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Asthma Speaker's Kit for Health Care Professionals

● Table of Contents

● Preface and Introduction

● Epidemiology

● Risk Factors

● Prevention

● Clinical Management of Asthma

● Managing Asthma

● Public Health Response to Asthma

● Appendix A: Glossary

● Resources

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❍ Introduction (ppt)

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❍ Asthma Prevalence and Control Characteristics by 

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❍ Self-Reported Increase in Asthma Severity After the 

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MMWR September 6, 2002; 51 (35):781-784

❍ Surveillance for Asthma — United States, 1980-1999.

MMWR March 29, 2002; 51(SS-1):1-13

❍ Self-Reported Asthma Prevalence Among Adults — United 

States, 2000.

MMWR August 17, 2001; 50(32):682-6

❍ Forecasted State-Specific Estimates of Self-Reported Asthma 

Prevalence — United States, 1998.

MMWR December 4, 1998; 47(47):1022-5

❍ Surveillance for Asthma — United States, 1960-1995.

MMWR April 24, 1998; 47(SS-1):1-28

● National Center for Health Statistics

See in particular the following:

❍ Asthma Prevalence, Health Care Use, and Mortality, 2000-

2001

❍ Changes to NHIS asthma survey

❍ Fast Stats A to Z - Asthma

❍ National Health Interview Survey

■ Summary Health Statistics for U.S. Children: National 

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● Healthy People 2010 - Asthma Sections

Healthy People 2010 is a statement of U.S. health objectives 

designed to identify the most significant preventable threats to 

health and to establish national goals to reduce these threats. 

❍ Issues and Trends

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● Key Clinical Activities for Quality Asthma Care: Recommendations of 

the National Asthma Education and Prevention Program.

MMWR March 28, 2003; 52(RR06):1-8 (19 slides, 426 Kb ppt | 372 

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● Managing Asthma: A Guide for Schools

● Purchasing Specifications for Care of Individuals With Asthma (html

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● Strategies for Addressing Asthma Within a Coordinated School 

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Disclaimer: Links to other federal and nonfederal organizations found at this site are provided 

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● Allergy and Asthma Network, Mothers of Asthmatics 

(AANMA)

AANMA, a national nonprofit network of families, offers information 

about living with allergies and asthma, including information on 

policy issues such as pending legislation and children’s rights at 

school. 

❍ AANMA Policy Issues Page

● Department of Health and Human Services (DHHS)

❍ Action Against Asthma: A Strategic Plan for the Department 

of Health and Human Services (May 2000)

This strategy is designed to help achieve the national Healthy 

People 2010 goals for asthma. The strategy envisions close 

coordination between DHHS initiatives and activities led by 

professional societies, universities, non-governmental and 

community-based organizations, providers of medical care, 

businesses, and other federal, state, local, and tribal 

government agencies in pursuit of progress in these areas 

over the next five years.

❍ Coordination of Federal Asthma Activities (pdf *) 

This report by the Federal Liaison Group on Asthma identifies 

federal programs that carry out asthma-related activities and 

contains recommendations on ways to strengthen and 

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improve coordination of those activities.

● Pew Environmental Health Commission

The Commission developed recommendations designed to bolster 

the nation’s ability to track and prevent health problems linked to 

conditions in the environment. 

❍ Attack Asthma: Why America Needs a Public Health Defense 

System to Battle Environmental Threats (pdf *)

● Thomas, Legislative Information on the Internet

Information on the U.S. Congress and searchable database of 

federal legislation. 

❍ U.S. Legislative Branch

Links to information about the legislative branch, the 

legislative process, and a searchable database of legislative 

branch Web sites.

top

State and Local

● Library of Congress: State and Local Governments

This site provides a meta-index of state and local government 

information and direct links to state government Web sites.

● National Conference of State Legislatures (NCSL)

NCSL is a bipartisan national forum for state lawmakers to 

communicate with one another and to share ideas on various topics, 

including asthma. 

❍ Asthma Web Resources

This site includes links to policy briefs on asthma, analyses of 

state legislation, and a searchable database of state 

legislation and statutes.

❍ Asthma, A Growing Epidemic (Environmental Health Series, 

2000) (html, pdf *)

● StateLaw

This site provides information on state governments and legislation 

from Washburn University School of Law.

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CDC | Non CDC

CDC

● Agency for Toxic Substances and Disease Registry (ATSDR)'s

Case Studies in Environmental Medicine: Environmental Triggers of 

Asthma

● Bam! Body and Mind Kid’s Page

❍ Disease Detectives: Dr. Asthma

❍ Fit for Life: Don’t Let Asthma Keep You Out of the Game

● National Center for Chronic Disease Prevention and Health 

Promotion

Division of Adolescent and School Health Risk Behaviors and Health 

Topics Web Site

● National Institute for Occupational Safety and Health 

(NIOSH)'s Asthma and Allergies Web site

● Office of Genomics and Disease Prevention

❍ Asthma Genomics: Implications for Public Health: A Public 

Health Perspective

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● Allergy and Asthma Network Mothers of Asthmatics

AANMA, a national nonprofit network of families, offers information 

about living with allergies and asthma.

● Alliance of Community Health Plans

❍ Asthma Intervention for Inner-City Children

This site provides background information about the 

intervention.

● Allies Against Asthma

❍ Allies Against Asthma Resource Bank

This is a centralized system for sharing information about 

tools and materials that may be useful to coalitions and 

community programs addressing asthma.

● American Academy of Allergy, Asthma & Immunology

❍ Taking on Asthma

This site provides information about an initiative to reduce the 

negative health consequences associated with asthma.

● American Association of Health Plans

❍ Taking on Asthma

This site provides information about an initiative to reduce the 

negative health consequences associated with asthma.

● American Lung Association's Asthma Site

ALA provides information about asthma and older people, teens and 

asthma, asthma medicines and attacks, peak flow meters, and 

home control of allergies and asthma.

● Asthma and Allergy Foundation of America

AAFA provides information about asthma and allergy education, 

advocacy, and research.

● Center for Health Care Strategies (CHCS)

CHCS directs national programs on behalf of two major health care 

philanthropies: The Robert Wood Johnson Foundation and The 

Annie E. Casey Foundation. 

❍ Improving Asthma Care for Children Program

● Institute of Medicine

❍ Clearing the Air: Asthma and Indoor Air Exposure

This book provides information about the role that indoor air 

pollution plays in asthma causation, prevalence, triggering, 

and severity.

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● National Association of State Boards of Education

❍ State-Level School Health Policies

This site includes information on state legal codes, rules, 

standards, administrative orders, mandates, and resolutions, 

and links to additional resources. 

● National Conference of State Legislatures (NCSL)

NCSL is a bipartisan, national forum for state lawmakers to 

communicate with one another and to share ideas on various topics, 

including asthma. 

❍ Asthma Web Resources

This site includes links to policy briefs on asthma, analyses of 

state legislation, and a searchable database of state 

legislation and statutes.

❍ Asthma: A Growing Epidemic (Environmental Health Series, 

2000)

❍ State Policies Regarding Student Rights to Possess & SelfAdminister Prescribed Medications for Asthma & Anaphylaxis

● National Heart, Lung, and Blood Institute

❍ National Asthma Education and Prevention Program

This site provides information about the program and about 

asthma according to target audience.

❍ Guidelines for the Diagnosis and Management of Asthma

● National Institute of Allergy and Infectious Diseases

NIAID provides support for scientists conducting research aimed at 

developing better ways to diagnose, treat, and prevent asthma.

● National Institute for Occupational Safety and Health 

(NIOSH)'s Asthma and Allergies Web site

NIOSH is the arm of CDC that conducts research and makes 

recommendations for the prevention of work-related disease and 

injury. This site provides information on occupational asthma and 

allergies.

● National Library of Medicine (NLM)

NLM, the largest online medical library, provides health information, 

library services, research programs, and general information related 

to topics such as asthma.

● PBS Kid's Asthma Tips

This site helps children learn what asthma is, what can trigger 

asthma attacks, and how to stay active and healthy if they have 

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asthma.

● Quest for the Code: An Adventure Game About Managing 

Asthma for Children

This site provides information on a free CD-ROM created to help 

children ages 7 to 15 learn how to manage their asthma.

● U.S. Environmental Protection Agency (EPA)

❍ AirNow Web site

This site offers air quality information by state and select 

cities, air quality forecasts and corresponding health effects, 

ozone maps, air pollution publications, and steps you can take 

to reduce air pollution.

❍ Asthma and Indoor Environments

This document provides information on how to reduce 

common asthma triggers in the home and other indoor 

environments.

❍ Clear Your Home of Asthma Triggers

This document provides information on how to eliminate 

asthma triggers in the home and how to reduce symptoms in 

children.

❍ Mold, Moisture and Your Home

This guide tells how to clean up residential mold problems 

and prevent mold growth.

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● About the Program (html) (PDF, 88KB *)

● Health Issues 

❍ Air Quality and Forest Fires

❍ Asthma

❍ Carbon Monoxide Poisoning

❍ Chronic Obstructive Pulmonary Disease (COPD)

❍ Mold

● Links

● En Español

More NCEH topics

● Emergency Response and Preparedness Information

● Cruise Ship Inspection Scores

● Childhood Lead Poisoning Prevention Program

● Newborn Screening Quality Assurance Program

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What's New?

Indoor Air 

Quality 

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by State

Asthma 

Prevalence 

and Control 

Characteristics 

by 

Race/Ethnicity 

— United 

States, 2002 

html or pdf

Asthma at a 

Glance html or 

pdf

 

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Air Pollution and Respiratory Health

About the Program

● Introduction

● Tracking

● Interventions

● Partnerships

● Other Air Quality Research and Interventions

Introduction

The Air Pollution and Respiratory Health Program of the National Center for 

Environmental Health, Centers for Disease Control and Prevention (CDC) 

leads CDC’s fight against environmental-related respiratory illnesses, 

including asthma, and studies indoor and outdoor air pollution.

CDC’s asthma program focuses on three main activities:

1. tracking: collecting and analyzing data on an ongoing basis to 

understand when, where, and in whom asthma occurs;

2. implementing scientifically proven interventions: ensuring 

that scientific information is translated into public health practices 

and programs to reduce the burden of asthma; and

3. establishing and maintaining partnerships: ensuring that all 

stakeholders have the opportunity to be involved in developing, 

implementing, and evaluating local asthma control asthma 

programs.

This same approach of research-based intervention conducted in 

partnership with international, national, and local partners is applied to 

CDC’s work in preventing carbon monoxide poisoning, studying the health 

effects of exposure to forest fire smoke, battling chronic obstructive 

pulmonary disease, and investigating human health effects of mold 

exposure.

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Tracking

CDC provides on-site, short-term consultation and epidemiological 

assistance to both domestic and international public health agencies. For 

example, CDC staff are currently studying the effect of outdoor air 

pollution on children’s asthma in the El Paso/Ciudad Juarez international 

trucking corridor in cooperation with the U.S.-Mexico Foundation and 

others.

In conjunction with the National Center for Health Statistics and the 

National Center for Chronic Disease Prevention and Health Promotion, the 

Air Pollution and Respiratory Health Program supports a number of major 

asthma data collection efforts, including:

1. collection of state-level adult asthma prevalence rates for detailed 

subgroups in 50 states and 4 territories through the Behavioral Risk 

Factor Surveillance System Survey;

2. collection of data on days of restricted activity, days in bed, days of 

work or school lost, physician visits, and hospitalizations due to 

asthma through the National Health Interview Survey; and

3. collection of in-depth state and local asthma data through 

development and testing of a National Asthma Survey (currently 

used in five states).

These data allow CDC and states to plan and evaluate asthma control 

interventions.

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Interventions

CDC’s National Asthma Control Program was created in 1999 to support 

the goals and objectives of Healthy People 2010. With appropriations of 

over $35 million, CDC funded 11 asthma tracking projects, 48 asthma 

interventions, and 33 asthma partnership projects for 2003, as well as 6 

urban school districts, 1 state education agency, and 6 non-governmental 

organizations to conduct school health-related asthma control programs.

CDC identified potentially effective interventions describing and 

documenting research-based asthma control interventions that are being 

implemented in communities worldwide 

(http://www.cdc.gov/nceh/airpollution/asthma/

interventions/interventions.htm). For example, CDC funds the Inner City 

Asthma Intervention, a four-year program implemented at 23 sites in 15 

states and based on nearly a decade of research performed by the 

National Institute of Allergy and Infectious Diseases. In addition, CDC 

funds the Controlling Asthma in American Cities Project (CAACP) in seven 

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cities. CAACP is a locally developed, multi-component asthma initiative 

aimed at reducing the burden of asthma in communities.

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Partnerships

CDC works with government and non-governmental agencies and 

organizations worldwide to conduct research and surveillance and to 

develop training materials, educational information, and innovative 

methods to address respiratory health problems associated with air 

pollution. Through these efforts CDC helps local and state governments 

and private agencies inform the public about the health effects of air 

pollution and provides people with accurate and useful information about 

steps they can take to protect their health.

CDC partners with state health departments in 29 states and the District of 

Columbia to develop asthma control plans that include disease tracking, 

intervention, and occupational components, as well as working with state 

health departments in 6 states to implement such plans. Additionally, CDC 

partners with major non-governmental agencies such as the American 

Lung Association, the Allergy and Asthma Foundation of America, and the 

Allergy and Asthma Network/Mothers of Asthmatics to support asthma 

control activities such as adult educational programs and addressing 

asthma control through school health programs.

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Other Air Quality Research and Interventions

CDC is engaged in a number of studies including ones that will evaluate 

the public health impact of forest fire smoke exposure, is investigating the 

link between recreational boating and carbon monoxide poisoning, and 

plans to analyze state data to define the public health problem potentially 

associated with Acute Idiopathic Pulmonary Hemorrhage among infants.

CDC has partnered with the National Interagency Prescribed Fire Training 

Center to investigate biomass smoke exposure among forest firefighters, 

with the National Park Service and state recreation departments to 

investigate carbon monoxide poisoning and recreational boating, and with 

Native American tribes to investigate the impact of mold exposure on 

human health.

For more information on the program, visit http://www.cdc.gov/nceh/airpollution, e-mail 

EHHEinq@cdc.gov, or call 1-888-232-6789.

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Air Quality and Forest Fires

Resources

● Fire Safety

● Wildfire Smoke: A Guide for 

Public Health Officials (PDF, 

303Kb *)

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Home | Basic Facts | Boat-Related | CDC Activities | Emergency-Related | Policy-Related | 

Work-Related

Basic Facts

Federal

● Checklist for the Prevention of Carbon Monoxide (CO) Poisoning

● Health Tips: Protect Your Family from a Silent Killer [Consejos de 

Salud: Proteja a su familia de un asesino silencioso]

(English | en Español)

● Public Service Announcements for Carbon Monoxide

(English | en Español)

● Questions and Answers about Carbon Monoxide Poisoning 

[Intoxicación por monóxido de carbono]

(English | en Español)

Nonfederal

● Carbon Monoxide Poisoning Multimedia Q&A on Personal Risk 

Factors

top

Boat-Related

● Carbon Monoxide Dangers from Generators and Propulsion 

Engines: On-Board Boats

● Carbon Monoxide Poisoning - An Invisible Danger on Houseboats: 

Protect yourself and others from carbon monoxide poisoning 

inside and outside houseboats

● Carbon-Monoxide Poisoning Resulting from Exposure to Ski-Boat 

Exhaust—Georgia, June 2002

MMWR September 20, 2002;51(37):829-830

● Carbon Monoxide Poisonings Resulting from Open Air Exposures 

to Operating Motorboats—Lake Havasu City, Arizona, 2003. 

MMWR April 23, 2004;53(15):314-318 (html | pdf)

Spotlights

Public Service 

Announcements 

for Carbon 

Monoxide:

English

en Español

Questions and 

Answers about 

Carbon 

Monoxide 

Poisoning 

[Intoxicación 

por Monóxido 

de Carbono]:

English

en Español

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● Houseboat-Associated Carbon Monoxide Poisonings on Lake 

Powell—Arizona and Utah, 2000

MMWR December 15, 2000;49(49):1105-8

● U.S. Coast Guard Carbon Monoxide Web site

top

CDC Activities

● CDC's Carbon Monoxide Poisoning Prevention Activities

(html) (PDF, 77KB)

Emergency-Related

● Carbon Monoxide Hazards from Small Gasoline Powered Engines

● Carbon Monoxide and Power Outage Safety

● Consumer Products Safety Commission and Federal Emergency 

Management Agency Warning on Use of Portable Generators 

During Power Outages

● Health Tips: Protect Your Family from a Silent Killer [Consejos de 

Salud: Proteja a su familia de un asesino silencioso]

(English | en Español)

● Public Service Announcements for Carbon Monoxide

(English | en Español)

● Questions and Answers about Carbon Monoxide Poisoning 

[Intoxicación por monóxido de carbono]

(English | en Español)

● Use of Carbon Monoxide Alarms to Prevent Poisonings During a 

Power Outage—North Carolina, December 2002. MMWR March 

12, 2004;53(9):189-92 (html | pdf)

top

Policy-Related

● National Vehicle Emissions Policies and Practices and Declining 

US Carbon Monoxide-Related Mortality

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Work-Related

● Carbon Monoxide Hazards from Small Gasoline Powered Engines

See also these related issues:

● Floods

● Hurricanes

● Power Outages

Disclaimer: Links to other federal and nonfederal organizations found at this site are 

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these organizations or their programs by CDC, and none should be inferred. CDC is not 

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Chronic Obstructive Pulmonary Disease

COPD FAQ [Datos sobre la Enfermedad Pulmonar Obstructive Cronica, 

EPOC]

(English | en Español) 

Chronic Obstructive Pulmonary Disease Surveillance -- United States, 

1971-2000. MMWR August 2, 2002;51(SS-6):1-16.

 

 

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Mold

● Basic Facts About Mold [Datos Básicos Sobre el Moho]

(English | en Español)

❍ Facts about Aspergillus molds

❍ Facts about Stachybotrys chartarum and other molds 

● CDC's Mold Program in Brief (html | pdf)

● Institute of Medicine's Damp Indoor Spaces and Health 

❍ Project description

❍ Press release

❍ Report

● Related Issues: Pulmonary Hemorrhage/Hemosiderosis Among 

Infants

● State of the Science on Molds and Human Health (Testimony to U.S. 

Congress, July 2002)

● Links

 

Spotlights

MMWR's 

Investigation 

of Acute 

Idiopathic 

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Hemorrhage 

Among 

Infants

Just Released: 

Institute of 

Medicine's 

Damp Indoor 

Spaces and 

Health 

● Project 

description

● Press release

● Report

EPA's "A Brief 

Guide to Mold, 

Moisture and 

Your Home"

OSHA's "A 

Brief Guide to 

Mold in the 

Workplace"

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Air Pollution and Respiratory Health Links *

Asthma | Indoor Air

Asthma

Other CDC Asthma Sites and Programs

● Agency for Toxic Substances and Disease Registry (ATSDR)'s Case Studies in 

Environmental Medicine: Environmental Triggers of Asthma

● Bam! Body and Mind Kid’s Page

❍ Disease Detectives: Dr. Asthma

❍ Fit for Life: Don’t Let Asthma Keep You Out of the Game

● National Center for Chronic Disease Prevention and Health Promotion: 

Division of Adolescent and School Health Risk Behaviors and Health Topics 

Web Site

● National Institute for Occupational Safety and Health (NIOSH)'s Asthma and 

Allergies Web site

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Non-CDC Asthma Sites and Programs

● Allergy and Asthma Network Mothers of Asthmatics

AANMA, a national nonprofit network of families, offers information about 

living with allergies and asthma.

● Alliance of Community Health Plans

❍ Asthma Intervention for Inner-City Children

This site provides background information about the intervention.

● Allies Against Asthma

❍ Allies Against Asthma Resource Bank

This is a centralized system for sharing information about tools and 

materials that may be useful to coalitions and community programs 

addressing asthma.

● American Academy of Allergy, Asthma & Immunology

❍ Taking on Asthma

This site provides information about an initiative to reduce the negative 

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health consequences associated with asthma.

● American Association of Health Plans

❍ Taking on Asthma

This site provides information about an initiative to reduce the negative 

health consequences associated with asthma.

● American Lung Association's Asthma Site

ALA provides information about asthma and older people, teens and asthma, 

asthma medicines and attacks, peak flow meters, and home control of 

allergies and asthma.

● Asthma and Allergy Foundation of America

AAFA provides information about asthma and allergy education, advocacy, 

and research.

● Center for Health Care Strategies (CHCS)

CHCS directs national programs on behalf of two major health care 

philanthropies: The Robert Wood Johnson Foundation and The Annie E. Casey 

Foundation.

❍ Improving Asthma Care for Children Program

● Institute of Medicine

❍ Clearing the Air: Asthma and Indoor Air Exposure

This book provides information about the role that indoor air pollution 

plays in asthma causation, prevalence, triggering, and severity.

● National Association of State Boards of Education

❍ State-Level School Health Policies

This site includes information on state legal codes, rules, standards, 

administrative orders, mandates, and resolutions, and links to 

additional resources.

● National Conference of State Legislatures (NCSL)

NCSL is a bipartisan, national forum for state lawmakers to communicate with 

one another and to share ideas on various topics, including asthma.

❍ Asthma Web Resources

This site includes links to policy briefs on asthma, analyses of state 

legislation, and a searchable database of state legislation and statutes.

❍ Asthma: A Growing Epidemic (Environmental Health Series, 2000)

❍ State Policies Regarding Student Rights to Possess & Self-Administer 

Prescribed Medications for Asthma & Anaphylaxis

● National Heart, Lung, and Blood Institute

❍ National Asthma Education and Prevention Program

This site provides information about the program and about asthma 

according to target audience.

❍ Guidelines for the Diagnosis and Management of Asthma

● National Institute of Allergy and Infectious Diseases

NIAID provides support for scientists conducting research aimed at 

developing better ways to diagnose, treat, and prevent asthma.

● National Institute for Occupational Safety and Health (NIOSH)'s 

Asthma and Allergies Web site

NIOSH is the arm of CDC that conducts research and makes 

recommendations for the prevention of work-related disease and injury. This 

site provides information on occupational asthma and allergies.

● National Library of Medicine (NLM)

NLM, the largest online medical library, provides health information, library 

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services, research programs, and general information related to topics such 

as asthma.

● PBS Kid's All About Asthma

This site helps children learn what asthma is, what can trigger asthma 

attacks, and how to stay active and healthy if they have asthma.

● Quest for the Code: An Adventure Game About Managing Asthma for 

Children

This site provides information on a free CD-ROM created to help children ages 

7 to 15 learn how to manage their asthma.

● U.S. Environmental Protection Agency (EPA)

❍ AirNow Web site

This site offers air quality information by state and select cities, air 

quality forecasts and corresponding health effects, ozone maps, air 

pollution publications, and steps you can take to reduce air pollution.

❍ Asthma and Indoor Environments

This document provides information on how to reduce common asthma 

triggers in the home and other indoor environments.

❍ Clear Your Home of Asthma Triggers

This document provides information on how to eliminate asthma 

triggers in the home and how to reduce symptoms in children.

❍ Mold, Moisture and Your Home

This guide tells how to clean up residential mold problems and prevent 

mold growth.

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Indoor Air

● Indoor Air Quality Information by State

*Links to other federal and nonfederal organizations found at this site are provided solely as a 

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programs by CDC, and none should be inferred. CDC is not responsible for the content of the 

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Asthma 

Content

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Program

Data & 

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Policy

Links

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Home

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Asthma Speaker's Kit for Health Care Professionals

Introduction | Epidemiology | Risk Factors | Prevention

Clinical Management | Managing Asthma

Public Health Response to Asthma | Glossary | Resources

Table of Contents

● Preface

● Introduction

❍ Slide 1: A Presentation on Asthma Management and 

Prevention

❍ Slide 2: What is Asthma?

❍ Slide 3: Pathology of Asthma

● Epidemiology

❍ Slide 5: Asthma Prevalence by Age, U.S., 1980-1996

❍ Slide 6: Asthma Prevalence by Sex, U.S., 1982-1996

❍ Slide 7: Asthma Prevalence by Race, U.S., 1982-1996

❍ Slide 8: Asthma Prevalence by Race, Ages 5-34, U.S., 1980-

1996

❍ Slide 9: Asthma Hospital Discharge Rates by Sex, U.S., 1980-

1998

❍ Slide 10: Asthma Hospital Discharge Rates by Race, U.S., 

1980-1998

❍ Slide 11: Asthma Hospital Discharge Rates by Race, Ages 5-

34, U.S., 1980-1998

❍ Slide 12: Age-Adjusted Asthma Mortality Rates by Sex, U.S., 

1979-1998

❍ Slide 13: Age-Adjusted Asthma Mortality Rates by Race, U.S., 

1979-1998

❍ Slide 14: Asthma Mortality Rates by Race, Ages 5-34, U.S., 

1979-1998

❍ Slide 15: Costs of Asthma

● Risk Factors

❍ Slide 16: Risk Factors for Development of Asthma

❍ Slide 17: Genetic Characteristics

❍ Slide 18: Environmental Exposures

❍ Slide 19: Clearing the Air: Categories for Associations of 

Various Elements

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❍ Slide 20: Clearing the Air: Indoor Air Exposures and Asthma 

Development

❍ Slide 21: Clearing the Air: Indoor Air Exposures and Asthma 

Exacerbation

● Prevention

❍ Slide 22: Reducing Exposure to House Dust Mites

❍ Slide 23: Reducing Exposure to Environmental Tobacco 

Smoke

❍ Slide 24: Reducing Exposure to Cockroaches

❍ Slide 25: Reducing Exposure to Pets

❍ Slide 26: Reducing Exposure to Mold

❍ Slide 27: Other Asthma Triggers

● Clinical Management of Asthma

❍ Slide 28: Clinical Management of Asthma

❍ Slide 29: Diagnosing Asthma: Medical History

❍ Slide 30: Diagnosing Asthma: Patient Checklist

❍ Slide 31: Diagnosing Asthma: Physical Examination

❍ Slide 32: Diagnosing Asthma: Spirometry

❍ Slide 33: Medications to Treat Asthma

❍ Slide 34: Long-term Control

❍ Slide 35: Quick-Relief

❍ Slide 36: How to Use a Spray Inhaler

❍ Slide 37: Inhalers and Spacers

❍ Slide 38: Nebulizers

● Managing Asthma

❍ Slide 39: Asthma Management Goals

❍ Slide 40: Asthma Management Plan

❍ Slide 41: Sample Asthma Management Plan

❍ Slide 42: Peak Expiratory Flow (PEF) Meters

❍ Slide 43: Peak Flow Chart

❍ Slide 44: Indication of a Severe Attack

❍ Slide 45: Things You Can Do

● Public Health Response to Asthma

❍ Slide 46: A Public Health Response to Asthma

❍ Slide 47: Surveillance

❍ Slide 48: Uses of Surveillance Data

❍ Slide 49: Education

❍ Slide 50: Coalitions

❍ Slide 51: Advocacy

❍ Slide 52: Interventions

❍ Slide 53: Medical Management Interventions

❍ Slide 54: Environmental Interventions

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❍ Slide 55: School Interventions

❍ Slide 56: Schools: Absences

❍ Slide 57: Schools: Harmful Exposures

❍ Slide 58: Schools: Actions

❍ Slide 59: Evaluation

❍ Slide 60: Summary

❍ Slide 61: Resources 1

❍ Slide 62: Resources 2

● Appendix A: Glossary

● Resources

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Asthma Speaker's Kit for Health Care Professionals

Introduction | Epidemiology | Risk Factors | Prevention

Clinical Management | Managing Asthma

Public Health Response to Asthma | Glossary | Resources

Preface

Asthma is a complex disease that is increasing in prevalence in the United 

States. Poor, inner-city minorities have disproportionately high rates of 

mortality from asthma. We still don’t know what causes this disease or how to 

cure it, but science shows us that asthma can be well controlled.

This slide presentation depicts the pathophysiology of the disease; prevalence, 

mortality, and morbidity measures at the national level; risk factors; medical 

management; and the public health response needed to successfully fight 

asthma.

The public health response to asthma has several components. The first is 

surveillance, which allows us to quantify how much asthma exists in the 

population, how severe it is, how well it is being controlled, and how much it 

costs. Sound data will allow us to make sound decisions when developing 

asthma programs.

Education is another component and can be either a part of a larger intervention 

or a stand-alone activity. Coalition building is a third component of the public 

health response, because a disease of this complexity requires the joint and 

committed efforts of a variety of partners. Advocacy is also required because 

asthma needs to be addressed in a comprehensive manner by multiple 

government agencies. Legislative issues include students’ access to medication 

at school and third-party reimbursement for patient asthma education.

Interventions are a key component and fall into the areas of medical 

management, environment, and schools. Finally, evaluation is needed to allow 

us to assess whether we are doing things right and whether we are doing the 

right things. A well-designed surveillance system coupled with appropriate 

process measures will provide sound evaluation results.

top

Introduction

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● Slide 1: A Presentation on Asthma Management and Prevention

Asthma is a complex disease that requires a long-term and 

multifaceted solution. This includes educating, treating, and 

providing ongoing medical care and monitoring for people with the 

disease, changing behaviors that lead to asthma or make it worse, 

and eliminating or avoiding triggers. All the topics we discuss today 

total "A Public Health Response to Asthma." 

● Slide 2: What is Asthma?

Asthma is a chronic disease of the airways that causes recurrent 

and distressing episodes of wheezing, breathlessness, chest 

tightness, and nighttime or early morning coughing. Asthma can be 

difficult to diagnose and to differentiate from other respiratory 

illnesses. 

● Slide 3: Pathology of Asthma

Airways are the passages that carry air to the lungs. As the airways 

progress through the lungs, they become smaller, like branches of a 

tree. It is currently thought that asthma produces its effects by 

leading to airway inflammation and airflow limitation. This 

inflammation may even be present when a person's asthma is 

asymptomatic (that is, when the person does not have any 

symptoms). 

When asthma is under control, as in the diagram on the left, the 

airways are clear, and air flows easily in and out. When asthma is 

not under control, the sides of the airways in the lungs become 

inflamed and swollen, as in the diagram on the right. During an 

attack, muscles around the airways constrict, and less air passes in 

and out of the lungs. Excess mucus forms in the airways, clogging 

them even further. The attack, also called an episode or 

exacerbation, can include coughing, chest tightness, wheezing, and 

difficulty breathing.

Asthma can be difficult to diagnose in infants, young children, the 

elderly, smokers, workers exposed to chemical inhalants, people 

with seasonal allergies, and people with recurrent acute respiratory 

infections. Regular physical exams that include measurements of 

lung function and evaluations of a patient's allergic status can help 

ensure a proper diagnosis.

top

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Epidemiology

● Slide 4: Epidemiology

Epidemiology is the study of the distribution and determinants of 

diseases and injuries in human populations. Epidemiologists 

describe who has a disease in a population to help identify its 

causes. Once the cause is understood, interventions can be 

developed to prevent, manage, and control the disease.

Although much is known about asthma physiology, triggers, and 

treatment, more information is needed to adequately define the 

scope of the problem across the country and to help pinpoint the 

actual cause of the disease. Epidemiologic studies will help us better 

understand which subpopulations are most severely affected by 

asthma and why. That information can help us focus interventions 

where they can be the most effective.

 

top

● Slide 5: Asthma Prevalence by Age, U.S., 1980-1996

Historically, the prevalence of asthma has been measured from a 

question on the National Health Interview Survey. It is simply the 

percentage of respondents who answer "yes" to the question "In 

the past 12 months, has anyone in the family had asthma"? This 

slide demonstrates the increase in 12-month asthma prevalence 

from 1980 to 1996. After 1996, the question about asthma was 

changed to ask about lifetime, medically diagnosed asthma. We can 

no longer measure asthma prevalence comparable to the 12-month 

prevalence value. 

In the graph, the yellow line indicates the percentage of the U.S. 

population affected by asthma each year. The prevalence of asthma 

increased from 3.1% in 1980 to 5.5% in 1996. The red and green 

lines show the difference in the prevalence of asthma for children 

and adults. The prevalence of asthma in children (under age 18 

years) is higher than it is in adults (age 18 and older). Asthma is 

the second most prevalent chronic condition among children. It 

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results in approximately 14 million days of missed school each year. 

In 1980, 3.6% of children had asthma. By 1995, the prevalence 

had increased to 7.5%, or approximately 5 million children. The 

decline to 6.2% for children in 1996 may be the beginning of a new 

trend, or it may simply result from random variation due to survey 

sampling procedures. In 1996, the sample size was considerably 

smaller than it was in earlier years, which results in greater 

variability in estimates. 

top

● Slide 6: Asthma Prevalence by Sex, U.S., 1982-1996

This graph shows prevalence from 1982 to 1996 by sex. The green 

line is for females and the red line is for males. Before 1992, 

prevalence differed only slightly. After 1992, however, the 

percentages for women were significantly higher than those for 

men. 

top

● Slide 7: Asthma Prevalence by Race, U.S., 1982-1996

This graph shows the prevalence from 1982 to 1996 by race. The 

green line is for whites and the red line is for blacks. Although 

prevalence for blacks each year is generally higher than that for 

whites, it is only significantly higher for 5 of the 15 years - 1988, 

1991, 1993, 1995, and 1996. In 1996, the percentage for blacks 

was 7.0% and the percentage for whites was 5.3%.

top

● Slide 8: Asthma Prevalence by Race, Ages 5-34, U.S., 1980-1996

Some researchers believe that 5 to 34 is a better age range for 

studying asthma because it is not confounded by the difficulty of 

diagnosis in very young children and by other diseases in the older 

population. This graph shows 12-month asthma prevalence for 

those age 5-34 by race. 

top

● Slide 9: Asthma Hospital Discharge Rates by Sex, U.S., 1980-1998

One way we can assess the morbidity, or impact on quality of life, 

of a particular illness is by determining the rate of hospitalizations 

from that illness. From 1980 to 1998, rates were consistently higher 

for females than for males. Asthma unnecessarily reduces the 

quality of life for many people. For example, hospitalizations for 

asthma cause people to miss school, work, and other activities. 

With proper disease management, however, people with asthma 

can lead more healthy, active lives.

top

● Slide 10: Asthma Hospital Discharge Rates by Race, U.S., 1980-

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1998

From 1980 to 1998, rates were consistently higher for blacks than 

for whites, and the rates for people of other races varied more 

because of the relatively smaller size of the population. 

top

● Slide 11: Asthma Hospital Discharge Rates by Race, Ages 5-34, 

U.S., 1980-1998

Hospitalization rates were consistently higher for children aged 5-14 

years than for older children and adults in both racial groups, 

although for whites the values for the two age groups were fairly 

close for several years. 

top

● Slide 12: Age-Adjusted Asthma Mortality Rates by Sex, U.S., 1979-

1998

During 1993 through 1998, more than 5,000 Americans died from 

asthma each year. With proper asthma management, many of 

these deaths might have been prevented. The green line is the 

mortality rate for women and the red line is for men. The yellow 

line represents the total population.

Clearly, asthma mortality rates rose during that period. Women 

have had higher mortality rates than men since 1981, but they did 

not have higher prevalence rates than men until after 1991. Most of 

the increase occurred before 1992 and the increase was greater in 

women than it was in men. Researchers have not yet determined 

the cause of the increase.

top

● Slide 13: Age-Adjusted Asthma Mortality Rates by Race, U.S., 1979-

1998

From 1979 through 1998, blacks had higher mortality rates from 

asthma than whites. In addition, the increase in mortality rates was 

greater for blacks than for whites. 

● Slide 14: Asthma Mortality Rates by Race, Ages 5-34, U.S., 1979-

1998

The 5- to 34-year age category is often used because some studies 

have shown that asthma is most accurately identified as a cause of 

death in that age group. Even though the rates are lower than 

those for all ages combined, asthma mortality rates clearly rose for 

this age group as well. Rates for the white and other race 

categories did not differ for this age group, and the rates for blacks 

were much higher.

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● Slide 15: Costs of Asthma

Kevin Weiss, et al. estimated that the cost of asthma in the United 

States in 1990 was 6.2 billion dollars and in 1998 was 12.7 billion 

dollars. Using figures from the later time, costs for 2000 would be 

around 13.8 billion dollars. The direct costs of asthma include the 

costs of asthma management programs, inpatient and outpatient 

medical care, physician services, emergency visits, ambulance use, 

drugs, short-term and long-term treatment complications, devices, 

nursing services, allergy testing, and research. Some of the indirect 

costs of asthma include absence from work and school; travel; time 

waiting for care; and at its most extreme, death. Costs most 

difficult to measure are anxiety, pain, suffering, and decreased 

potential resulting from school absenteeism.

Asthma drains the nation's health-care budget. Time, energy, and 

money are being spent in hospitals and emergency departments 

where services are expensive and do not address long-term 

reduction of symptoms. Although appropriate management of 

people with asthma should decrease the overall cost of the disease 

to society, the most important benefit would be the improved health 

and well being of people with asthma and their families.

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Risk Factors

● Slide 16: Risk Factors for Development of Asthma

Risk factors are characteristics of people that increase the 

probability that they will experience a specific disease or a condition 

associated with a disease. Risk factors for asthma include genetic 

predisposition and environmental exposures, such as house dust 

mites and environmental tobacco smoke. However, just because a 

person is at risk for a disease does not mean that he or she will 

develop that disease. Being aware of the risk factors may help 

people take precautions to avoid acquiring those diseases or 

conditions. Other risk factors to asthma can cause someone with 

the disease to have an exacerbation (worsening) of symptoms. We 

will talk about those risk factors later. 

top

● Slide 17: Genetic Characteristics

Atopy is a genetic factor characterized by the body's production of 

immunoglobulin E after exposure to common environmental 

allergens. A person with high levels of IgE in the blood is more 

likely to have an allergic response when exposed to certain 

substances in the environment - so high levels of IgE may predict 

the future development of asthma. If a person has a parent with 

asthma, he or she is three to six times more likely to develop 

asthma than someone who does not have a parent with asthma.

top

● Slide 18: Environmental Exposures

In 2000, the Institute of Medicine published the report "Clearing the 

Air." This report reviews the evidence about indoor air exposures 

and asthma as presented in the scientific literature. The report 

looked at components that affected both the development of the 

disease itself and the exacerbation of symptoms in someone who 

already has the disease. 

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● Slide 19: Clearing the Air: Categories for Associations of Various 

Elements

The committee used a uniform set of categories to summarize its 

conclusions about the association between exposure to indoor 

agents and asthma. We will focus on the first three categories. 

❍ Sufficient evidence of a causal relationship.

This means that the evidence is strong enough to document 

that exposure to these substances causes the disease’s onset 

or exacerbation.

❍ Sufficient evidence of an association.

This means that the evidence is strong enough to document 

an association between the agent and the outcome has been 

observed in studies in which chance, bias, and confounding 

factors can be reasonably ruled out.

❍ Limited or suggested evidence of an association.

This means that the evidence suggests an association, but 

chance, bias, and confounding factors cannot be ruled out 

with confidence.

top

● Slide 20: Clearing the Air: Indoor Air Exposures and Asthma 

Development

The Institute of Medicine committee concluded evidence was 

sufficient to suggest a causal relationship between exposure to 

house dust mite allergen and development of asthma in susceptible 

children. It also found sufficient evidence of an association between 

exposure to environmental tobacco smoke - also know as ETS or 

secondhand smoke - in younger children and the development of 

asthma. This includes both prenatal exposure to active maternal 

smoking and ETS exposure after birth. Lastly, they found some 

evidence to link asthma's development with exposure to cockroach 

allergen in preschool-aged children, and with infections with 

respiratory syncytial virus (RSV). 

top

● Slide 21: Clearing the Air: Indoor Air Exposures and Asthma 

Exacerbation

Four exposures are considered causes of asthma exacerbations: 

exposures to cat, cockroach, and house dust mite allergen, and 

exposure of young children to ETS.

Four additional exposures are associated with worsening the 

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disease: dog allergen, fungi or molds, rhinoviruses, and a high level 

of exposure to nitrous oxides.

Evidence suggests an association between asthma exacerbations 

and exposure to domestic birds, ETS in older children and adults, 

formaldehyde, fragrances, and several respiratory infectious agents.

Let's look closer at some of these agents that the Institute of 

Medicine identified and consider ways to reduce the level of 

exposure to these agents in the home. 

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Prevention

● Slide 22: Reducing Exposure to House Dust Mites

Dust mites thrive in soft furnishings like pillows, mattresses, 

carpets, and drapes. These microscopic organisms give off particles 

that cause allergic reactions when inhaled. They need moisture to 

survive and therefore thrive in humid environments. Decreasing the 

number of dust mites to which people with asthma are exposed 

may help control their asthma. One key way of doing this in the 

bedroom is by using mattress and pillow case covers. These 

bedding encasements, which are available commercially, may be 

plastic or vinyl and are covered with cotton, nylon, or knit fabric. 

They provide a barrier between the dust mites and the person with 

asthma. A sheet and pillow case are usually placed over the 

encasement for increased comfort. Any linens placed over the 

encasements should be washed weekly in hot water. 

Down-filled pillows, quilts, or comforters should not be used. Down 

filling consists of tiny feathers that contain large numbers of dust 

mites. Also, stuffed animals and clutter should be removed from the 

bedroom.

If a child with asthma wants to play or sleep with a stuffed toy, 

wash the toy frequently in hot water, or put it in the freezer for a 

few hours every 2 weeks. Freezing cold kills dust mites as 

effectively as hot water. The hot water needs to be about 130 

degrees to kill mites, and this is generally hotter than most 

household hot water. If you re-set your hot water heater 

thermostat to 130 degrees, you have to take other precautions to 

prevent scalding.

Another thing to consider in the bedroom is getting rid of fabric 

curtains and replacing them with shades or mini-blinds. Replace 

upholstered chairs with plastic or wood, and, if possible, get rid of 

carpeting in favor of vinyl or wood floors with area rugs that can be 

shaken out frequently. Because dust mites need high humidity, try 

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to keep the humidity levels in your home to under 50%. In hot, 

humid climates, this requires the use of air conditioning and 

possibly dehumidifiers. In dryer, cooler climates, you may be able 

to achieve this by opening windows and ensuring good air flow. 

top

● Slide 23: Reducing Exposure to Environmental Tobacco Smoke

Any discussion of reducing harmful exposures that exacerbate 

asthma in children must include steps to combat exposure to ETS. 

Parents of children with asthma should try to stop smoking. Until 

they can successfully quit, they should smoke only outdoors, not in 

the home or in the family car. They should not allow others to 

smoke in the home and should make sure the child's school is 

smoke-free.

The effects of ETS and other indoor air pollutants are sometimes 

compounded by the fact that many homes and offices built from the 

1970s on were built tightly for energy efficiency, which allows little 

fresh air circulation and increases the potential for exposure. 

top

● Slide 24: Reducing Exposure to Cockroaches

Allergy to cockroaches is an important risk factor for worsening 

asthma. Decreasing exposure to cockroaches in the home can help 

reduce asthma attacks. To do this, remove as many water and food 

sources as possible because cockroaches need food and water to 

survive. That is why kitchens and bathrooms are areas where we 

commonly see cockroaches. Food, including pet food, or water 

anywhere in the home will attract roaches, so immediately wash 

soiled dishes, throw away discardable food containers, and remove 

standing water from all rooms. Keep trash in closed containers, and 

keep food covered and put away. Discard grocery bags, 

newspapers, cardboard boxes, and other clutter.

People tend to eat where they watch television. As a result, 

cockroaches and cockroach remains are frequently found in living 

rooms, family rooms, and bedrooms. You may find cockroaches any 

place where food is eaten and crumbs are left behind. These areas 

will need to be vacuumed or swept at least every 2-3 days to get 

rid of food crumbs.

top

● Slide 25: Reducing Exposure to Pets

Animals are a common source of allergens. They shed fur and 

feathers; they leave saliva, urine, and feces. Cats and rodents are 

potent asthma sensitizers, whereas dogs cause less allergic 

sensitivity than other mammals. People with asthma may find that 

their pets trigger an attack. The simplest solution to this situation 

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is, of course, to find another home for the pet. However, some pet 

owners may be too emotionally attached to their pets or unable to 

locate a safe new home for the animal. Fortunately, other steps can 

be taken to reduce the impact of pet allergens in the home.

At the very least, any animal causing an allergic reaction should not 

be allowed in the bedroom of the affected person. Pets such as cats 

and dogs should be kept outside as much as possible. Frequent 

vacuuming will help to minimize the presence of the allergen. If the 

room has a hard surface floor, it should be damp mopped weekly. If 

you have carpeting, try to use a vacuum cleaner equipped with a 

high-efficiency particle arresting or HEPA filter. At a minimum, use 

specifically designed micro-filtration vacuum cleaner bags, which 

can be purchased at any department store. Use pet beds or 

blankets that are washable, and wash them weekly. If the 

veterinarian says it's OK, bathe the animal every week or two.

top

● Slide 26: Reducing Exposure to Mold

When mold is inhaled, it can cause asthma attacks. Mold grows 

outdoors and indoors, especially in humid areas like bathroom 

showers and basements. Eliminating mold throughout the home can 

help control asthma attacks. To do this, one needs to keep humidity 

levels between 35 and 50%. A gauge called a hygrometer can be 

used to monitor humidity levels. When the humidity is above 60%, 

a dehumidifier or air conditioner should be used and the windows 

kept closed. If a humidifier must be used, it should be cleaned 

weekly with diluted bleach, and the water should be changed daily 

so that mold does not grow. 

In the kitchen, use an exhaust fan to remove water vapor when 

cooking. Each week, empty water pans which are found below selfdefrosting refrigerators. Remove spoiling foods immediately. Empty 

trash frequently to keep the home clean. In the bathroom, use an 

exhaust fan or open a window to remove humidity after showering. 

Use a squeegee to remove excess water from the shower stall, tub, 

and tiles.

Vent a clothes dryer by attaching a vent hose to it and running the 

hose outside. Dry clothes immediately after washing, either in a 

dryer or by hanging clothes outside.

Do not lay carpet and pad on a concrete floor. Correct seepage or 

flooding problems, and remove any previously flooded carpets. 

Ideally, people with asthma should not have bedrooms on the 

basement level, especially if the basement tends to be humid. Also, 

they should not have potted plants in their bedroom because the 

soil is a breeding ground for mold. 

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top

● Slide 27: Other Asthma Triggers

In addition to the indoor agents studied extensively by the Institute 

of Medicine, there are other possible triggers for asthma that affect 

some people. These triggers can include strenuous physical 

exercise; adverse weather conditions like freezing temperatures, 

high humidity, and thunderstorms; and some foods and food 

additives and drugs. Strong emotional states, either positive or 

negative, can lead to hyperventilation and an asthma episode. 

However, with proper management, many of these episodes can be 

avoided.

Outdoor air pollution, caused by industrial emissions and 

automobile exhaust, also can cause an asthma episode. In fact, in 

large cities that have air pollution problems like Los Angeles, 

Houston, and Atlanta, the number of emergency department visits 

for asthma episodes goes up during ozone action days when the air 

quality is especially poor. 

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Clinical Management of Asthma

● Slide 28: Clinical Management of Asthma

We are fortunate to have available standards related to asthma 

care. These are the Clinical Practice Guidelines developed by the 

National Asthma Education and Prevention Program's Expert Panel, 

under the National Heart, Lung and Blood Institute. Developed in 

1991 and updated in 1997 and 2002, these guidelines offer specific 

advice in several key areas of asthma assessment and 

management. The guidelines provide a gold standard for asthma 

care and are recognized by federal public health agencies, healthcare providers, universities, and nonprofit organizations. 

top

● Slide 29: Diagnosing Asthma: Medical History

Asthma can be difficult to diagnose. Clinicians use a variety of 

means to try to determine whether episodic symptoms of airflow 

obstruction are present and whether this obstruction is at least 

partially reversible. A detailed medical history is a key element of 

this process.

The physician may ask questions about coughing, especially at 

night, and whether the patient's breathing problems are worse after 

physical activity or during a particular season. Other symptoms, 

such as chest tightness, wheezing, colds that last beyond 10 days, 

and relief after use of medication, should be discussed. 

The physician will ask about the patient's family history of asthma, 

allergy, sinusitis, rhinitis or nasal polyps, and home environment. 

The physician also will try to quantify the severity of disease by 

asking about its impact on the patient and his or her family 

members - such as lost school or work days and limitation of 

activity.

top

● Slide 30: Diagnosing Asthma: Patient Checklist

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A physician may ask questions such as these when examining 

someone with possible asthma:

❍ Do you have a troublesome cough, particularly at night?

❍ Are you awakened by coughing or difficult breathing?

❍ Do you cough or wheeze after physical activity?

❍ Do you have breathing problems during a particular season?

❍ Do you cough, wheeze, or develop chest tightness after 

exposure to allergens?

❍ Do colds "go to your chest" or last more than 10 days?

❍ Do you use any medications? How often?

❍ Are your symptoms relieved after you take medication?

top

● Slide 31: Diagnosing Asthma: Physical Examination

In the absence of specific symptoms, some physical findings still 

increase the possibility that a patient has asthma. These include:

❍ A wheezing sound in the lungs

❍ Hyperexpansion of the chest area (expansion of the area 

between the neck and abdomen), especially in children

❍ Hunched shoulders

❍ Chest deformity

❍ Nasal swelling

❍ Increased secretions or polyps, and

❍ Indications of an allergic skin condition

The physician may suggest that the patient be tested for allergies to help 

isolate substances to which he or she has a strong allergic reaction.

top

● Slide 32: Diagnosing Asthma: Spirometry

Testing of lung function, or spirometry, is another means of 

diagnosing asthma. A spirometer is a piece of equipment that 

measures the maximum amount of air forcibly exhaled from the 

lungs after the patient has taken a very deep breath. Airflow can be 

measured before and after a patient uses a fast-acting 

bronchodilator to determine the medication’s affect on reversing 

airflow obstruction. 

top

● Slide 33: Medications to Treat Asthma

Because everyone's asthma is different, medications to treat it 

come in many forms: liquids, pills, powders, vapors, and injections. 

Treating asthma involves managing both the chronic inflammation 

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and recurrent episodes of airflow limitation and bronchoconstriction. 

top

● Slide 34: Long-term Control

Long-term control medicines are taken daily over a long period of 

time. The most effective of these to reduce inflammation of the 

airways are corticosteroids, which are generally prescribed in 

inhaled form or in pills. Another important type of long-term control 

medicine is long-acting beta2-agonists. Usually inhaled, but also 

available orally, this medicine relaxes the smooth muscles of the 

airways for long-term prevention of symptoms, especially at night.

The last type of long-term control medication to treat asthma is 

leukotriene modifiers. Leukotriene modifiers may be considered as 

alternative therapy to low doses of inhaled corticosteriods for 

children with mild persistent asthma, but the position of leukotriene 

modifiers in therapy has not been fully established. Leukotriene 

modifiers improve symptoms and pulmonary function and reduce 

the need for quick-relief medications. 

top

● Slide 35: Quick-Relief

Quick-relief medications are used to help counter the effects of an 

acute asthma episode. These are generally short-acting beta2-

agonist bronchodilators delivered through an inhaler. People with an 

inhaler need to know how to use it correctly for the drug to reach 

the lungs and have a full effect. 

top

● Slide 36: How to Use a Spray Inhaler

Inhalers also are called metered-dose inhalers, meaning that 

medications are measured by the inhaler apparatus. They are 

usually the press-and-breathe type. 

Many people, especially young children, have a hard time 

coordinating the pressing and the breathing. This means they may 

not get the full dose of their medication. If an inhalant is not having 

much effect, it could mean the person is not using it properly or it is 

blocked or empty. A health-care provider should evaluate the 

technique of patients using inhalers at each visit.

If the health-care provider sees that someone is having difficulty 

using the inhaler, he or she can prescribe a spacer. Spacers come in 

a variety of shapes and sizes, but the concept is the same for all. 

The inhaler is attached at one end and a mouthpiece at the other 

end. When the inhaler is pressed, the drug is released into the 

spacer chamber and the person can slowly inhale it in two or three 

breaths. 

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top

● Slide 37: Inhalers and Spacers

Spacers also can reduce potential side effects like mouth sores and 

mouth dryness common to some inhaled medications. Here are 

some examples of actual inhalers and spacers. 

top

● Slide 38: Nebulizers

A nebulizer is a device which allows people to inhale asthma 

medication in a mist or wet aerosol. It consists of a cup, a 

mouthpiece attached to a T-shaped port or a mask, and thin plastic 

tubing to connect to the compressed air machine. This equipment 

may be needed for small children or others who cannot coordinate 

the use of an inhaler. It is often used in emergency departments to 

deliver medicine quickly and effectively to a person having severe 

symptoms. 

top

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Managing Asthma

● Slide 39: Asthma Management Goals

Treating some diseases by taking a pill once a day may be 

sufficient. Asthma is much more complex to treat. Asthma must be 

managed in a comprehensive fashion. The goals of a successful 

asthma management program are to: 

❍ Achieve and maintain control of symptoms

❍ Prevent asthma exacerbation

❍ Maintain pulmonary function as close to normal levels as 

possible

❍ Avoid adverse effects from asthma medications

❍ Prevent irreversible airway obstruction, and

❍ Prevent death from asthma

Proper case management should avert many emergency visits and 

hospital stays as well as much of the anxiety associated with asthma. 

Education is the key, not only for people with asthma, but also for their 

families and care givers and for physicians and researchers. 

top

● Slide 40: Asthma Management Plan

Individual management plans should be developed with a physician. 

Different people have different requirements and specific triggers 

that initiate their attacks and need to be avoided. The management 

plan should be guided by the severity of the person’s asthma, the 

benefits and risks of each treatment, and the availability of the 

various forms of treatment. Routine follow-up care is an integral 

part of good management. As people with asthma grow and 

change, their asthma also changes, and their management plan 

needs to address those changes. An asthma management plan 

should serve as a communications tool between the physician, the 

person with asthma, and his or her family.

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Educating people with asthma is crucial to the success of any 

management plan. Patients may be reluctant to continue taking 

prescribed medicines simply because they do not understand that 

the medications are not addictive -- a common fear that often is not 

addressed. People with asthma also need to understand the correct 

way to inhale their medications and to monitor lung function with 

peak flow meters. In addition, these individuals and their families 

need to know what actions to take if they are faced with an asthma 

emergency. A well thought-out management plan, discussed during 

routine health-care visits, will address these concerns.

top

● Slide 41: Sample Asthma Management Plan

An asthma management plan like the one shown here helps people 

with asthma determine what medicines to use and what actions to 

take in particular situations. If they are breathing well, have no 

cough or wheeze, and have no trouble at work or play, they are in 

the green zone. Green means go and they should continue to use 

preventive medicines. If they experience a cough, wheeze, or tight 

chest, or wake up at night, they are in the yellow zone and should 

take caution and administer quick-relief medication. If the medicine 

has no effect or they are experiencing trouble breathing, they are in 

the red, danger zone and should get medical assistance.

A key indicator as to a person's overall respiratory wellness is his or 

her peak flow number. This is determined by using a peak 

expiratory flow (PEF) meter, a device which measures how well air 

moves out of the lungs.

top

● Slide 42: Peak Expiratory Flow (PEF) Meters

These are peak expiratory flow meters. PEF meters come in 

different styles, but they all measure the amount of air a person 

can blow out in liters per minute. You set the indicator to zero, take 

a deep breath, put your lips around the mouthpiece and exhale as 

hard and fast as you can. Then you read the number on the scale.

The proper use of PEF meters can help predict asthma episodes and 

monitor response to therapy. The goal is to monitor the airflow 

consistently to recognize any changes from normal. People with 

asthma need to know how and when to use the PEF meter and how 

to record the results.

top

● Slide 43: Peak Flow Chart

This is an example of a peak flow chart. The chart can help display 

a person's personal control zone, caution zone, and danger zone. 

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People with moderate persistent or severe persistent asthma should 

take peak flow readings and record them every morning and 

evening and before inhaling certain medications. A person also 

should take a peak flow reading when he or she has symptoms to 

determine the severity of the episode and monitor the response to 

therapy.

top

● Slide 44: Indication of a Severe Attack

An attack can worsen over minutes, hours, or even days. 

Recognition and proper treatment of an attack can prevent 

discomfort, and in some cases, emergency care and hospitalization. 

In an attack, symptoms should be listed and the peak expiratory 

flow (PEF) rate determined. If a person's PEF is below his or her 

green zone despite increased medication, the attack may be 

worsening. The attack also may be worsening if the person needs 

more quick-relief medication or feels that the medication is not 

helping as much as it usually does.

A mild attack usually can be treated at home with quick-relief 

bronchodilator medication. A patient's individual management plan 

should provide the physician and patient with a guideline to follow, 

including prescription medication that may require consistent use 

for several days to improve the symptoms of the attack. A 

moderate attack may require a physician visit or hospital care. 

Patients who do not respond promptly to the medication or who 

have the symptoms listed here need emergency care.

top

● Slide 45: Things You Can Do

An effective management plan for asthma requires avoiding the 

things that cause attacks and taking the appropriate medications to 

prevent symptoms. A physician-patient partnership in which asthma 

is continually controlled and monitored is essential to a successful 

plan.

Educating people with asthma and parents of children with asthma 

is a major part of controlling the disease. Many people already are 

aware of the benefit of asthma management; they just need to 

know how to better participate in their own care. Many things can 

be done to promote better care for people with asthma. For 

example, existing asthma resources can be used to help teach the 

benefits of proper asthma management. Forming asthma support 

groups at local schools is a good way to reach children with asthma. 

Groups such as the Asthma and Allergy Foundation of America; 

Allergy and Asthma Network, Mothers of Asthmatics; and the 

American Lung Association are willing to share their experience and 

information with those interested in starting an asthma support 

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group.

top

● Slide 35: Quick-Relief

Quick-relief medications are used to help counter the effects of an 

acute asthma episode. These are generally short-acting beta2-

agonist bronchodilators delivered through an inhaler. People with an 

inhaler need to know how to use it correctly for the drug to reach 

the lungs and have a full effect. 

top

● Slide 36: How to Use a Spray Inhaler

Inhalers also are called metered-dose inhalers, meaning that 

medications are measured by the inhaler apparatus. They are 

usually the press-and-breathe type. 

Many people, especially young children, have a hard time 

coordinating the pressing and the breathing. This means they may 

not get the full dose of their medication. If an inhalant is not having 

much effect, it could mean the person is not using it properly or it is 

blocked or empty. A health-care provider should evaluate the 

technique of patients using inhalers at each visit.

If the health-care provider sees that someone is having difficulty 

using the inhaler, he or she can prescribe a spacer. Spacers come in 

a variety of shapes and sizes, but the concept is the same for all. 

The inhaler is attached at one end and a mouthpiece at the other 

end. When the inhaler is pressed, the drug is released into the 

spacer chamber and the person can slowly inhale it in two or three 

breaths. 

top

● Slide 37: Inhalers and Spacers

Spacers also can reduce potential side effects like mouth sores and 

mouth dryness common to some inhaled medications. Here are 

some examples of actual inhalers and spacers. 

top

● Slide 38: Nebulizers

A nebulizer is a device which allows people to inhale asthma 

medication in a mist or wet aerosol. It consists of a cup, a 

mouthpiece attached to a T-shaped port or a mask, and thin plastic 

tubing to connect to the compressed air machine. This equipment 

may be needed for small children or others who cannot coordinate 

the use of an inhaler. It is often used in emergency departments to 

deliver medicine quickly and effectively to a person having severe 

symptoms. 

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top

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Asthma Health Studies

Division of Laboratory Sciences Mold

Emergency and Environmental 

Health Services

Radiation Studies

U.S.-Mexico Border Environmental 

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Effects

NCEH Home| Programs | Publications | Contact Us | Privacy | About NCEH

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This page last reviewed September 09, 2004

Air Pollution and Respiratory Health Branch

National Center for Environmental Health

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Content

Home

Basics

CDC 

Program

Data & 

Surveillance

Interventions

Legislation & 

Policy

Links

Air Pollution 

& 

Respiratory 

Health 

Content

Home

About the 

Program

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and Forest 

Fires

Asthma

Carbon 

Monoxide 

Poisoning

Chronic 

Obstructive 

Pulmonary 

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Mold

Links

Asthma Speaker's Kit for Health Care Professionals

Introduction | Epidemiology | Risk Factors | Prevention

Clinical Management | Managing Asthma

Public Health Response to Asthma | Glossary | Resources

Public Health Response to Asthma

● Slide 46: A Public Health Response to Asthma

As you can see, asthma is a complex disease which requires a 

coordinated and multifaceted response from many organizations to 

effectively combat it. I'd like to take some time to discuss the 

components of a public health response to asthma. You can think 

about where you and the organizations or interests you represent fit 

into this response. 

top

● Slide 47: Surveillance

Surveillance, the process by which the distribution and occurrence 

of asthma in a population is understood over time, is the first step 

to addressing a health problem from a public health perspective. 

The size of the problem is important to know. This might be 

assessed in a number of ways--for example, the number of people 

with a disease or the number of people dying of the disease. With 

asthma, we do not yet know how to prevent or cure the disease, 

but we do know how to decrease its severity. As a result, 

monitoring the number of people with asthma who receive care in 

an emergency department or are hospitalized can be important.

Severity is decreased primarily through disease control. Knowing 

how people with asthma take care of their disease is helpful. For 

example, how many people have asthma-management plans and 

take appropriate medications? Asthma is costly to the medical care 

system and to society. Although disease management is costly, 

emergency care, hospitalizations, and deaths are costly as well. 

Monitoring cost over time provides useful information.

top

● Slide 48: Uses of Surveillance Data

Knowing about the disease means little if we do not act on the 

knowledge and intervene in a manner that improves the health of 

people with asthma. Data are crucial to defining where and what 

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kind of programs are needed, as well as providing information for 

educational purposes.

Finally, data are essential to program evaluation. Good data help 

determine whether we are doing the right thing with our 

interventions and whether we are doing things right.

top

● Slide 49: Education

Asthma education can be a component of a larger intervention or a 

stand-alone activity. Educational programs can be targeted to 

people with asthma, parents of children with asthma, medical-care 

providers, school personnel, and the general public. Asthma 

education needs to cover the spectrum from mass public education 

using a variety of media to one-on-one education in a provider's 

office. At this time, asthma education in the clinical setting is not 

reimbursable by most third-party payers. However, we can look at 

diabetes and see the positive effect of patient education. We can 

use diabetes as a model for targeting the issue of reimbursement 

for education sessions.

top

● Slide 50: Coalitions

For an asthma campaign at any level to succeed, it needs the 

cooperation of a coalition of committed partners. On the national 

level, federal organizations such the National Institutes of Health, 

the Centers for Disease Control and Prevention, and the 

Environmental Protection Agency are working together to address 

asthma. On the state level, health departments can coordinate with 

organizations like the American Lung Association, insurance 

companies and managed-care groups, school districts, universities, 

housing authorities, and medical providers.

In addition, national and state agencies can help support local 

coalitions with modest start-up grants, educational sessions and 

materials, scientifically sound intervention protocols, and 

opportunities to network. 

The former Executive Director of the Arizona Asthma Coalition has 

stated that "The beauty of a coalition is that it fosters collaboration 

by providing the strategic direction, structure, process and the 

safety for like-minded partners to dissolve barriers and build the 

support necessary to achieve its goals." She also acknowledges that 

coalitions are hard work and time consuming and can cause a great 

amount of stress as different groups with different agendas come 

together. Perhaps some of you already have worked with a coalition 

and can relate to the challenges they provide. However, given the 

complexities of asthma and the number of different aspects that its 

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effective management requires, a coalition is a virtually essential 

element of a public health response.

top

● Slide 51: Advocacy

All public health activities require both advocates and resources. A 

well-conceived approach to addressing the asthma problem in your 

jurisdiction, one based on sound data and grounded in science, will 

help you obtain these essential elements. Asthma has numerous 

risk factors, and it needs to be addressed comprehensively by 

multiple government agencies responsible for the environment and 

schools. The private sector, including voluntary organizations, 

health maintenance organizations, and hospitals, also needs to be 

involved. In addition, appropriate legislation can contribute to 

asthma control through means such as ensuring access to asthma 

medication in school or third-party payment for asthma-education 

activities. Clearly, a broad range of policy advocacy is required.

top

● Slide 52: Interventions

Addressing asthma will require intervention activities not only within 

federal, state, and local governments, but also within communities, 

neighborhoods, and homes. Interventions can be simple, focusing 

on a specific element of asthma, or they can be complex and 

integrated to address asthma issues on several fronts. Much 

depends on the level of funding, staff resources, and commitment 

by partners. There are many types and combinations of possible 

asthma interventions. Three major types to be discussed here are 

medical-management, environment, and schools. Active groups to 

facilitate these activities must be formed on all levels, but 

particularly on the local level. Important local-level activities include 

reducing the level of asthma triggers in homes and schools and 

ensuring that all people with asthma receive the medical help 

necessary to manage their asthma.

top

● Slide 53: Medical Management Interventions

Although guidelines exist for state-of-the-art treatment of people 

with asthma, only a small percentage of people with asthma benefit 

from these guidelines. Ensuring that people with asthma know 

about their disease and are empowered to demand appropriate 

management is a role of the public health system. Disseminating 

management guidelines; developing curricula for medical-care 

providers about asthma management; and ensuring appropriate 

management of people treated for asthma in public health clinics or 

public hospitals or with Medicaid dollars are all important public 

health activities.

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top

● Slide 54: Environmental Interventions

The public health system can help people create and maintain a 

healthy home and work environment. Homes need to be pest-free 

because allergens from cockroaches, mice, rats, and other vermin 

can cause asthma episodes. Mold and mildew, which can result 

from structural problems in the home, also can make asthma 

worse. People living in rented or public housing may need 

assistance in convincing landlords to solve these sorts of problems. 

Other sources of allergens and irritants or a dirty household may 

relate to individual behavior. General educational efforts through 

the public health system may help people understand the 

importance of removing these sources from their homes, 

particularly if they or their children have asthma. The public health 

system can also help people obtain low-cost asthma-proofing 

products such as dust mite-impermeable covers for bedding.

Programs also can be established where people work to improve air 

quality. Smoking cessation, declaring areas off-limits to smoking, 

improving air circulation, avoiding or eliminating industrial 

chemicals or other substances with strong odors, and improving 

cleaning procedures can all improve air quality.

top

● Slide 55: School Interventions

School-based asthma education is essential. Asthma is the leading 

cause of school absenteeism caused by a chronic illness. Education 

goes hand-in-hand with modifying the school environment and 

improving asthma awareness in schools. Finally, the nature of 

asthma and its management raises issues that need to be resolved 

through a partnership between school officials, parents, health-care 

providers, and students with asthma. 

top

● Slide 56: Schools: Absences

Asthma is a major concern of parents, teachers, and school 

administrators. However, asthma is not just an issue because of 

school absences. Many children with asthma have to take 

medication during school hours, and medication must be available 

at all times in the event of an attack. Children need access to 

medications in the school, on the playground or sport field, on 

school buses, and during field trips. 

Schools provide an ideal situation for children to learn about asthma 

management in small groups with other children who also have 

asthma. Numerous research efforts have demonstrated the value of 

such activities. School boards and administrators also should seek 

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out asthma information from state or local agencies that could be 

used as in-service training for school staff. 

Because children spend a considerable amount of time in school, 

the physical environment of the school is important in the 

prevention of asthma episodes. Let's look closer at things that can 

affect the indoor quality of a school building.

● Slide 57: Schools: Harmful Exposures

As in a home, water leaks in a school can result in mold and mildew 

growth. Carpet can increase the mold problem and also expose 

children to dust mites when they sit or lie on the floor. Cockroaches 

may be common in food-preparation areas, and air quality may be 

an issue if air circulation is inadequate. Animals in the classroom 

can expose children to pet dander and its related allergens.

Tools for Schools is a program developed at the Environment 

Protection Agency that focuses on developing and maintaining a 

healthy school environment. Although not specially targeted to 

asthma, it addresses the important environmental factors needed 

for a safe environment for children with asthma.

top

● Slide 58: Schools: Actions

Children face many challenges with asthma while they are at 

school. Drug-free school policies have made medications illegal to 

carry in some school districts. Most schools do not have a full-time 

nurse, so a variety of medications, including those for asthma, are 

stored and dispensed by the school's administrative personnel. 

Because the asthma episodes of some children are more likely to 

occur with increased physical activity, teachers and staff members 

should be particularly aware of the condition of a child with asthma 

during gym class and recess. In addition, many students spend 

extra hours on the school grounds when the school nurse and 

administrative personnel may not be present. Providing access to 

medications during these after school periods is an added 

challenge. For every child with asthma, an up-to-date management 

plan should be on file in the school, along with the medications 

needed to respond to that plan. Medications also need to be 

available during sporting events, field trips, and other off-campus 

events.

top

● Slide 59: Evaluation

With all intervention programs, evaluation is necessary to provide 

answers to two questions. First, "Are we doing the right thing?"--in 

other words, are we applying approaches that have been 

demonstrated through scientific research to improve the health of 

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those to whom the intervention is applied? And second, "Are we 

doing things right?"--in other words, as we apply this proven 

approach, are we applying it correctly? A well-designed surveillance 

system coupled with appropriate process measures will provide the 

answers to these evaluation questions.

top

● Slide 60: Summary

Thank you for considering the challenges of asthma management 

and control. I hope this discussion gives you and your organizations 

a better idea of steps you can take to become a part of a Public 

Health Response to Asthma.

top

● Slide 61: Resources 1 and Slide 62: Resources 2

These are some organizations that serve as asthma resources. All of 

these organizations have established asthma information and 

prevention programs to help people manage their asthma. Contact 

any of these organizations when establishing your own asthma 

management program. 

top

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Glossary

Asthma

A chronic inflammatory disorder of the airways. Airway inflammation is 

associated with airway hyper-responsiveness, airflow limitation, and 

respiratory symptoms. In susceptible individuals this inflammation causes 

recurrent episodes of wheezing, breathlessness, chest tightness, and cough, 

particularly at night and/or in the early morning. These symptoms are 

usually associated with widespread but variable airflow limitation. Asthma 

also causes an associated increase in airway responsiveness to a variety of 

stimuli.

Asthma Management

A comprehensive approach to achieving and maintaining control of asthma. 

It includes patient education to develop a partnership in management, 

assessing and monitoring severity, avoiding or controlling asthma triggers, 

establishing plans for medication and management of exacerbations, and 

regular follow-up care.

Atopy

The propensity, usually genetic, for developing IgE-mediated responses to 

common environmental allergens.

Causal factors

Risk factors that sensitize the airways and cause the onset of asthma. The 

most important of these factors are allergens and chemical sensitizes.

Contributing factors

Risk factors that either augment the likelihood of asthma developing upon 

exposure to them, or may even increase susceptibility to asthma. These 

factors including smoking, viral infections, small size at birth, and 

environmental pollutants.

Environmental control

Removal of risk factors from the environment.

Exacerbation

Any worsening of asthma. Onset can be acute and sudden, or gradual over 

several days. A correlation between symptoms and peak flow is not 

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necessarily found.

PEF (peak expiratory flow) home monitoring

Measurement of PEF on regular basis at home with a portable peak flow 

meter. PEF home monitoring is especially useful to patients over 5 years of 

age with moderate persistent to severe persistent asthma.

Risk factor

An agent that when present increases the probability of disorder expression. 

There are two types of risk factors:

❍ Risk factors involved in the development of the condition of 

asthma can be inherited, such as atopy. Alternatively, a risk 

factor can be due to environmental exposure. See "causal 

factors" and "contributing factors."

❍ Risk factors that cause asthma exacerbation in individuals who 

already have the condition. These are also called triggers.

Trigger 

A risk factor that causes exacerbation of asthma; a stimulus that causes an 

increase in asthma symptoms and/or airflow limitation.

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Disclaimer: Links to other federal and nonfederal organizations found at this site are provided 

solely as a service to our users. These links do not constitute an endorsement of these 

organizations or their programs by CDC, and none should be inferred. CDC is not responsible for 

the content of the individual organization Web pages found at these links.

● National Asthma Education and Prevention Program

(1-301-592-8573)

● Asthma and Allergy Foundation of America

(1-800-727-8462) 

● American Lung Association

(1-800-LUNGUSA) 

● American Academy of Allergy, Asthma and Immunology

(1-800-822-2762) 

● Allergy and Asthma Network, Mothers of Asthmatics

(1-800-878-4403) 

● American College of Allergy, Asthma and Immunology

(1-800-842-7777) 

● American College of Chest Physicians

(1-847-498-1400) 

● American Thoracic Society

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CDC's National Center for Environmental Health (NCEH) strives to 

promote health and quality of life by preventing or controlling those 

diseases or deaths that result from interactions between people 

and their environment.

NCEH Spotlights ... 

Hurricane Recovery

To protect your health and safety, learn more about preparing for 

hurricanes ...more

Carbon Monoxide Poisoning

Hurricanes often cause power outages. Indoor use of portable 

generators, charcoal grills, or camp stoves can lead to carbon 

monoxide poisoning. Take steps to protect your family... more

Floods

Here are some basic facts to remember for protection during a 

flood and in its aftermath...more

CDC Survey Documents Serious Crisis In Sudanese Refugee 

Children

HHS/CDC recommend immediate increase in feeding programs, 

food rations, and public health measures ...more

Office of Global Health

The Office of Global Health (OGH) at NCEH/ATSDR is proud to 

announce the redesigned and updated OGH website. By following 

the link, you will be able to access information about NCEH/ATSDR 

international activities and projects, Global Health Priorities, Global 

Environmental Health, and related links to partners and 

international organizations. 

Lead and Water

CDC has updated some Questions and Answers about lead in tap 

water. 

>>more spotlights

NCEH Topics:

Air Pollution

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of Chemical 

Weapons

Disaster 

Epidemiology

Earthquakes

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Blooms

Healthy Places

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Noise

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Chemical agents List of chemical agents and links to related 

materials.

 

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Provides the public, first responders, clinicians, and hospitals with information 

on preparing for and responding to radiation emergencies.

Oak Ridge Institute for Science and Education’s Radiation 

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Provides basic explanations and definitions related to radiation and 

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scene of an emergency (prehospital) and in the hospital.

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relacionados con la genética humana y la forma 

en la que pueden ser usados para mejorar la 

salud y prevenir las enfermedades.

Servicios de Emergencia y Salud Ambiental (EEHS) Ofrecer liderazgo 

al nivel nacional e internacional para la coordinación, realización y 

evaluación de servicios de emergencia y salud ambiental.

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Cruceros

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 About the National Center for Environmental

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Overview

The environment is everything around us—the air we breathe, the water 

we drink and use, and the food we consume. It’s also the chemicals, 

radiation, microbes, and physical forces with which we come into contact. 

Our interactions with the environment are complex and are not always 

healthy. We at the National Center for Environmental Health, also known 

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interactions between people and the environment. We are especially 

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We seek to achieve our mission through science, service, and leadership. 

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About the National Center for Environmental Health

established a global health office to coordinate and expand our global 

activities.

The nature of our work is also expanding. Because genetic knowledge, 

tests, and services will play an increasingly larger role in public health 

practice, we are working to make sure that knowledge of human genetics 

is translated into effective and ethical public health actions.

No matter where and how we work, we are committed to safeguarding 

the health of the U.S. public, both in the United States and abroad. 

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NCEH Mission

To provide national leadership, through science and service, that promotes 

health and quality of life by preventing or controlling those diseases, birth 

defects, disabilities, or deaths that result from interactions between people 

and their environment.

NCEH Main Activities

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human genetic knowledge, tests, and services

• Public health surveillance

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 health agencies in preventing and responding to public health

 challenges

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NCEH Programs and Activities

• Emergency and Environmental Health Services

• Environmental Hazards and Health Effects

• Laboratory Sciences

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• Global Health at NCEH

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History of the National Center for Environmental Health

• A Brief History of the National Center for Environmental Health

• 1980-1994 History by Subject

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NCEH Program Information

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• 2000 Fact Book

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For state and local health 

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Response

(24--hour assistance 

during emergencies) 

770-488-7100.

Toll-free telephone 

number for information 

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lead poisoning, cruise ship 

inspection, cholesterol 

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 Programs and Activities

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Blooms

Healthy Places

Hurricanes

Lead Poisoning

Mold

Noise

Tornadoes

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Environmental 

Public Health

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>> complete A-Z list

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Chemical 

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Biological

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Air Pollution and Respiratory Health Global Health Office

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For state and local health 

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(24--hour assistance 

during emergencies) 

770-488-7100.

Toll-free telephone 

number for information 

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lead poisoning, cruise ship 

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 More NCEH Information

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Earthquakes

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Floods

Harmful Algal 

Blooms

Healthy Places

Hurricanes

Lead Poisoning

Mold

Noise

Tornadoes

Tracking, 

Environmental 

Public Health

Vessel Sanitation

>> complete A-Z list

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Preparedness:

General 

Chemical 

Radiological 

Biological

More NCEH 

Information:

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NCEH Funded 

Projects

Shared Vision

 

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Effects

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Environmental Health Topics

A | B | C | D | E | F | G | H | I | J | K | L | M

N | O | P | R | S | T | V | W |

Indice de Temas del NCEH

A

Air Pollution and Respiratory Health

Algal Blooms, Harmful

Asthma: A Public Health Response

Asthma At-A-Glance

Asthma Interventions

B

Biomonitoring At-A-Glance

Blood Lead Level Laboratory Reference System

Border, U.S.-Mexico Border Environmental Health Issues

C

Cancer Clusters

Carbon Monoxide

Chemical Agent Exposure Limits

Chemical Agent Monitoring

Chemical Exposure, Second National Report on Human Exposure to 

Environmental Chemicals

Chemical Warfare Agents, the CDC's role in protecting people

Chemical Weapons (Demilitarization)

Childhood Lead Poisoning Prevention Grant Program

Chronic Obstructive Pulmonary Disease (COPD)

Community Design, Building Healthy Places

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Toll-free telephone 

number for information 

and faxes on childhood 

lead poisoning, cruise ship 

inspection, cholesterol 

measurements,and list of 

publications:

NCEH Health Line

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Confined Animal Feeding Operations (CAFOs)

Cruise Ship Sanitation Program

D

Demilitarization of Chemical Weapons

Demilitarization of Chemical Weapons (Brochure)

Demilitarization of Chemical Weapons: How Safe are Incinerators?

Disaster Epidemiology and Assessment

E

Earthquake - A Prevention Guide to Promote Your Personal Health and 

Safety

Emergency and Environmental Health Services

Emergency Preparedness and Response Branch

Environmental Hazards and Health Effects

Environmental Hazards Epidemiology Response Program

Environmental Health Listserv: 

An easy way to communicate among Environmental Health 

Professionals

Environmental Health, National Center for

Environmental Health Services

Environmental Public Health Indicators

Environmental Public Health Tracking

Exposure of Air Force Veterans to Agent Orange in Vietnam

Exposure Report, National Report on Human Exposure to 

Environmental Chemicals

Extreme COLD - A Prevention Guide to Promote Your Personal Health 

and Safety

Extreme HEAT - A Prevention Guide to Promote Your Personal Health 

and Safety 

F

Flood - A Prevention Guide to Promote Your Personal Health and Safety

G

Genetically Modified Food, Investigation of Human Health Effects 

Associated with Potential Exposure to Genetically Modified Corn

Genomics and Disease Prevention

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Gulf War - The Health Impact of Chemical Exposures During the Gulf 

War

H

Health Studies Branch

Health Studies: Developing Prevention Strategies for Adverse Health 

Effects Related to Environmental Hazards and Disasters

Healthy Places, Designing and Building

Hearing and Noise

Housing Inspection - Basic

Hurricane - A Prevention Guide to Promote Your Personal Health and 

Safety

I

Indicators, Environmental Public Health

Indoor Spraying of a Dangerous Pesticide in Mississippi

International Emergency and Refugee Health

Interventions, Asthma

L

Laboratory Sciences

Lead Poisoning - Preventing Lead Poisoning in Young Children

Lead Poisoning Prevention Program

M

Mexico, U.S.-Mexico Border Environmental Health Issues

Mold

N

Nasopharyngeal Radium Irradiation (NRI)

National Center for Environmental Health

Newborn Screening, Factsheet

Noise

O

Office of Global Health

P

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Persian Gulf War Studies

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R

Radiation Emergencies

Radiation Studies and Energy-Related Health Research

Radon Research

Refugee Health

Rodent Control

T

Tornado - A Prevention Guide to Promote Your Personal Health and 

Safety

Tracking, Environmental Public Health

V

Vessel Sanitation - Sanitary Inspection of International Cruise Ships

Veterans' Health

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W

Water - Drinking Water and Water-related Issues

Water - A Survey of the Quality of Water Drawn from Domestic Wells 

in Nine Midwest States

Weather Emergencies

 

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Air Pollution and Respiratory Health Global Health Office

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Effects

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Related CDC Programs | Resources

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Save the Date: 

Second Annual 

National 

Environmental 

Public Health 

Tracking 

Conference

(April 20-22, 

2005)

Dialogue on 

Environmental 

Health Public 

Tracking (June 29-

30, 2004)

National 

Environmental 

Public Health 

Tracking Program 

Mini-Monograph 

in Environmental 

Health 

Perspectives online

Environmental Public Health Tracking Program 

About the Program

● At A Glance

● Program in Brief (html) (pdf *)

● Conceptual Diagram (pdf *) (ppt **) 

● Biomonitoring & Environmental Public Health Tracking (html) 

(pdf *)

● Background

Conferences and Meetings

● Save the Date: Second Annual National Environmental

Public Health Tracking Conference

(April 20-22, 2005) (pdf *)

● Dialogue on Environmental Public Health Tracking

(June 29-30, 2004) 

● First National Conference (March 24-26, 2004) 

Memoranda of Understanding

● EPA

● NASA

Program Grants & Contacts

● Funded Programs and Contacts

● 2002 RFPs: State|Centers of Excellence

● 2003 RFP (html) (pdf)

Partnerships

Related CDC Programs

● CDC's Biomonitoring Program

❍ Biomonitoring & Environmental Public Health Tracking

(html) (pdf *)

❍ National Report on Human Exposure to Environmental 

Chemicals

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● Environmental Public Health Indicators Project

Resources

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Air Pollution and Respiratory Health Global Health Office

Asthma Health Studies

Division of Laboratory Sciences Mold

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Services

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Effects

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Environmental 

Health Studies

Content

Home

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Feeding Operations 

(CAFOs)

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and Assessment

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Conditions

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Health Studies Branch

Mission Statement

The Health Studies Branch (HSB) of the Centers for Disease Control and 

Prevention’s (CDC's) National Center for Environmental Health (NCEH) is 

responsible for investigating human health effects associated with 

exposure to environmental hazards and to natural and technological 

disasters. HSB’s primary mission is to develop and evaluate strategies for 

preventing human exposure to environmental hazards and disasters and 

for minimizing the effects of such exposures when they do occur. To 

accomplish this mission, HSB investigators conduct epidemiologic rapid 

response and research activities in cooperation with federal, state, local, 

and international health agencies.

Goals of HSB

The goal of HSB is to provide environmental health leadership, science, 

and service for all major categories of environmental hazards. Some of 

these hazards include the following:

● Cancer Clusters

❍ Churchill County (Fallon), Nevada Cancer Study

● Concentrated Animal Feeding Operations (CAFOs)

● Disaster Epidemiology and Assessment

● Extreme Weather Conditions

● Harmful Algal Blooms

● Noise

● Pesticides

● U.S.-Mexico Border Environmental Health Issues

● Water-Related Environmental Public Health

The depth and breadth of HSB’s work are a tribute not only to the energy 

and dedication of HSB’s scientific and administrative staff, but also to the 

support that HSB receives from the Division of Environmental Hazards and 

Health Effects and from NCEH.

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Services

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Effects

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assistance:CDC 

Emergency Response

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during emergencies)

770-488-7100.

Toll-free telephone

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ship inspection, 

cholesterol measurements,

and list of publications:

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Air Pollution and Respiratory Health Global Health Office

Asthma Health Studies

Division of Laboratory Sciences Mold

Emergency and Environmental Health 

Services

Preventing Lead Poisoning in Young Children

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Effects

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Environmental Public Health Tracking International Cruise Ships

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NCEH Content

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NCEH en Español

For state and local

health department 

assistance:CDC 

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during emergencies)

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Toll-free telephone

number for information

and faxes on childhood 

lead poisoning, cruise 

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and list of publications:

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On this page... 

Environmental Public 

Health Services

Lead Poisoning 

Prevention

Vessel Sanitation 

Program

International 

Emergency and 

Refugee Health

Public Health 

Emergency 

Preparedness

Designing and Building 

Healthy Places

 

Emergency and Environmental Health Services

Safeguarding people's health from environmental threats...

Our mission at Emergency and Environmental Health 

Services (EEHS), a division of CDC’s National Center for 

Environmental Health, is to provide national and 

international leadership for coordinating, delivering, and 

evaluating emergency and environmental public health 

services. 

To improve public health practices nationwide, EEHS provides 

consultation, training, and technical and resource assistance to state and 

local health departments and to federal and international agencies. 

EEHS... 

● provides national leadership in the development of environmental 

health policy and prevention programs to improve environmental 

public health practice nationwide,

● provides resources and technical assistance on environmentally 

related health issues, such as childhood lead poisoning,

● responds to national and international emergencies, and 

● provides technical support for public health activities during 

famines, civil strife, and other environmental threats. 

Environmental Public Health Services

CDC provides scientific guidance and technical 

assistance to state, local, tribal, and other 

government agencies engaged in environmental 

public health service programs. EEHS...

● participates in disease outbreak 

investigations,

● identifies environmental signs contributing 

to outbreaks, and

● supports those environmental disciplines 

that involve food safety and water and 

sanitation issues. 

http://www.cdc.gov/nceh/eehs/ (1 of 4) [10/6/2004 2:37:07 PM]
NCEH Environmental Health Services

Lead Poisoning Prevention

Childhood lead poisoning remains a major 

preventable environmental public health problem 

in the United States. Approximately half a million 

U.S. children younger than 6 years of age have 

blood lead levels high enough to affect their 

intelligence, behavior, and development. EEHS...

● works with other federal agencies to 

develop an integrated national childhood 

lead poisoning prevention program, 

● helps develop and evaluate state and 

community childhood lead poisoning 

prevention programs,

● maintains a system for collecting and 

sharing data on lead poisoning, and 

● conducts and evaluates scientific research 

on childhood lead poisoning. 

Vessel Sanitation Program

Some of the larger cruise vessels have the 

capacity to carry as many as 5,000 passengers 

and crew. These passengers and crew not only 

are at risk for illness from contaminated food and 

water but also from viruses that are transmitted 

from person to person. CDC established the 

Vessel Sanitation Program (VSP) in 1975 to 

protect the health of cruise ship travelers and 

crew members. VSP...

● develops and puts sanitation programs into 

practice and conducts sanitation seminars 

for crew members, 

● inspects vessels to ensure compliance with 

CDC's Recommended Ship Building 

Construction Guidelines for Cruise Vessels 

Destined to Call on U.S. Ports, 

● collects and monitors reports of diarrheal 

illness to detect outbreaks on passenger 

vessels, and 

● provides technical assistance on public 

health issues related to vessel sanitation 

such as outbreaks. 

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NCEH Environmental Health Services

International Emergency and Refugee Health

The International Emergency and Refugee Health 

Branch (IERHB) coordinates CDC's response to 

complex humanitarian emergencies and applies 

scientific and public health principles to the study 

of these events. IERHB...

● provides technical assistance to various 

federal agencies, the United Nations, and 

other organizations concerned with the 

health of refugee populations;

● works closely with international partners to 

identify the number and nature of landminerelated injuries and deaths; and 

● provides technical assistance and training in 

public health emergency planning for 

employees, educational institutions, and 

international organizations. 

Public Health Emergency Preparedness

The Emergency Preparedness and Response 

Branch (EPRB) coordinates CDC’s activities in 

assisting state and local health departments in 

their emergency preparedness and response 

efforts to ensure public health readiness. EPRB...

● integrates scientific principles into public 

health guidance for emergency 

 preparedness operations, and

● identifies and shares best practices from 

academic training and field operations for 

all-hazards preparedness and response.

CDC’s Chemical Demilitarization Branch (CDB)

ensures that the health and safety of workers and 

the general population are protected during the 

handling and destruction of the nation's chemical 

weapons. CDB...

● reviews all chemical weapons elimination 

plans,

● works closely with the Department of 

Defense throughout the disposal process, 

and

● evaluates the medical response capacity of 

local communities to make sure that 

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NCEH Environmental Health Services

responders are prepared for any related 

emergencies. 

Designing and Building Healthy Places

As the leading public health agency in the United 

States, CDC scientifically considers all factors that 

affect the nation’s health. As we progress further 

into the 21st century, the interaction between 

people and their environments — natural as well 

as human-made — continues to emerge as a 

major issue concerning public health. Health 

issues that are related to community design and 

the built environment are a concern of NCEH. The 

design and building of healthy places work to 

enhance the quality of life and the complete 

physical, mental, and social well-being of our 

people.

 

Air Pollution and Respiratory Health Global Health Office

Asthma Health Studies

Division of Laboratory Sciences Mold

Emergency and Environmental Health 

Services

Preventing Lead Poisoning in Young Children

Environmental Hazards and Health 

Effects

Radiation Studies

Vessel Sanitation - Sanitary Inspection of 

Environmental Public Health Tracking International Cruise Ships

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This page last reviewed September 30, 2003 

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Radiation Studies - CDC/NCEH

Radiation Studies 

Home

Public Health 

Research

International Projects

Nasopharyngeal 

Radium Irradiation

Radon Research

Links to Related

Web Sites

On the CDC public health 

emergency response 

web site:

Radiation Emergency 

Response

Welcome to Radiation Studies

CDC plays a unique role in identifying potentially harmful environmental exposures 

and examining health risks associated with these exposures. One aspect of this work 

is its radiation studies program, which looks at the relationship between 

environmental radiation exposures and public health. 

General Radiation Facts International Projects

CDC provides basic information on 

radiation and its health effects as 

well as emergency instructions for 

individuals and families.

CDC has worked with the governments 

of other nations to look at 

environmental radiation exposures and 

their health effects.

Public Health Research Nasopharyngeal Radium 

Irradiation

CDC studies the health effects of 

environmental radiation exposures 

from nuclear weapons production 

facilities in the United States.

● Feasibility Study of Weapons 

Test Fallout

● Fernald Feed Processing 

Center

● Hanford Nuclear Weapons 

Facility

● Idaho National Engineering & 

Environmental Lab

● Los Alamos National Lab

● Savannah River Site

● Citizens' Advisory 

Committees

This treatment, which was given to 

some children and members of the 

military in the 1940s and 1950s to 

treat hearing loss and ear infections, 

may have had long-term adverse 

health effects.

Radon Research

CDC has been working with EPA and 

other agencies to identify the health 

risks associated with residential radon.

Links to Related Web Sites

Links to radiation sites. CDC is not 

responsible for the content of the 

individual organization Web pages 

found at these links.

Air Pollution and Respiratory Health Global Health Office

Asthma Health Studies

Division of Laboratory Sciences Mold

Emergency and Environmental Health 

Services

Preventing Lead Poisoning in Young Children

Environmental Hazards and Health 

Effects

Radiation Studies

Vessel Sanitation - Sanitary Inspection of 

Environmental Public Health Tracking International Cruise Ships

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This page last reviewed August 12, 2004 

United States Department of Health and Human Services

Centers for Disease Control and Prevention

National Center for Environmental Health

Radiation Studies

Spotlights 

Update:

Information on radiation 

emergency response is 

now located on CDC's public 

health and emergency 

response site.

Upcoming Meetings: 

The next INEEL Health 

Effects Subcommittee

meeting will be held on 

August 10-11, 2004, in 

Idaho Falls, ID. 

The next SRS Health Effects 

Subcommittee meeting will 

be held on August 25, 2004, 

in Columbia, SC.

http://www.cdc.gov/nceh/radiation/default.htm [10/6/2004 2:37:08 PM]
U.S.-Mexico Border Environmental Health Issues: Home Page | CDC HSB

 

Environmental 

Health Studies

Content

Home

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Feeding Operations 

(CAFOs)

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and Assessment

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Conditions

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Noise

Pesticides

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Environmental Health 

Issues

Water-Related 

Environmental Public 

Health

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About NCEH

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Searchable Index | Strategic Plan | 2000 Fact Book 

NCEH Fact Sheets | NCEH Brochures

 

Health Studies Branch

U.S.-Mexico Border Environmental Health Issues

● EHHE Activities 

❍ Overview

❍ Major Collaborations 

■ Border 2012 Program

■ Pan American Health Organization

■ Instituto Nacional de Salud Publica

❍ Other Projects

● Links

● Publications

 

 

Air Pollution and Respiratory Health Environmental Public Health Tracking

Asthma Health Studies

Division of Laboratory Sciences Mold

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Services

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U.S.-Mexico Border Environmental

Environmental Hazards and Health Health

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This page last reviewed September 07, 2004 

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NCEH Home

About NCEH

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Contact NCEH

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NCEH Kids

Employment

For state and local

health department 

assistance:CDC 

Emergency Response

(24--hour assistance 

during emergencies)

770-488-7100.

Toll-free telephone

number for information

and faxes on childhood 

lead poisoning, cruise 

ship inspection, 

cholesterol measurements,

and list of publications:

NCEH Health Line

1-888-232-6789

About the program:

● Brochure (html) (PDF, 346 Kb *)

Focus Areas:

● Air Pollution and Respiratory Health

● Asthma

● Cancer Clusters

● Carbon Monoxide

● Concentrated Animal Feeding Operations

● Environmental Public Health Indicators

● Environmental Public Health Tracking

● Extreme Weather Conditions

● Harmful Algal Blooms

● Health Studies

● Mold

● Radiation Studies

● US-Mexico Border Environmental Health

● Water-Related Environmental Public Health

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> Air Pollution and Respiratory Health > Environmental Public Health Tracking

> Asthma > Health Studies

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>

>

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>

>

Radiation Studies

US-Mexico Border Environmental Health

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Disease Registry 

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For state and local health 

department assistance:

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(24--hour assistance 

during emergencies) 

770-488-7100.

Toll-free telephone 

number for information 

and faxes on childhood 

lead poisoning, cruise ship 

inspection, cholesterol 

measurements,and list of 

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 Health

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