Regional Disparity in Asthma Prevalence and Distribution of Asthma Education Programs in Texas

Patient education needs in severe asthma, a pilot study

BACKGROUND

Severe asthma is characterized by frequent exacerbations, altered lung function, and impaired quality of life. Tailored patient education allows for the improvement of both asthma management and quality of life. Our study aimed to assess the needs of severe asthma patient in therapeutic education, according to previous therapeutic patient education background and asthma phenotype.

METHODS

Consecutive patients monitored for severe asthma in a tertiary referral center were considered for inclusion and answered a questionnaire detailing their patient education needs and the topics they would like to discuss. Asthma history, clinical and biological data, and lung function results were recorded.

RESULTS

Fifty-three patients were included and 47 (88.7%) expressed at least one need. The most frequently selected topics were "life with asthma" (83%), "treatment use" (68%), and "exacerbation management" (60%), independent of previous participation in a patient education program dedicated to asthma. Patients of older age at inclusion, uncontrolled asthma, and T2-high phenotypes were associated with different profiles of patient education needs.

CONCLUSION

Our study identified frequent and various patient educational needs among severe asthmatics, highlighting the importance of an in-depth assessment of severe asthmatics expectations and the crucial need for the development of dedicated educational tools.

Ensuring equitable access to guideline-based asthma care across the lifespan: Tips and future directions to the successful implementation of the new NAEPP 2020 guidelines, a Work Group Report of the AAAAI Asthma, Cough, Diagnosis, and Treatment Committee

The most recent recommendations from the 2020 National Asthma Education and Prevention Program Update and Global Initiative for Asthma 2021 guide evidence-based clinical decision making. However, given the present state of health disparities by age, income, and race, the equitable implementation and dissemination of these guidelines will be unlikely without further guidance. This work group report reviews the current state of the new asthma guideline implementation; presents updated evidence-based therapeutic options with attention to specific patient populations; and addresses barriers to the implementation of these guidelines in minoritized, historically marginalized, and underresourced communities. Allergists and immunologists can use practical ways to accomplish the goals of improved asthma care access and advanced asthma care across the life span, with specific considerations to historically marginalized populations. Modifiable barriers to guideline implementation include financial barriers, environmental factors, and allergy subspecialty access and care coordination. Various programs to improve access to guideline-based asthma care include community programs, school-based asthma programs, and digital health solutions, with an emphasis on reducing disparities by race.

A Comparison of Activity Participation between Children with and without Asthma

Background

Asthma affects approximately 6 million children in the United States and can greatly impact quality of life and occupational engagement. Although occupational therapists are well-equipped to address participation limitations, insufficient evidence exists to support the role of occupational therapists in asthma treatment.

Method

The purpose of this study was to further understand the occupational limitations experienced by children with asthma. We also explored a dual diagnosis of asthma and obesity. The participants included children with (n = 84) and without (n = 63) asthma living in New York City. The Child Behavior Checklist, Youth Self Report, Brief Respiratory Questionnaire, and accelerometer data were used to examine occupational participation.

Results

Although accelerometry data demonstrated that children with asthma were equally as active as their non-asthmatic peers, the participants with asthma perceived themselves as participating more in sedentary occupations and were less likely to be members of sports teams. They also had more missed school days and nights of troubled sleep. The children with both asthma and obesity reported the highest level of activity limitations.

Conclusion

This study illustrates specific limitations experienced by children with asthma and supports the need for occupational therapy intervention. Future studies are needed to design and assess interventions that will support the addition of occupational therapists to multidisciplinary asthma treatment teams.

Diabetes Education Desert: Regional Disparity Between Diabetes Prevalence and Diabetes Self-Management Education Programs in Texas

Diabetes is a major chronic disease that was the seventh leading cause of death in the United States in 2017. Although diabetes self-management education (DSME) programs have been implemented to promote patients' self-management skills, the disease continues to grow and some regions have a heavier burden of diabetes diagnoses than others. Focusing on the unbalanced diabetes prevalence across counties, this study aims to identify regional distribution of diabetes education programs in Texas counties, and explore whether diabetes prevalence is worse in certain counties that are geographically isolated from DSME programs. Data from the Centers for Disease Control and Prevention, American Diabetes Association, and American Association of Diabetes Educators were analyzed using ESRI ArcGIS software. When the authors geocoded 167 DSME programs in Texas, it was found that 47 programs (28.7%) were concentrated in 1 single county, and only 49 counties (19.3%) of the total counties (n = 254) had at least 1 DSME program. It also was revealed that the 25 counties (10%) with the highest diabetes prevalence had only 4 DSME programs (2.4%), indicating that there are still marginalized areas with no access to diabetes education programs. Considering the distance from each county's center to the nearest DSME program and diabetes prevalence, 3 counties were identified as diabetes education deserts. When designing, implementing, and evaluating strategies to reduce the burden of diabetes, policy makers and health care providers should account for the existing regional disparity in diabetes education and its impact on diabetes prevalence.