Asthma Pathophysiology Asthma Overview

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Asthma Pathophysiology Asthma Overview. Presented by: Michelle Harkins, MD University of New Mexico. This session will cover. Review asthma statistics Define asthma Outline key pathophysiologic features Review signs and symptoms of asthma - PowerPoint PPT Presentation

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Asthma PathophysiologyAsthma OverviewPresented by:Michelle Harkins, MDUniversity of New Mexico[add speaker info]What is expected of the facilitator of this topic?A working knowledge of the NAEPP EPR-3 and asthma management basics including asthma pathophysiology; the role of inflammation; exercise induced bronchospasm; asthma triggers; symptoms; and impairment and risk domains. About this sectionAsthma Overview is intended to be taught in 45 minutes and contains 35 slides. NOTE TO PRESENTER: It is important to know your audience for this section. For example asking the question, how much do you know about the biological response or the role of inflammation, will give you a better understanding of where you should spend most of your time during this presentation. It is important to be mindful of the time dedicated for this section. 1This session will coverReview asthma statisticsDefine asthmaOutline key pathophysiologic featuresReview signs and symptoms of asthmaReference to NAEPP EPR-3: asthma severity classification system-including impairment and risk domainsDiagnosing asthma2

Prevalence vs Incidence Prevalence - the proportion or percentage of a population that has disease at a specific point or period of timeIncidence the number of new cases of disease that develop in a population of individuals at risk during a specific point or period of time4We are about to have a discussion about asthma epidemiology. I want to be sure that you have a basic understanding of prevalence and incidence and the differences in how these two words are used.

According to the CDC, asthma prevalence = 7.7% in 50 states and District of Columbia [Source: CDC. NCHS. NHIS, 2007]There are 22.9 million patients who currently have asthma. Over the period 1980 1996, the prevalence of asthma in the US increased.

1980-1996 prevalence of asthma in US increasedSince 1999, mortality and hospitalization due to asthma have decreased

5Trends in Asthma Morbidity and Mortality. American Lung Association, Epidemiology and Statistics Unit, Research and Program Services Division. September, 2012.Approximately 25.9 million Americans (including 7.1 million children) had asthma in 2011; a rate of 84.8 per 1,000 population.

The highest prevalence rate was seen in those 5-17 years of age (105.5 per 1,000 population).

Overall, the rate in those under 18 (94.9 per 1,000) was significantly greater than those over 18 (81.6 per 1,000; not shown).6Trends in Asthma Morbidity and Mortality. American Lung Association, Epidemiology and Statistics Unit, Research and Program Services Division. September, 2012.In 2011, 10.8 million males and 15.1 million females had asthma. The overall prevalence rate in females (97.3 per 1,000 persons) was 35% greater than the rate in males (71.9 per 1,000 persons).

Among adults 18 years and older, females were 62% more likely than males to have asthma (100.1 per 1,000 versus 61.8 per 1,000). However, this pattern is reversed among children. The current asthma prevalence rate for boys under 18 (101.7 per 1,000) was 16% higher than the rate among girls (87.8 per 1,000).7Trends in Asthma Morbidity and Mortality. American Lung Association, Epidemiology and Statistics Unit, Research and Program Services Division. September, 2012.In 2011, 10.8 million males and 15.1 million females had asthma. The overall prevalence rate in females (97.3 per 1,000 persons) was 35% greater than the rate in males (71.9 per 1,000 persons).

Among adults 18 years and older, females were 62% more likely than males to have asthma (100.1 per 1,000 versus rat61.8 per 1,000). However, this pattern is reversed among children. The current asthma prevalence e for boys under 18 (101.7 per 1,000) was 16% higher than the rate among girls (87.8 per 1,000).8New Mexico BRFSS Results for 2010: Current Prevalence: Percent of New Mexico Children who Currently Have Asthma by Various Demographic CharacteristicsRace/Ethnicity:White, Non-Hispanic 8.1%Hispanic 7.4%Native American 13.1%SOURCE: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2009

Trends in Asthma Morbidity and Mortality. American Lung Association, Epidemiology and Statistics Unit, Research and Program Services Division. September, 2012.In 2011, an estimated 13.2 million Americans (including 4.1 million children under 18) had an asthma attack. This represents 51% of the 25.9 million people who currently have asthma. The asthma attack rate was 43.1 per 1,000 population.

For the past twelve years, 5-17 year olds had the highest attack prevalence rates while those over 65 had the lowest every year.

Since 1999 the asthma attack prevalence rate in those under 18 has been significantly greater than among those over 18; in 2011, these rates were 54.6 versus 39.4 per 1,000 respectively.10Trends in Asthma Morbidity and Mortality. American Lung Association, Epidemiology and Statistics Unit, Research and Program Services Division. September, 2012.A first listed diagnosis is the diagnosis identified as the principal diagnosis or listed first on themedical record. The hospital discharge rate for asthma was stable in the early 1990s, peaking at 511,000 discharges (19.5 per 10,000 population) in 1995 and 574,000 (19.8 per 10,000 population) in 2003.

During 2010, 439,000 discharges (14.3 per 10,000 population) were attributed to asthma. Between 2003 and 2010 there was a 24% decrease in the hospitalization discharge rate for asthma in the United States.

The 2010 discharge rate for asthma in blacks (28.5 per 10,000) was 3.2 times higher than that seen in whites and 2.5 times higher than that seen in other races (9.0 and 11.6 per 10,000, respectively). These rates, however, should be interpreted with caution due to a large percentage of discharges for which race was not reported.11

Asthma age-adjusted hospitalization rates per 10,000 standard population by county, New Mexico, 2007-2011 average

Asthma hospitalization rates per 10,000 standard population among youth (0-14 years) by county, New Mexico, 2007-2011 average

Trends in Asthma Morbidity and Mortality. American Lung Association, Epidemiology and Statistics Unit, Research and Program Services Division. September, 2012.In 2009, 3,388 people died of asthma, a 26% decrease since 1999.

Approximately 64% of these deaths occurred in women.

Asthma deaths are rare among children and increase with age.

In 2009, 157 children under 15 died from asthma (0.2 per 100,000 population) compared to 617 adults over 85.

The death rate in those 85 and over was 175% greater than the second highest mortality rate, seen among those 75-84 years of age (11.0 per 100,000 versus 4.0 per 100,000).14Trends in Asthma Morbidity and Mortality. American Lung Association, Epidemiology and Statistics Unit, Research and Program Services Division. September, 2012.In 2009, the female age-adjusted death rate was 50% greater than the rate seen in males.

The age-adjusted death rate was 3.1 times higher among the black population than among the white population (2.5 versus 0.8 per 100,000, respectively).

Black women had the highest age-adjusted mortality rate due to asthma in 2009 (2.5 per 100,000).

In 2009, 302 Hispanics died of asthma an age-adjusted death rate of 0.9 per 100,000 population.

Age-adjusted death rates in Hispanics were 64% lower than non-Hispanic blacks, and 12% higher than non-Hispanic whites.

However, studies have suggested that Puerto Ricans had higher age-adjusted death rates than all other Hispanic subgroups and non-Hispanic whites and blacks.15

Asthma Age-Adjusted Death Rates Based on the 1940 and 2000 Standard populations, 1979-2005

19791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200519400.91.01.01.01.21.11.21.21.31.41.41.41.51.41.41.51.51.51.41.41.21.11.01.01.00.90.920001.31.41.51.51.71.61.81.81.92.02.12.12.22.02.12.22.22.22.12.01.71.61.51.51.41.31.3Mortality figures due to asthma have been continuing to decline for the past 6 years. The number of deaths due to asthma in 2005 was approximately 16.6% lower than the number of deaths seen in 1999. (Centers for Disease Control and Prevention. National Center for Health Statistics. National Vital Statistics Reports. Deaths: Final Data for 1999-2005. April 24, 2008. Vol 56, No 10.)

In recent years the number of asthma deaths has declined (decreased by 17% since 1999). In 2005, 3,884 people died of asthma. Asthma death rates are rare among children and increase with age. Approximately 66% of these deaths occurred in women. The age-adjusted death rate was three times higher among the black population than among the white population. Black women had the highest age-adjusted death rate due to asthma in 2005.

Information for the presenter about this graph: The change from the 1940 standard to the 2000 standard has three important outcomes: (i) provides age-adjusted rates that are less divergent from crude rates (ii) ensures that all government agencies use the same standard and (iii) corrects the public perception that age adjustment to the 1940 population provides out-of-date statistics. Use of the 2000 population standard places more weight on death rates at older ages and less weight on death rates at younger ages. Because most lung disease rates increase with age, death rates using the new standard are higher than those using the old standard. Age-adjusted deaths rates for asthma were approximately 1.5 times greater using the 2000 standard population than those based on the 1