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8/18/2019 Asthma Speaker Kit
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AsthmaAsthmaA Presentation on Asthma Management and Prevention
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What is Asthma?
Chronic disease of the airways that may causeWheezingBreathlessnessChest tightness
Nighttime or early morning coughing
Episodes are usually associated withwidespread, but variable, airflow obstruction
within the lung that is often reversible eitherspontaneously or with treatment.
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Pathology of Asthma
Source: “What You and Your Family Can Do Aout Asthma! y the "loal #nitiative For Asthma
Created and funded y $#%&$%'(#) *++,
$ormal Asthma
Asthma
involves
inflammation of
the air-ays
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What is ./idemiology?
The study of the distribution and
determinants of diseases and
inuries in human populations.
Source: Mausner and 0ramer) Mausner and (ahn ./idemiology1 An #ntroductory 2e3t) *+4,5
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Child and Adult Asthma Prevalence
6nited States) *+4718779
*81Month
'ifetime• Child
Adult
Source: $ational %ealth #ntervie- Survey CDC $ational Center for %ealth Statistics
Current
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Asthma Prevalence y Se3
6nited States) *+4718779
*81Month
'ifetime• Female
Male
Source: $ational %ealth #ntervie- Survey CDC $ational Center for %ealth Statistics
Current
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*81Month Asthma Prevalence y ;ace
6nited States) *+471*++<
Source: $ational %ealth #ntervie- Survey CDC $ational Center for %ealth Statistics
(lac=
White
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Asthma Prevalence y ;ace&.thnicity
6nited States) *++918779
'ifetime
Current
▲ (lac= $%
White $%
%is/anic
Source: $ational %ealth #ntervie- Survey $ational Center for %ealth Statistics
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Current Asthma Prevalence for Youth
y ;ace&.thnicity) Ages ,1*9) 877,18779
Centers for Disease Control and Prevention5 $ational Center for %ealth Statistics5 %ealth
Data #nteractive5 ---5cdc5gov&nchs&hdi5htm5 >uly *,) 877+@5
*75* Bverall
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Asthma Dis/arities Among 65S5 Children
!ow"income populations, minorities, and children living ininner cities e#perience more E$ visits, hospitalizations,
and deaths due to asthma than the general population.%
The burden of asthma falls disproportionately on non"&ispanic blac', (merican )ndian*(las'an Native and
some &ispanic +i.e., uerto -ican populations./, 0
*'ieu 2A et al5 ;acial&.thnic ariation in Asthma Status and Management PracticesAmong Children in Managed Medicaid5 Pediatrics 8778 *7+:4,94
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Po/ulation Dis/arities in Asthma
Current asthma /revalence is higher
among
children than adults
boys than girls
women than men
Asthma moridity and mortality is
higher among
(frican (mericans than Caucasians
Source: MMWR 8779,
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AsthmaJ %os/ital Discharge ;atesK
y Se3 6nited States: *+471877<
Source: $ational %os/ital Discharge Survey) CDC $ational Center for %ealth Statistics) J First1listeddiagnosis) K Age1adLusted to 8777 65S5 /o/ulation
Males
Females
Ad lt d Child A th % it l Di h
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Adult and Child Asthma %os/ital Discharge
;ates
6nited States) *++
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Asthma %os/ital Discharge ;ates
y ;ace
6nited States) *+471877<
White
Bther
(lac=
Source: $ational %os/ital Discharge Survey) CDC $ational Center for %ealth Statistics) J First1listeddiagnosis) K Age1adLusted to 8777 65S5 /o/ulation
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Asthma Mortality ;ates y Age
6nited States: *+9+1877,
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Asthma Mortality ;ates y ;ace
6nited States: *+9+1877,
White
(lac=
Source: 6nderlying Cause of Death CDC $ational Center for %ealth Statistics
1 Age1adLusted to 8777 65S5 /o/ulation
ICD-9 ICD-10
Bther
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;is= Factors for Develo/ing Asthma
"enetic characteristics
Bccu/ational e3/osures .nvironmental e3/osures
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;is= Factors for Develo/ing Asthma:
"enetic CharacteristicsAto/y
The body2s predisposition to develop an antibody
called immunoglobulin E +)gE in response toe#posure to environmental allergens
Can be measured in the blood
)ncludes allergic rhinitis, asthma, hay fever, and
eczema
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;is= Factors for Develo/ing Asthma:
.nvironmental .3/osure
Clearing the Air:
Asthma and Indoor Air Exposures
htt/:&&---5iom5edu GPulicationsH)nstitute of 3edicine, /444
Committee on the (ssessment of (sthma and )ndoor (ir
-eview of current evidence about indoor air e#posures
and asthma
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Clearing the Air:
Categories for Associations of arious
.lements
5ufficient evidence of a causal relationship
5ufficient evidence of an association
!imited or suggested evidence of anassociation
)nade6uate or insufficient evidence to
determine whether an association e#ists!imited or suggestive evidence of noassociation
http://www.iom.edu/http://www.iom.edu/
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Clearing the Air:
#ndoor Air .3/osures N Asthma Develo/ment
(iological Agents
Sufficient evidence of causal
relationshi/
&ouse dust mite
Sufficient evidence of association
None found
'imited or suggestive evidence of
association
Coc'roach +among pre"school aged
children
-espiratory syncytial virus +-57
Chemical Agents Sufficient evidence of causal
relationshi/ None found
Sufficient evidence of association Environmental Tobacco 5mo'e
+among pre"school aged children
'imited or suggestive evidence ofassociation None found
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Clearing the Air:
#ndoor Air .3/osures N Asthma .3aceration
(iological Agents
Sufficient evidence of causal
relationshi/
Cat
Coc'roach
&ouse dust mite
Sufficient evidence of an association
$og
8ungus*3olds
-hinovirus
'imited or suggestive evidence ofassociation
$omestic birds
Chlamydia and 3ycoplasma pneumonia
-57
Chemical Agents Sufficient evidence of causal
relationshi/ Environmental tobacco smo'e
+among pre"school aged children
Sufficient evidence of
association N9/, N9: +high levels
'imited or suggestive evidence ofassociation Environmental Tobacco 5mo'e
+among school"aged, older children,and adults
8ormaldehyde 8ragrances
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;educing .3/osure to %ouse Dust Mites
;se beddingencasements
Wash bed linens wee'ly
(void down fillings
!imit stuffed animals tothose that can be washed
-educe humidity level+between 04< and =4<
relative humidity perE-"0
Source: “What You and Your Family Can Do Aout Asthma! y the "loal #nitiative For
Asthma Created and funded y $#%&$%'(#) *++,
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;educing .3/osure to
.nvironmental 2oacco Smo=e
.vidence suggests an
association et-een
environmental toacco smo=e
e3/osure and e3acerations of
asthma among school1aged)
older children) and adults5
.vidence sho-s an association
et-een environmental toaccosmo=e e3/osure and asthma
develo/ment among /re1school
aged children5
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;educing .3/osure to Coc=roaches
-emove as many water and food sources aspossible to avoid coc'roaches.
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;educing .3/osure to Pets
eople who are allergic to pets should not
have them in the house.
(t a minimum, do not allow pets in the
bedroom.
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;educing .3/osure to Mold
Eliminating mold and the moist conditions that permit
mold growth may help prevent asthma e#acerbations.
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Bther Asthma 2riggers
(ir pollution
Trees, grass, and weed pollen
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Clinical Management of Asthma
E#pert anel -eport 0National (sthma Education and revention rogram
National &eart, !ung and Blood )nstitute, /44>
Source: htt/:&&---5nhli5nih5gov&guidelines&asthma&asthgdln5/df
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8779 $A.PP .P;1
Treatment recommendations based on?5everity
Control
-esponsiveness
rovide patient self"managementeducation at multiple points of care
-educe e#posure to inhaled indoorallergens to control asthma"multifacetedapproach
Source: htt/:&&---5nhli5nih5gov&guidelines&asthma&asthgdln5/df
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What is "#P?
@uidelines )mplementation anel -eport for
E#pert anel -eport 0
-ecommendations and strategies to
implement E-"0
5i# 'ey messages
Source: htt/:&&---5nhli5nih5gov&guidelines&asthma&gi/Er/t5/df
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"#POs Si3 0ey Messages
)nhaled
Corticosteroids
(sthma (ction lan
(sthma 5everity
(sthma Control
8ollow"up 7isits
(llergen and )rritant
E#posure Control
Source: htt/:&&---5nhli5nih5gov&guidelines&asthma&gi/Er/t5/df
http://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.pdfhttp://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.pdfhttp://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.pdfhttp://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.pdf
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Diagnosing Asthma:
Medical %istory
5ymptoms
Coughing
Wheezing
5hortness of breathChest tightness
5ymptom atterns
5everity
8amily &istory
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Diagnosing Asthma
Troublesome cough, particularly at night (wa'ened by coughing
Coughing or wheezing after physical
activityBreathing problems during particular
seasons
Coughing, wheezing, or chest tightness
after allergen e#posure
Colds that last more than %4 days
-elief when medication is used
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Diagnosing Asthma
Wheezing sounds during normal breathing
&ypere#pansion of the thora#
)ncreased nasal secretions or nasal polyps
(topic dermatitis, eczema, or other allergic
s'in conditions
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Diagnosing Asthma:
S/irometry
Test lung function when diagnosing asthma
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Medications to 2reat Asthma
Medicationscome in severalforms5
2-o maLorcategories ofmedications are:!ong"term control
Auic' relief
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Medications to 2reat Asthma:
'ong12erm Control
2a=en daily over a long /eriod of time
6sed to reduce inflammation) rela3 air-aymuscles) and im/rove sym/toms and lung
function
)nhaled corticosteroids
!ong"acting beta/"agonists
!eu'otriene modifiers
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Medications to 2reat Asthma:
uic=1;elief
6sed in acutee/isodes
"enerally short1acting eta8agonists
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Medications to 2reat Asthma:
%o- to 6se a S/ray #nhaler
The health"care
provider should
evaluate inhaler
techni6ue at each
visit.
Source: “What You and Your Family Can Do Aout Asthma! y the "loal #nitiative forAsthma Created and funded y $#%&$%'(#
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Medications to 2reat Asthma:
#nhalers and S/acers
5pacers can help patients who
have difficulty with inhaler use
and can reduce potential for
adverse effects from
medication.
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Medications to 2reat Asthma:
$euliQer
3achine produces a mist of
the medication
;sed for small children or
for severe asthma episodes
No evidence that it is more
effective than an inhaler
used with a spacer
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Managing Asthma:
Asthma Management "oals
(chieve and maintain control of symptoms3aintain normal activity levels, including
e#ercise3aintain pulmonary function as close to
normal levels as possiblerevent asthma e#acerbations (void adverse effects from asthma
medicationsrevent asthma mortality
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Managing Asthma:
Asthma Action Plan
$evelop with a physician
Tailor to meet individual needs
Educate patients and families about all aspects ofplan-ecognizing symptoms
3edication benefits and side effectsroper use of inhalers and ea' E#piratory 8low +E8
meters
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Managing Asthma:
Sam/le Asthma Action Plan
$escribes medicines
to use and actions to
ta'e
$ational %eart) (lood) and 'ung #nstitute .3/ert Panel ;e/ort G.P; H: "uidelines for theDiagnosis and Management of Asthma5 $#% Pulication no5 741I7,*) 87795
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Managing Asthma:
Pea= .3/iratory Flo- GP.FH Meters
(llows patient to assess status of his*her asthma
ersons who use pea' flow meters should do so fre6uently
3any physicians re6uire for all severe patients
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Managing Asthma:
Pea= Flo- Chart
Peo/le -ithmoderate orsevere asthmashould ta=ereadings:Every morningEvery evening (fter an
e#acerbationBefore inhaling
certain medications
Source: “What You and Your Family Can Do Aout Asthma! y the "loal #nitiative ForAsthma Created and funded y $#%&$%'(#
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Managing Asthma:
#ndications of a Severe Attac=
Breathless at rest
&unched forward
5pea's in words rather than complete sentences
(gitated
ea' flow rate less than 4< of normal
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Managing Asthma:
2hings Peo/le -ith Asthma Can Do
&ave an individual management plan containing
our medications +controller and 6uic'"relief
our asthma triggers
What to do when you are having an asthma attac'Educate yourself and others about
(sthma (ction lans
Environmental interventions
5ee' help from asthma resourcesDoin an asthma support group
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A Pulic %ealth ;es/onse to Asthma
( call to action for organizations and people withan interest in asthma management to wor' as
partners in reducing the burden of asthma within
our nation2s communities.
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A Pulic %ealth ;es/onse to Asthma:
Surveillance
Bver timeR
&ow much asthma does the population have
&ow severe is asthma across the population
&ow well controlled is asthma in the populationWhat is the cost of asthma
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A Pulic %ealth ;es/onse to Asthma:
6ses of Surveillance Data
Basis for planning andtargeting interventionactivities
Evaluating interventionactivities
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A Pulic %ealth ;es/onse
to Asthma .ducation
.ducation /rograms can e targeted to:
eople with asthma
arents of children with asthma3edical care providers
5chool staff
ublic
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A Pulic %ealth ;es/onse to Asthma:
Coalition
5uccessful asthma campaigns need the
cooperation of committed partners.
A P li % lth ; t A th
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A Pulic %ealth ;es/onse to Asthma:
Advocacy
(sthma needs to be addressed
comprehensively by multiple government and
non"government agencies.
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A Pulic %ealth ;es/onse to Asthma:
#nterventions
3edical managementEducation
Environment
5chools
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A Pulic %ealth ;es/onse to Asthma:
Medical Management #nterventions
Ensure people with asthma
'now about their disease and
are empowered to demand
appropriate management
A P li % lth ; t A th
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A Pulic %ealth ;es/onse to Asthma:
.nvironmental #nterventions
%el/ /eo/le create andmaintain healthy home) school)
and -or= environments5
.nvironmental interventions
may consist of:
(ssessments to identifyasthma triggers
Education on how to remove
asthma triggers
-emediation to remove
asthma triggers
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A Pulic %ealth ;es/onse to Asthma:
School #ntervention Science1(ased "uidance
3anagement and supportsystems
&ealth and mental health
services (sthma education for
students, staff, and parents
&ealthy school environment
hysical education and activity 5chool, family, and community
efforts
Source: ---5cdc5gov&%ealthyYouth&asthma&strategies
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0ey As/ects
-e6uire team effort
Coordinate health, including mental and physical
health, education, environment, family, and
community efforts
(ssess needs of school and prioritize +every
action step is not feasible to every school or
district
8ocus on students with fre6uent asthmasymptoms, health room visits, and absenteeism
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%. 3anagement F5upport 5ystems
8amily*Community
)nvolvement
hysical
Education
Nutrition
5ervices
&ealthy 5chool
Environment
&ealth romotion
8or 5taff
&ealth
Education
&ealth
5ervices
Counseling,sychological, and
5ocial 5ervices
G. &ealthy 5chool
Environment
/. &ealth F
3ental &ealth
5ervices
0. (sthma
Education
. 5chool, 8amily,
F Community
Efforts
=. hysical
Education F
(ctivity
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A Pulic %ealth ;es/onse to Asthma:
School ( leading chronic disease cause of school absence
Common disease addressed by school nurses
(ffects teachers, administrators, nurses, coaches, students,bus drivers, after school program staff, maintenancepersonnel
B hild i l f 7
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are li=ely to have asthma5J
Bn average) children in a classroom of 7
J
./idemiology and Statistics 6nit5 2rends in Asthma Moridity and Mortality5 $YC: A'A) uly 877
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A Pulic %ealth ;es/onse to
Asthma:
What can ma=e asthma -orse in the school?
3old and mildew
(nimals in classroom
Carpeted classroomsCoc'roaches
oor air 6uality
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Asthma1Friendly School
DD and 2ool=it
BLectivesersonal stories to relate to
viewer (spects of an asthma"friendly
school5i# strategies for addressing
asthma in a coordinated school
health program
otential impact of asthma"friendly schools
A P li % lth ; t A th
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A Pulic %ealth ;es/onse to Asthma:
School Actions
Establish policies and procedures to support children withasthma.
Heep students2 asthma action plans at the school.
3a'e medications available
$uring school hours Before physical activity and sports
$uring before" and after"school programs
9n field trips or when away from campus
Train school staff to recognize signs of an asthma attac'and to use appropriate medications.
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A Pulic %ealth ;es/onse to Asthma:
.valuation
2he systematic investigation of thestructure) activities) or outcomes of
asthma control /rograms5 (re we doing the right thing
(re we doing things right
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(enefits of Program .valuation
Evaluations help asthma programs3anage resources and services effectively;nderstand reasons for current performance
Build capacity
lan and implement new activities
$emonstrate the value of their efforts
Ensure accountability
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6sing .valuation to #m/rove Programs
%ighlight effective /rogram com/onents-ecognize achievements-eplicate successes
Assess and /rioritiQe needs
2arget /rogram im/rovements
Advocate for the /rogram
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Frame-or= for Program .valuation
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A Pulic %ealth ;es/onse to Asthma:
Summary
(sthma is a comple# disease that is not yet preventable or curable.
(sthma can be managed with medication, environmental changes, and behavior
modifications.
By wor'ing together, we can ensure that people with asthma enoy a high 6uality of life.
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;esources
National (sthma Education and revention rogram http?**www.nhlbi.nih.gov*about*naepp *
(sthma and (llergy 8oundation of (merica http?**www.aafa.org
(merican !ung (ssociation http?**www.lungusa.org
(merican (cademy of (llergy, (sthma, and )mmunology http?**www.aaaai.org
(llergy and (sthma Networ'*3others of (sthmatics, )nc. http?**www.aanma.org
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;esources
(merican College of (llergy, (sthma, and)mmunology
http?**www.acaai.org
(merican College of Chest hysicians
http?**www.chestnet.org
(merican Thoracic 5ociety http?**www.thoracic.org
The Centers for $isease Control and revention
http?**www.cdc.gov*asthma
http://www.nhlbi.nih.gov/about/naepp/http://www.aanma.org/http://www.aanma.org/http://www.aanma.org/http://www.aanma.org/http://www.aaaai.org/http://www.aaaai.org/http://www.lungusa.org/http://www.lungusa.org/http://www.aafa.org/http://www.aafa.org/http://www.nhlbi.nih.gov/about/naepp/http://www.nhlbi.nih.gov/about/naepp/