you rate your asthma control during the past 4 weeks?
A score of ≤19 means your patient’s asthma may not be under control.
ACT is for patients with asthma 12 years and older.
Asthma Control Test is a trademark of QualityMetric Incorporated.
Copyright 2002, by QualityMetric Incorporated.
TOTAL
The Importance of Asthma Action Plans
• when to begin rescue treatments,
• how to give these treatments,
• the duration of rescue treatments and
• when to stop self-management and seek
medical attention..
Objective #6
Measuring
Albuterol usage as
a measure of
control
Objective #6: Measuring Albuterol Usage as a Measure of Control
 Albuterol in a rescue medication and does not control
inflammation or loss of lung function.
 Using albuterol as the only drug results in more office
visits, emergency room visit, more hospitalization
and more deaths than any form of controller therapy.
 There are 200 puffs in most canisters of Albuterol.
 A well controlled patient with asthma should use
1 albuterol canister per year.
NIH Guidelines: Monitor Use of Short-Acting
Beta2-agonists As a Marker of Asthma Control
• “Use of SABA >2 days a week for symptom relief
(not prevention of EIB) generally indicates
inadequate control and the need to step up
treatment.”
• Daily albuterol use is a marker of poorly controlled
asthma
EIB=exercise-induced bronchospasm.
NIH, National Heart, Lung, and Blood Institute. Expert Panel Report 3: Guidelines for the Diagnosis and Management
of Asthma (EPR–3 2007). NIH Item No. 08–4051. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm.
Accessed November 26, 2008.
1 of 3 Adults With Asthma Surveyed in
PCP Offices Reported Using
Albuterol at Least Once a Day
Results from cross-sectional patient survey in PCP offices at the time of visit, regardless of
reason (58% non-respiratory, 42% respiratory). Data for 2238 adults with a self-reported
physician diagnosis of asthma who reported their albuterol use for the previous 4 weeks.
Data on file, GlaxoSmithKline.
Objectives
This presentation provided an overview of:
1.
NMA Asthma and Allergy Rescue Project
2.
Impact of asthma on the African American community.
3.
The importance of asthma control.
4.
Guidelines Implementation Panel (GIP) six messages.
5.
Utilization of ACT Test benefits.
6.
Measuring Albuterol usage as a measure of control.
Contact Information
Cheryl Dukes
Project Director
cdukes@nmanet.org
Roslyn A. Douglas, M.A.
Project Assistant
rdouglas@nmanet.org
TELEPHONE:
202-347-1895
WEB ADDRESS: www.NMAasthmanet.org
Principle Investigator
The Principle Investigator for the NMA Asthma and Allergy
Rescue Project is Michael LeNoir, MD.
www.NMAasthmanet.org
THANK YOU FOR YOUR ATTENTION
Q & A?
National Medical Association
8403 Colesville Road: Suite 920
Silver Spring, MD
20910
www.NMAnet.org
202-347-1895
Thank You !