# 24 {#section .Chapter-# .unnumbered}

# Respiratory Diseases

#### Asthma

24-1 Deaths from asthma

24-1a Children under age 5 years

24-1b Children aged 5 to 14 years

24-1c Adolescents and adults aged 15 to 34 years

24-1d Adults aged 35 to 64 years

24-1e Adults aged 65 years and older

24-2 Hospitalizations for asthma

24-2a Children under age 5 years

24-2b Children and adults age 5 to 64 years

24-2c Adults aged 65 years and older

24-3 Hospital emergency department visits for asthma

24-3a Children under age 5 years

24-3b Children and adults aged 5 to 64 years

24-3c Adults aged 65 years and older

24-4 Activity limitations

24-5 School or work days lost

24-6 Patient education

24-7 Appropriate asthma care

24-7a Written asthma management plans

24-7b Persons with prescribed inhalers who receive instruction

24-7c Education about recognizing early signs and symptoms of asthma
episodes and how to respond appropriately

24-7d Medication regimens that prevent the need for more than one
canister of short-acting beta agonists per month

24-7e Followup medical care for long-term management

24-7f Assistance with assessing and reducing exposure to environmental
risk factors

24-8 Surveillance systems

#### Chronic Obstructive Pulmonary Disease (COPD)

24-9 Activity limitations due to chronic lung and breathing problems

24-10 Deaths from COPD

#### Obstructive Sleep Apnea (OSA)

24-11 Medical evaluation and followup

24-11a Seek medical evaluation

24-11b Receive followup care

24-12 Vehicular crashes related to excessive sleepiness

### Asthma

24-1. Reduce asthma deaths.

  ---------------------- ------------------------------------------------
  24-1a. Children under  
  age 5 years.           

  **National Data        National Vital Statistics Systems (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics Systems (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 1,000,000 population.

  **Baseline**           2.1 (1998).

  **Numerator**          Number of asthma deaths (ICD-9 code 493) among
                         children under age 5 years.

  **Denominator**        Number of children under age 5 years.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  24-1b. Children aged 5 
  to 14 years.           

  **National Data        National Vital Statistics Systems (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics Systems (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 1,000,000 population.

  **Baseline**           3.3 (1998).

  **Numerator**          Number of asthma deaths (ICD-9 code 493) among
                         children aged 5 to 14 years.

  **Denominator**        Number of children aged 5 to 14 years.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Part C for a description of NVSS and
                         Appendix A for focus area contact information.

  24-1c. Adolescents and 
  adults aged 15 to 34   
  years.                 

  **National Data        National Vital Statistics Systems (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics Systems (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 1,000,000 population.

  **Baseline**           5.0 (1998).

  **Numerator**          Number of asthma deaths (ICD-9 code 493) among
                         adolescents and adults aged 15 to 34 years.

  **Denominator**        Number of adolescents and adults aged 15 to 34
                         years.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  24-1d. Adults aged 35  
  to 64 years.           

  **National Data        National Vital Statistics Systems (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics Systems (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 1,000,000 population.

  **Baseline**           17.8 (1998).

  **Numerator**          Number of asthma deaths (ICD-9 code 493) among
                         adults aged 35 to 64 years.

  **Denominator**        Number of adults aged 35 to 64 years.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Part C for a description of NVSS and
                         Appendix A for focus area contact information.

  24-1e. Adults aged 65  
  years and older.       

  **National Data        National Vital Statistics Systems (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics Systems (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 1,000,000 population.

  **Baseline**           86.3 (1998).

  **Numerator**          Number of asthma deaths (ICD-9 code 493) among
                         adults aged 65 years and older.

  **Denominator**        Number of adults aged 65 years and older.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

24-2. Reduce hospitalizations for asthma.

+---------------------+------------------------------------------------+
| 24-2a. Children     |                                                |
| under age 5 years.  |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Hospital Discharge Survey (NHDS),     |
| Source**            | CDC, NCHS.                                     |
+---------------------+------------------------------------------------+
| **State Data        | State hospital discharge data systems.         |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 11.1 (Environmental Health).      |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 10,000 population.                    |
+---------------------+------------------------------------------------+
| **Baseline**        | 45.6 (1998).                                   |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of discharges with principal diagnosis  |
|                     | of asthma (ICD-9-CM code 493) among children   |
|                     | under age 5 years.                             |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of children under age 5 years.          |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian population.                      |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Hospital Discharge      |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Final Diagnoses (Including E-code          |
|                     |     diagnoses)\                                |
|                     |     Principal:                                 |
|                     |     \_\_\_\_\_                                 |
|                     | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Principal diagnosis is the diagnosis chiefly   |
|                     | responsible for admission of the person to the |
|                     | hospital.                                      |
+---------------------+------------------------------------------------+
|                     | This objective differs from Healthy People     |
|                     | 2000 objective 11.1 in that different age      |
|                     | breakouts are specified.                       |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHDS and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  24-2b. Children and    
  adults aged 5 to 64    
  years.                 

  **National Data        National Hospital Discharge Survey (NHDS), CDC,
  Source**               NCHS.

  **State Data Source**  State hospital discharge data systems.

  **Healthy People 2000  Adapted from 11.1 (Environmental Health).
  Objective**            

  **Measure**            Rate per 10,000 population (age adjusted---see
                         Comments).

  **Baseline**           12.5 (1998).

  **Numerator**          Number of discharges with first listed diagnosis
                         of asthma (ICD-9-CM code 493) among children and
                         adults aged 5 to 64 years.

  **Denominator**        Number of children and adults aged 5 to 64
                         years.

  **Population           U.S. civilian population.
  Targeted**             

  **Questions Used To    See Questions Used To Obtain the National Data
  Obtain the National    provided with objective 24-2a.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Comments provided with objective 24-2a for
                         more information.

                         Data are age adjusted to the 2000 standard
                         population. Age-adjusted rates are weighted sums
                         of age-specific rates. For a discussion on age
                         adjustment, see Part A, section 5.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  24-2c. Adults aged 65  
  years and older.       

  **National Data        National Hospital Discharge Survey (NHDS), CDC,
  Source**               NCHS.

  **State Data Source**  State hospital discharge data systems.

  **Healthy People 2000  Adapted from 11.1 (Environmental Health).
  Objective**            

  **Measure**            Rate per 10,000 population (age adjusted---see
                         Comments).

  **Baseline**           17.7 (1998).

  **Numerator**          Number of discharges with first listed diagnosis
                         of asthma (ICD-9-CM code 493) among adults aged
                         65 years and older.

  **Denominator**        Number of adults aged 65 years and older.

  **Population           U.S. civilian population.
  Targeted**             

  **Questions Used To    See Questions Used To Obtain the National Data
  Obtain the National    provided with objective 24-2a.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Comments provided with objective 24-2b for
                         more information.
  ---------------------- ------------------------------------------------

24-3. Reduce hospital emergency department visits for asthma.

+---------------------+------------------------------------------------+
| 24-3a. Children     |                                                |
| under age 5 years.  |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Hospital Ambulatory Medical Care      |
| Source**            | Survey (NHAMCS), CDC, NCHS.                    |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 10,000 population.                    |
+---------------------+------------------------------------------------+
| **Baseline**        | 150.0 (1995--97).                              |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of visits to an emergency department    |
|                     | with first listed diagnosis of asthma          |
|                     | (ICD-9-CM code 493) among children under age 5 |
|                     | years.                                         |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of children under age 5 years.          |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997--98 National Hospital Ambulatory |
| Obtain the National | Medical Care Survey:                           |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Physician's diagnosis for the visit        |
|                     |                                                |
|                     |     Primary diagnosis \_\_\_\_\_               |
+---------------------+------------------------------------------------+
| **Expected          | Annual                                         |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Part C for a description of NHAMCS and     |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  24-3b. Children and    
  adults aged 5 to 64    
  years.                 

  **National Data        National Hospital Ambulatory Medical Care Survey
  Source**               (NHAMCS), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 10,000 population.

  **Baseline**           71.1 (1995--97).

  **Numerator**          Number of visits to an emergency department with
                         first listed diagnosis of asthma (ICD-9-CM code
                         493) among children and adults aged 5 to 64
                         years.

  **Denominator**        Number of children and adults aged 5 to 64
                         years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    See Questions Used To Obtain the National Data
  Obtain the National    provided with objective 24-3a.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Part C for a description of NHAMCS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  24-3c. Adults aged 65  
  years and older.       

  **National Data        National Hospital Ambulatory Medical Care Survey
  Source**               (NHAMCS), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 10,000.

  **Baseline**           29.5 (1995--97).

  **Numerator**          Number of visits to an emergency department with
                         first listed diagnosis of asthma (ICD-9-CM code
                         493) among adults aged 65 years and older.

  **Denominator**        Number of adults aged 65 years and older.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    See Questions Used To Obtain the National Data
  Obtain the National    provided with objective 24-3a.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Part C for a description on NHAMCS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

+---------------------+------------------------------------------------+
| 24-4. Reduce        |                                                |
| activity            |                                                |
| limitations among   |                                                |
| persons with        |                                                |
| asthma.             |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | 17.4 (Diabetes and Chronic Disabling           |
| 2000 Objective**    | Conditions), age adjusted to the 2000 standard |
|                     | population.                                    |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 20 (1994--96).                                 |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of persons who report having asthma and |
|                     | activity limitation in the past year.          |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons who report having asthma.    |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized population |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1996 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[NUMERATOR:\]                                 |
|                     |                                                |
|                     | -   Does any impairment or health problem now  |
|                     |     keep (name) from working at a job or       |
|                     |     business (or play/school for children      |
|                     |     under 18 years)?                           |
+---------------------+------------------------------------------------+
|                     | -   Is (name) limited in the kind or amount of |
|                     |     work (name) can do because of any          |
|                     |     impairment or health problem?              |
+---------------------+------------------------------------------------+
|                     | -   Does any impairment or health problem now  |
|                     |     keep (name) from doing any housework at    |
|                     |     all?                                       |
+---------------------+------------------------------------------------+
|                     | -   Is (name) limited in the kind or amount of |
|                     |     housework (name) can do because of any     |
|                     |     impairment or health problem?              |
+---------------------+------------------------------------------------+
|                     | -   Is (name) limited in anyway in any         |
|                     |     activities because of an impairment or     |
|                     |     health problem?                            |
+---------------------+------------------------------------------------+
|                     | \[DENOMINATOR:\]                               |
|                     |                                                |
|                     | -   During the past 12 months did anyone in    |
|                     |     the family (names) have asthma?            |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Persons are classified as having an activity   |
|                     | limitation if they responded "yes" to any of   |
|                     | the questions listed above under Numerator.    |
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | Subsequent versions of the NHIS will use       |
|                     | different questions on a periodic basis to     |
|                     | provide data related to this objective.        |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  24-5. (Developmental)  
  Reduce the number of   
  school or work days    
  missed by persons with 
  asthma due to asthma.  

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed data source is the National Health
                         Interview Survey (NHIS), CDC, NCHS.

                         See Part C for a description of NHIS and
                         Appendix A for focus area contract information.
  ---------------------- ------------------------------------------------

+---------------------+------------------------------------------------+
| 24-6. Increase the  |                                                |
| proportion of       |                                                |
| persons with asthma |                                                |
| who receive formal  |                                                |
| patient education,  |                                                |
| including           |                                                |
| information about   |                                                |
| community and       |                                                |
| self-help           |                                                |
| resources, as an    |                                                |
| essential part of   |                                                |
| the management of   |                                                |
| their condition.    |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | 17.14b (Diabetes and Chronic Disabling         |
| 2000 Objective**    | Conditions) age adjusted to the 2000 standard  |
|                     | population.                                    |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 8.4 (1998).                                    |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of persons aged 18 years and older who  |
|                     | report having asthma and have ever taken a     |
|                     | course or class on how to manage their asthma. |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons aged 18 years and older who  |
|                     | report having asthma in the past year.         |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[NUMERATOR:\]                                 |
|                     |                                                |
|                     | -   Have you ever taken a course or class in   |
|                     |     how to manage your asthma yourself?        |
+---------------------+------------------------------------------------+
|                     | \[DENOMINATOR:\]                               |
|                     |                                                |
|                     | -   Have you ever been told by a doctor or     |
|                     |     other health professional that you had     |
|                     |     asthma?                                    |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

24-7. (Developmental) Increase the proportion of persons with asthma who
receive appropriate asthma care according to the NAEPP Guidelines.

  ---------------------- ------------------------------------------------
  24-7a. (Developmental) 
  Persons with asthma    
  who receive written    
  asthma management      
  plans from their       
  health care provider.  

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed data source is the National Health
                         Interview Survey (NHIS), CDC, NCHS.

                         See Part C for a description of NHIS and
                         Appendix A for focus area contract information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  24-7b. (Developmental) 
  Persons with asthma    
  with prescribed        
  inhalers who receive   
  instruction on how to  
  use the inhaler        
  properly.              

  **Comments**           See Comments provided with objective 24-7a for
                         more information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  24-7c. (Developmental) 
  Persons with asthma    
  who receive education  
  about recognizing the  
  early signs and        
  symptoms of asthma     
  episodes and how to    
  respond appropriately, 
  including instruction  
  on peak flow           
  monitoring for those   
  who use daily therapy. 

  **Comments**           See Comments provided with objective 24-7a for
                         more information.

  24-7d. (Developmental) 
  Persons with asthma    
  who receive medication 
  regimens that prevent  
  the need for more than 
  one canister of        
  short-acting inhaled   
  beta agonists per      
  month for relief of    
  symptoms.              

  **Comments**           See Comments provided with objective 24-7a for
                         more information.

  24-7e. (Developmental) 
  Persons who receive    
  followup medical care  
  for long-term          
  management of asthma   
  after any              
  hospitalization due to 
  asthma.                

  **Comments**           See Comments provided with objective 24-7a for
                         more information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  24-7f. (Developmental) 
  Persons with asthma    
  who receive assistance 
  with assessing and     
  reducing exposure to   
  environmental risk     
  factors in their home, 
  school, and work       
  environments.          

  **Comments**           See Comments provided with objective 24-7a for
                         more information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  24-8. (Developmental)  
  Establish in at least  
  25 States a            
  surveillance system    
  for tracking asthma    
  death, illness,        
  disability, impact of  
  occupational and       
  environmental factors  
  on asthma, access to   
  medical care, and      
  asthma management.     

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         Proposed data sources are periodic surveys by
                         the Council of State and Territorial
                         Epidemiologists and the Association of Schools
                         of Public Health.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

### Chronic Obstructive Pulmonary Disease (COPD)

+---------------------+------------------------------------------------+
| 24-9. Reduce the    |                                                |
| proportion of       |                                                |
| adults whose        |                                                |
| activity is limited |                                                |
| due to chronic lung |                                                |
| and breathing       |                                                |
| problems.           |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 2.2 (1997).                                    |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adults aged 45 years and older who   |
|                     | report activity limitation due to a chronic    |
|                     | lung or breathing problem in the past year.    |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adults aged 45 years and older who   |
|                     | report activity limitation in the past year.   |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[NUMERATOR:\]                                 |
|                     |                                                |
|                     | -   What condition or health problem causes    |
|                     |     ([Subject name's]{.underline}) limitation? |
|                     |                                                |
|                     |     \[Response categories include:\]           |
|                     |                                                |
|                     |     Lung/breathing problem                     |
|                     |                                                |
|                     |     \[If yes,\]                                |
|                     |                                                |
|                     |     -   How long have you had (lung/breathing  |
|                     |         problem)?                              |
+---------------------+------------------------------------------------+
|                     | \[DENOMINATOR:\]                               |
|                     |                                                |
|                     | -   I am now going to ask you about (your/the) |
|                     |     general health ( /of family members) and   |
|                     |     the effects of any physical, mental, or    |
|                     |     emotional health problems.                 |
+---------------------+------------------------------------------------+
|                     | -   Because of a physical, mental or emotional |
|                     |     problem (do/does) (you/anyone) in the      |
|                     |     family need the help of other persons with |
|                     |     PERSONAL CARE NEEDS, such as eating,       |
|                     |     bathing, dressing, or getting around       |
|                     |     inside this home?                          |
+---------------------+------------------------------------------------+
|                     | -   Because of a physical, mental or emotional |
|                     |     problem (do/does) (you/anyone) in the      |
|                     |     family need the help of other persons in   |
|                     |     handling ROUTINE NEEDS, such as everyday   |
|                     |     household chores, doing necessary          |
|                     |     business, shopping, or getting around for  |
|                     |     other purposes?                            |
+---------------------+------------------------------------------------+
|                     | -   Does a physical, mental or emotional       |
|                     |     problem NOW keep (you/any family members   |
|                     |     aged 18 and older) from working at a job   |
|                     |     or business?                               |
+---------------------+------------------------------------------------+
|                     | -   (Are any of family members aged 18 and     |
|                     |     older) limited in the kind OR amount of    |
|                     |     work (you/they) can do because of a        |
|                     |     physical, mental or emotional problem?     |
+---------------------+------------------------------------------------+
|                     | -   Because of a health problem, (do/does)     |
|                     |     (you/anyone) in the family have difficulty |
|                     |     walking without using any special          |
|                     |     equipment?                                 |
+---------------------+------------------------------------------------+
|                     | -   (Are/Is) (you/anyone) in the family        |
|                     |     LIMITED IN ANY WAY in any activities       |
|                     |     because of difficulty remembering or       |
|                     |     because (you/they) experience periods of   |
|                     |     confusion?                                 |
+---------------------+------------------------------------------------+
|                     | -   (Are/Is) (you/anyone) in the family        |
|                     |     LIMITED IN ANY WAY in any activities       |
|                     |     because of physical, mental or emotional   |
|                     |     problems?                                  |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Adults aged 45 years and older are defined as  |
|                     | being limited in activity due to a chronic     |
|                     | lung or breathing problem if they respond      |
|                     | "yes" to any of the limitation questions       |
|                     | listed above in the Denominator section and    |
|                     | report that the reason for the limitation is a |
|                     | chronic lung or breathing problem. An adult is |
|                     | considered to have a chronic lung/breathing    |
|                     | problem if they report having the condition    |
|                     | for 3 months or more.                          |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  24-10. Reduce deaths   
  from chronic           
  obstructive pulmonary  
  disease (COPD) among   
  adults.                

  **National Data        National Vital Statistics Systems (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics Systems (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Adapted from 3.3 (Tobacco), age adjusted to the
  Objective**            2000 standard population.

  **Measure**            Rate per 100,000 (age adjusted---see Comments).

  **Baseline**           119.4 (1998).

  **Numerator**          Number of COPD deaths (ICD-9 code 490-496) among
                         adults aged 45 years and older.

  **Denominator**        Number of adults aged 45 years and older.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           This objective is adapted from Healthy People
                         2000 objective 3.3 (Tobacco), which tracked COPD
                         among persons of all ages and was age adjusted
                         to the 1940 standard population. This measure
                         tracks adults aged 45 years and older only and
                         is age adjusted to the 2000 standard population.
                         See Appendix C for comparison data. Age-adjusted
                         rates are weighted sums of age-specific rates.
                         For a discussion on age adjustment, see Part A,
                         section 5.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

### Obstructive Sleep Apnea (OSA)

24-11. (Developmental) Increase the proportion of persons with symptoms
of obstructive sleep apnea whose condition is medically managed.

  ---------------------- ------------------------------------------------
  24-11a.                
  (Developmental)        
  Persons with excessive 
  daytime sleepiness,    
  loud snoring, and      
  other signs associated 
  with obstructive sleep 
  apnea who seek medical 
  evaluation.            

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed data source is the National Health
                         Interview Survey (NHIS), CDC, NCHS.

                         See Part C for a description of NHIS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  24-11b.                
  (Developmental)        
  Persons with excessive 
  daytime sleepiness,    
  loud snoring, and      
  other signs associated 
  with obstructive sleep 
  apnea, who receive     
  followup medical care  
  for long-term          
  management of their    
  condition.             

  **Comments**           See Comments provided with objective 24-11b for
                         more information.

  24-12. (Developmental) 
  Reduce the proportion  
  of vehicular crashes   
  caused by persons with 
  excessive sleepiness.  

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed data source for this objective is the
                         National Health Interview Survey (NHIS), CDC,
                         NCHS. A set of questions have been drafted for
                         inclusion in a future NHIS.

                         Other proposed data sources are the Fatality
                         Analysis Reporting System (FARS), DOT, NHTSA.

                         See Part C for a description of NHIS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------