Asthma & COPD

Background

Asthma and chronic obstructive pulmonary disease (COPD) are both respiratory diseases that prevent the lungs from functioning properly. These diseases swell the airways affecting respiratory function, or the ability to breathe. Both asthma and chronic obstructive pulmonary disease are significant public health issues. The burden of these respiratory diseases affects not only individuals and their families, but also the community at whole. With a large burden on the health care system, the cost of respiratory diseases is paid for with tax dollars and results in higher health insurance rates and lost productivity. Promoting respiratory health through better prevention, detection, treatment, and education efforts is a public health priority in the Greater Nashua Public Health Region (GNPHR).

Asthma & COPD Data Overview

Check out the points below for the main takeaways from this page. 

• 10.7% of Nashua adults had asthma in 2017, compared to the state average of 13.2%. 

• In 2019, southeast Nashua had the highest rate of asthma ED visits at 454.9 asthma ED visits per ten thousand residents. They were followed by southwest Nashua at 181.1 asthma ED visits per ten thousand residents. This pattern continues with COPD ED visits, where southeast Nashua had 926.2 COPD ED visits per ten thousand residents, and southwest Nashua had 339 COPD ED visits per ten thousand residents.

• 55% of NH adults with asthma consider their asthma to be well controlled. The remaining 45% consider their asthma to be not well controlled or very poorly controlled. 

• 9% of NH children with asthma are considered to have very poorly controlled asthma. 36% of NH children with asthma are considered to have not well controlled asthma. 

Asthma

While adults can have asthma, it is one of the most common long-term diseases in children. Asthma causes wheezing, breathlessness, chest tightness, and coughing at night or early in the morning. People living with asthma always have the disease, but only experience asthma attacks when a trigger bothers the lungs. Over a lifetime, asthma can cause permanent lung damage. Since it can be be difficult to determine if someone has asthma, especially in children five years of age and younger, it is important to see a health care provider regularly.

Each year, asthma costs the U.S. about $56 billion. Asthma is a public health priority because in the last decade, the proportion of people with asthma in the U.S. grew by nearly 15%. There are gaps in education for asthmatics on how to control their asthma triggers and in accessing lifesaving medications to control asthma. Less than 50% of children with asthma get an asthma action plan and less than seven in 10 adult asthmatics are taught how to recognize asthma symptoms. This needs to change.

Asthma Prevalence

Asthma affects every race, sex, and age. There are currently more than 25 million people living with asthma in the U.S., with NH having some of the highest rates. The CDC estimates that NH is has the highest adult asthma prevalence, affecting 13.2% of adults and 7.21% of children, accounting for over 4,000 emergency room visits, and costing over $177 million in direct annual medical costs. Many of the reasons for hospital visits and deaths due to asthma are preventable with education, an asthma action plan, minimizing triggers, and access to affordable medication (CDC).

Asthma Control

Although asthma is a chronic condition, people can live normal, healthy lives when their asthma is managed. It is recommended for people living with asthma to work with their health care provider to learn how to keep their asthma under control. Asthma control is defined as the degree to which symptoms, functional limitations, and risks of adverse effects are minimized, and how well the goals of treatment are met (NH DHHS). 

The BRFSS Childhood Asthma Callback Survey (ACB) surveyed parents regarding their child’s asthma and found that from 2012 to 2014, just over half (55%) of children with asthma had their asthma well controlled. Poorly controlled asthma may impair a child’s ability to attend school, affect his or her academic performance, and cause caregivers to miss work as they care for their sick child. According to the CDC, in 2008 there were 14.2 million missed days of work due to asthma and in 2013, students missed 13.8 million days of school. An indication of poorly controlled asthma in children and adults includes visiting the emergency department for asthma related concerns. 

Adult Asthma Control

The National Heart, Lung, and Blood Institute developed guidance for the diagnosis and management of asthma. Factors included into the assessment of asthma control in patients are: daily asthma symptoms, nighttime awakenings due to asthma, frequency of use of rescue medications, lung function, interference with normal activity, and exacerbations requiring oral corticosteroids. To control asthma, they recommend the following four components to asthma management: assessing and monitoring asthma severity and control controlling environmental triggers, appropriate medication, and patient education.

Childhood Asthma Control

The two most important pieces of managing asthma in children include education and an asthma action plan. Health care providers and families are working together to help children manage their asthma through the following:

•  Teaching children and caregivers to manage asthma by using a personalized asthma action plan shared with school staff and other caregivers. Such a plan helps children use medicine properly and avoid asthma triggers.

•  Working with community health workers, local health departments, pharmacists, and others to ensure that children with asthma receive needed services.

•  Working with children and caregivers to assess each child’s asthma, prescribe appropriate medicines, and determine whether home health visits would help prevent attacks (CDC).

Asthma and the Environment

Exposure to environmental factors can make asthma symptoms worse and trigger an attack. Such environmental factors include secondhand smoke, dust mites, air pollution, pets, wood smoke, mold, and bad weather (thunderstorms, high humidity, or freezing temperatures). Adults and children who are asthmatic are more likely to have symptoms when the air has a presence of ozone (found in smog) and particle pollution (found in haze, smoke, and dust). Numerous studies have even shown an association between air pollution exposures and asthma, including increased hospital admissions for asthma due to particulate matter, an outdoor air pollutant. To best reduce asthma attacks, it is important to regularly take medication and avoid exposure to known triggers (CDC EPHT).

Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a group of diseases that cause airflow blockage and breathing-related problems, including emphysema and chronic bronchitis. While 16 million Americans have difficulty breathing due to this disease, more people suffer without diagnosis. Nationally, eight out of 10 cases of chronic obstructive pulmonary disease are caused by exposure to cigarette smoke (HP2020). Genetic factors also play a strong role in the development of this disease. Although there is no cure, chronic obstructive pulmonary disease can be prevented and treated. Treatment can lessen symptoms and improve quality of life.

In NH, approximately one in 15 adults (6.5%) live with chronic obstructive pulmonary disease, with higher rates among women compared to men (BREATHE NH).

Health Equity & Asthma/COPD

A person's health can be seriously impacted by their race, ethnicity, gender, income level, education, and other socioeconomic factors. In regards to asthma and chronic obstructive pulmonary disorder...

• Women are more likely to have asthma than men.

• Multi-Racial and Hispanic individuals face the highest burden of asthma in NH.

• People with less than a high school degree are more than 2X as likely to have asthma than college graduates.

• Lower income individuals are up to 3X more likely to have asthma than higher income individuals.

• One in five Hispanic adults unable to afford their asthma medication.

• Women and African Americans are more likely to die from asthma.

• About 16% of black children and 7% of white children have asthma (CDC).

• Blacks and American Indian/Alaska Natives have the highest current asthma rates compared to other races and ethnicities. Hispanics and Asians had lower current asthma prevalence rates than other racial and ethnic groups (American Lung Association).

• In 2018, current asthma rates among adults ages 18 to 65 were highest for those on Medicaid and lowest for those with no medical insurance (American Lung Association).

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