Education on asthma self-management: Helping people with asthma (and their families) use asthma medications correctly, avoid exposure to asthma triggers, and manage their asthma symptoms can reduce hospitalizations, missed school or work days, and healthcare costs.

Asthma self-management education requires repetition and reinforcement. All care providers have a role in providing asthma self-management education, which is best supported through integrated programs that incorporate clinic-based, home-based, and school-based elements. Effective asthma education empowers patients to request guidelines-based care.

Example Equity Approaches

• Expand comprehensive asthma education programs for high-risk populations.
• Expand delivery of culturally and linguistically appropriate asthma self-management education. For example, partner with historically Black colleges and universities.
• Expand programs for community health workers, promotoras, nurses, social workers and certified asthma educators to provide asthma education.
• Review inhaler technique at every care touchpoint.

Resources

• Health Equity, Asthma and Allergy Foundation of America
• EMPOWER, Asthma Education for Young People, National Environmental Education Foundation and Hip Hop Public Health
• Recommendation for School-Based Self-Management Interventions, The Community Guide
• Open Airways for Schools, American Lung Association
• Kickin Asthma, American Lung Association
• Breathe Well, Live Well for HBCUs, American Lung Association

X-tinguishing Smoking and Exposure to Secondhand Smoke Among People with Asthma: Helping people quit smoking and avoid secondhand smoke can reduce hospitalizations, missed school, healthcare costs, and how often they have to use rescue medicine. Building strategic partnerships and understanding cultural differences can help you reach people with the greatest need.

Example Equity Approaches

• Collaborate with your state tobacco program, cancer programs, and coalitions to promote equitable ways to reduce smoking and second-hand smoke.
• Use culturally appropriate media and education efforts to build awareness, including youth prevention and cessation messages.
• Help more multi-unit housing become smoke-free and adopt an anonymous reporting mechanism.
• Involve people who experience inequities in tobacco control coalitions.
• Remove smoking restriction exemptions such as those that impact sales limits and in-store placement.

Resources

• A Practitioners Guide for Advancing Health Equity: Community Strategies for Prevention, Centers for Disease Control and Prevention
• Best Practices User Guides-Health Equity in Tobacco Prevention and Control, Centers for Disease Control and Prevention
• Smokefree Policies in Multi-Unit Housing, American Lung Association

Home Visits for Trigger Reduction and Asthma Self-Management Education: Improving access to evidence-based home visiting services can help people manage their asthma. When asthma is controlled, hospital visits, missed school or work, and healthcare costs can all decrease.

Example Equity Approaches

• Expand home visiting programs to be led by community health workers, promotoras, nurses, social workers, case managers, and certified asthma educators.
• Increase access to home visiting assessments by offering virtual services.
• Maintain a partner network to facilitate free or low-cost access to resources such as food, clothing, utilities assistance, asthma-friendly cleaning, mold removal, pest management, and housing/tenant assistance.
• Partner with organizations who can provide trigger-reduction products like vacuums with HEPA filters, transportation vouchers, and asthma friendly cleaning products.

Resources

• Home Characteristics and Asthma Triggers Checklist for Home Visitors, Centers for Disease Control and Prevention, U.S. Environmental Protection Agency, and U.S. Department of Housing and Urban Development
• Strategies for Addressing Asthma in Homes, Centers for Disease Control and Prevention
• Managing Asthma Through Home Visits, U.S. Environmental Protection Agency
• Indoor Environmental Determinants of Health: Indoor Air Quality as a Social Determinant of Health, Asthma and Allergy Network
• Solving for the Indoor Environmental Determinants of Health in Asthma, U.S. Environmental Protection Agency
• Housing Disparities and Asthma: Reinvesting in Neighborhoods to Promote Health Equity, Children’s Hospital of Philadelphia
• Asthma Safe Homes, the Role of Tenants and Landlords, National Center for Healthy Housing

Achievement of Guidelines-Based Medical Management Among People with Asthma: Healthcare providers and their teams can improve the care they give people with asthma by using national guidelines for medical management of asthma. Asthma programs can support healthcare providers by using the below equity approaches.

Example Equity Approaches

• Encourage insurance companies to adopt policies and payment systems that support the delivery of guidelines-based asthma care.
  • Ensure care providers offer personalized, culturally-appropriate asthma action plans using the patients and caregivers’ language and level of health literacy.
  • Improve patient-provider shared decision-making by helping patient navigators support quality patient-provider communication.
  • Help healthcare professionals identify patients with asthma who experience social determinants of health-related issues and build community partnerships to match patients with local resources.
  • Support healthcare providers to adopt data driven quality improvement systems.
• Encourage your state Medicaid office and public and private insurance companies to develop quality improvement goals that improve outcomes for patients with asthma.
• Educate and provide tools for nurses, health educators, community health workers, case managers, and promotoras to provide guidelines-based asthma care and improve communication on diagnosis and treatment options.
• Share information about how to access medication and prescription discounts.

Resources

• EXHALE Guides, Centers for Disease Control and Prevention
• Achieving Equity in Asthma Care: Opportunities and Actions for Change, Allergy and Asthma Network
• Cultivating Equity in Asthma Care: Shared Decision-Making Resources for Providers, Allergy and Asthma Network
• Healthcare Equity, Regional Asthma Management and Prevention
• Medicaid and Racial Health Equity, Kaiser Family Foundation
• Environmental Management of Pediatric Asthma Guidelines, National Environmental Education Foundation

Linkages and Coordination of Care Across Settings Among People with Asthma: When people with asthma have a team of care providers who are connected and coordinated, their health outcomes and quality of life can improve. Employers, hospitals, schools, childcare centers, and at-home care providers can work together to strengthen the support for people with asthma.

Example Equity Approaches

• Build community partnerships and/or coalitions with local organizations who serve people with asthma.
• Expand access to specialist care by increasing referrals from primary care, expanding specialist care coverage, and recruiting more specialists for areas with fewer available specialists.
• Expand care teams to include case managers who address social needs and provide mental health support for patients with asthma.
• Increase funding, awareness, and training for school-based asthma management programs.
  • Include school nurses as partners in a child’s care team.
  • Support increasing the number of school nurses.
  • Ensure schools are equipped to obtain asthma medicines and train appropriate staff to administer medicines.

Resources

• Hospital asthma programs:
  • Boston Children’s Hospital Community Asthma Initiative
• Health plan asthma programs:
  • Unlocking the Power of Home Based Asthma Services: Model Health Benefit Packages, Regional Asthma Management Program
  • Medicaid and School Based Services, Centers for Medicare and Medicaid Services
• School-based asthma programs:
  • Strategies for Addressing Asthma within a coordinated School Health Program, Centers for Disease Control and Prevention
  • Strategies for Addressing Asthma in Schools, Centers for Disease Control and Prevention
  • Athletes and Asthma: The Community Coach’s Role, Minnesota Department of Health
• Guide to Sustaining Effective Asthma Home Intervention Programs, U.S. Department of Housing and Urban Development

Environmental Policies or Best Practices to Reduce Asthma Triggers: Helping people with asthma live, learn, work, and play in healthy environments can improve their health outcomes and quality of life. Policies that support people who are most affected by asthma can have the greatest impact.

Example Equity Approaches

• Help housing agencies adopt and enforce housing codes that protect people with asthma from exposure to indoor air pollutants, irritants, and allergens, including use of integrated pest management.
• Invest in healthy air protections in disproportionately impacted communities and promote the reduction of greenhouse gasses to minimize climate change.
• Educate communities about the health impacts of hotter temperatures, more high-ozone days, extreme weather, flooding, drought, wildfires, and smoke and how to protect themselves.
• Identify and raise awareness of home improvement incentives, loans, grants, or tax credits to help low-income families improve their home’s energy efficiency or remove health hazards such as mold, moisture, or pests.
• Establish partnerships to eliminate workplace exposure to asthma triggers, such as engineering controls (e.g., in ventilation systems) or replacing workplace materials that can trigger asthma.

Resources

• Outdoor Air Tools and Publications, Regional Asthma Management and Prevention
• Air Pollution and Health Equity, American Lung Association
• Protect Your Lungs Before, During, and After a Wildfire, American Lung Association
• Environmental History Form for Pediatric Asthma, National Environmental Education Foundation
• Clean School Bus Program, U.S. Environmental Protection Agency
• Weatherization Assistance Program, U.S. Department of Energy
• Asthma Capitals, Asthma and Allergy Foundation of America