The team of researchers reviewed two large-scale surveys, Asthma In America and Asthma Insight and Management, conducted in 1998 and 2009 respectively, with thousands of patients with asthma and hundreds of physicians. The report is published in the journal Allergy and Asthma Proceedings.

Unfortunately, their findings indicate that the burden of asthma lessened only slightly if at all across the last decade. Rates of acute care use (hospitalizations, emergency department visits, and other urgent care visits) remained virtually unchanged over the time period between the two studies.

While most physicians reported awareness of the national guidelines, in the most recent survey fewer reported always following them. Spirometry was used by three-quarters of asthma specialists in both surveys to aid in diagnosis but was infrequently used by nonsubspecialists. And a significant number of physicians reported not prescribing inhaled corticosteroids for persistent asthma, as advised by the guidelines.

The authors conclude, “The state of US asthma care and clinical outcomes changed little from 1998 to 2009.”

We can’t let another decade go by with so little progress. As Floyd Malveaux, MD, PhD, executive director of the Merck Childhood Asthma Network, recently wrote in an article on Huffington Post, “the statistics are dramatic proof that we are failing to deliver the health care, education and self-management tools needed by many to manage their asthma….My personal and professional experience with asthma won’t let me sit idly by while children with asthma fall off the radar.”

For more from the event, check out the Rock Health YouTube channel. 

The total cost of asthma due to pollution is much higher than past traditional risk assessments have indicated and there is growing evidence that exposure to traffic-related air pollution is a cause of asthma and a trigger for attacks. They conducted the study in Long Beach and Riverside, CA, communities with high regional air pollution levels and large roads near residential neighborhoods.

Total additional asthma-specific costs there due to traffic-related pollution is about $18 million per year, almost half of which is due to new asthma cases caused by pollution, they report. Brandt worked with researchers at the University of Basel, Switzerland, Sonoma Technology, Inc. and the University of Southern California.

Using updated techniques that count asthma cases attributable to air pollution for the first time and including a broader range of health care costs such as parents’ missed work days, extra doctor visits and travel time along with prescriptions, the researchers found that a single episode of bronchitic symptoms cost an average $972 in Riverside and $915 in Long Beach. Bronchitic symptoms (daily cough, congestion or phlegm, or bronchitis for three months in a row) are a critical outcome for children with asthma.

Further, people who live in cities with high traffic-related air pollution bear a higher burden of these costs than those in less polluted areas, they say.

Brandt and colleagues say the total annual cost for a typical asthma case was $3,819 in Long Beach and $4,063 in Riverside, and “the largest share of the cost of an asthma case was the indirect cost of asthma-related school absences.” School absences are an important economic consequence, they add, because “they often lead to parents or caregivers missing work.”

Overall, Brandt points out that the results are relevant and applicable to many settings and “families with children who have asthma are bearing a high cost. The total annual estimate between $3,800 and $4,000 represents 7 percent of median household income in our study in these two communities. This is troublesome because that is higher than the 5 percent considered to be a bearable or sustainable level of health care costs for a family.”

Riverside and Long Beach account for about 7 percent of the total population of California, the authors say, which suggests that state-wide costs of asthma related to air pollution are “truly substantial.”

For this work, Brandt and colleagues analyzed several surveys on health care visits by children with asthma and their previous estimates of the number of asthma cases attributable to pollution to estimate the annual costs of childhood asthma. They also estimated the cost of asthma exacerbation due to regional air pollutants. They feel the new method does a better job of accounting for the full impact of traffic-related pollution and will be widely applicable in urban areas.

She points out, “Traditional risk assessment methods for air pollution have underestimated both the overall burden of asthma and the cost of the disease associated with air pollution. Our findings suggest the cost has been substantially underestimated and steps must be taken to reduce the burden of traffic-related pollution.”

Our Q&A – about Asthmapolis and the potential of mobile technology to improve the quality of care and public health - is published in their Quality Matters newsletter this month. Read more »

In addition, the newsletter has another article on apps for health care quality improvement that is  well worth reading.

Providers have proven eager adopters of health care “apps,” the software applications used on cell phones and other mobile devices to perform specific tasks, such as charting data points or aggregating information. Apps can be easily integrated into providers’ workflow, delivering information when and where they need it. Disease management apps, in particular, can improve communication between patients and providers and promote adherence to recommended care. Still, for apps to achieve their potential, they will need to be factored into reimbursement models and meet clear clinical needs. Read more »

Asthmapolis is featured as an example of the possibilities of a new data economy in health and healthcare.

It’s a long (65 pgs) but quite well written and thoughtful report that is freely available (with minimal registration) here:  www.csc.com/lefreports.

For shorter takes there is also a press release and a feature article, and a video or two.

According to the White House website, “The Obama administration established the Champions of Change award to recognize and encourage ‘everyday heroes’ working to better their communities through hard work and creative solutions.” Many of these folks – such as awardee Todd Park, CTO of HHS – now occupy key roles in government where they are sparking new companies and revolutionizing industrial ecosystems using whole new approaches to data.

The day started with a fiery session by Aneesh Chopra, who proclaimed now the best time in history to innovate. A panel discussion with industry experts, including entrepreneur and author Eric Ries, Proctor and Gamble CTO Bruce Brown, and McKinsey Global Institute director James Manyika, provided an encouraging perspective on the value of data in innovation, and adjacently, its role in an emerging collection of new lean processes in the development of projects that become companies, and within big companies, innovative new products and services. See Ries’ fantastic overview of the day that compelling ties this all together.

Kundra’s remarks highlighted the development and amazing growth of Data.gov, the US platform which has grown from just 47 datasets to over 390,000 in two years. He outlined the future of the platform, promising more machine-readable data, a tool for creating exportable data visualizations, and easier mechanisms for agencies to publish data.

Cass Sunstein (and the back of superhero Todd Park's head)

The session closed with a lecture by Cass Sunstein, an American legal scholar and current Administrator of the White House Office of Information and Regulatory Affairs. Sunstein underscored the essential role of civic engagement in the sustainability and health of the democracy with an anecdote from Benjamin Franklin. By the story, at the close of the Constitutional Convention in 1787, when leaving Independence Hall, Franklin was approached by a woman who asked:

“Well, Doctor, what have we got—a Republic or a Monarchy?”
Franklin replied, “A Republic, if you can keep it.”

Centuries later, my fellow awardees – from Zonability, a company that makes zoning laws easily accessed online, to the team who independently redesigned the Federal Register to make it more user friendly – relentlessly apply their ingenuity, skills and energy to solve specific problems, strengthen our democracy, and improve our daily life.

The Champions of Change ceremony on June 16 concentrated specifically on the use of open data and innovation. Nomination of the developers was a collaboration between Government Technology magazine and its partner, the Center for Digital Government.

But there is an incredible history of Champions from other domains including the arts, education, and communities. You can find bios, posts and overviews on the Champions of Change website.

The August issue of Government Technology, is out today; look online for an overview of the award and projects, and video interviews with the developers. It follows an article in June that summarized the event.