Last Updated: February 2023

Author: Asthma Program, Vermont Department of Health

The percent of adults with asthma who have received a written asthma management plan slowly increased between 2006 - 2016. The percent then dipped to 20% in 2018 with a significant jump to 45% (and above the target) in 2019. 

The decline from 2016 to 2018 may be a result of the release of a new version of the Vermont Annual Asthma Action Plan (in August 2016) that may have divided preferences among health care providers of what tool to use. Some providers may have embedded their treatment plans into their electronic health records, which is a good step, but requires providers to share copies of plans with patients, a step we hear anecdotally needs improvement.

The jump from 2018 to 2019 may in part be due to the indirect benefit to adults resulting from the Vermont Asthma Program’s initiating the Asthma Friendly Schools Recognition Program in 2018 that involved a statewide media campaign about having an up-to-date asthma action plan as a key best practice.

The decline in 2020 is likely due to fewer routine doctor’s visits in 2020 due to Covid.

Healthcare professionals (clinicians) should provide asthma self-management education to patients with asthma and their families or caregivers. Asthma self-management education is essential to reducing asthma-related adverse health effects. Learning how to improve one’s asthma management through avoiding triggers, taking medication properly, and seeing a provider regularly are some of the key education elements and result in improved quality of life by reducing urgent care visits, emergency department visits, hospitalizations, and healthcare costs. In addition, every patient with asthma should be given a written asthma action plan providing instructions for daily asthma management and for recognizing and handling worsening asthma. ¹

This indicator is part of Healthy Vermonters 2020 (the State Health Assessment) that documents the health status of Vermonters at the start of the decade and the population health indicators and goals that will guide the work of public health through 2020. Click here for more information.

1. Douglass J, et al. BMJ 2002;324:1003–5.

• Maternal and Child Health is a division in the Department of Health that works with the Vermont Asthma Program on increasing coordination at schools and among school nurses to address absenteeism and asthma education for school nurses/students, including training school nurses in selected supervisory unions throughout the state on asthma self-management.
• Blueprint for Health is a partner that works with the Vermont Asthma Program on educating community health teams on asthma education and tools available to improve self-management, including Asthma Action Plans and Healthier Living Workshops that support improving asthma management.
• Rutland Regional Medical Center is a partner that has worked with the Vermont Asthma Program on home visiting programs, the MAPLE hospital discharge protocol and community education.
• DVHA is a partner that works with the Vermont Asthma Program on reducing the burden of asthma among Medicaid-insured including exploring reimbursement for community-based education.
• Vermont Department of Health Offices of Local Health are partners that work with the Vermont Asthma Program to disseminate asthma action plans and reach local communities.
• Asthma Advisory Panel is a partner organization made up of a cross-section of experts in diverse fields and organizations that works with the Vermont Asthma Program on developing strategic goals and relationships.
• Asthma Regional Council is a partner that works with the Vermont Asthma Program on facilitating meetings between the different New England Asthma Programs
• Northeast American Lung Association is a partner that works with the Vermont Asthma Program on supplying education materials to asthma educators within the state.
• University of Vermont: Pediatrics is a partner that works with the Vermont Asthma Program on expanding access and delivery of supplementary asthma self-management education to those with uncontrolled asthma and severe persistent asthma to prevent asthma-related emergency department visits and hospitalizations.
• Vermont Child Health Improvement Project is a partner that has worked with the Vermont Asthma Program on implementing a learning collaborative to reinforce and expand asthma guideline care bast practice standards among health care providers.
• Vermont Chronic Care Initiative is a partner that has worked with the asthma program on incorporating asthma education into their case management home visiting programs.
• Vermont One Care is a partner that works with the Vermont Asthma Program at improving care for pediatric and adult populations by hosting a learning collaborative and facilitating quality improvement projects among participating providers and practices in guideline care.
• Hark Website Design, Branding & Communication is a partner that works with Vermont Asthma Program creating a digital media plan with the goal of increasing awareness of secondhand smoke exposures, increasing referrals to 802Quits, promoting importance of flu shots and asthma action plans, and reducing exposures to asthma triggers in homes and schools.

In 2007, the National Asthma Education and Prevention Program (NAEPP), coordinated by the National Heart, Lung, and Blood Institute (NHLBI), released its third set of clinical practice guidelines for asthma. The Expert Panel Report 3—Guidelines for the Diagnosis and Management of Asthma (EPR-3) that reflected the latest scientific advances in asthma drawn from a systematic review of the published medical literature by an NAEPP-convened expert panel. It continues to describe a range of generally accepted best-practice approaches for making clinical decisions about asthma care.

Asking providers to develop and share with patients an Annual Asthma Action Plan helps promote the implementation of the clinical practice guidelines for asthma.

The Vermont Asthma Program works with clinicians and practices around the state to ensure adherence to best practice guidelines and to increase the usage of Asthma Action Plans – a validated tool that translates treatment plans into steps to take with changing asthma symptoms, and key communication tool for family and caretakers. The Asthma Action Plan can also support educating patients on how to manage asthma and supporting self-care. The Vermont Asthma Program identified specific regions and schools with higher hospitalization and/or emergency room visits and focused effort to improve action plan use in areas of disparate asthma burden, but also disseminates Asthma Action Plans to clinical settings throughout the state for those who need them.

The Vermont Asthma Program supports expansion of asthma self-management education in various settings in high-burden areas, including through Rutland Pediatric to support its home visiting program, Springfield Regional Hospital, and more recently the University of Vermont Pediatrics to enhance AS-ME delivery to severe and high risk patients, including remote educational services. The Program holds or contributes to provider learning collaboratives to educate on guideline care and support for quality improvement in areas with higher hospitalization and/or emergency room visits due to asthma. For example, the Program worked in partnership with Vermont's One Care to plan and implement a Learning Collaborative among providers serving those with asthma and COPD, and included the creation by a provider of up-to-date Asthma Action Plans a key quality improvement metric. The Vermont Asthma Program also works with clinical partners to find ways of expanding guideline care, such as development and implementation of the M.A.P.L.E plan initiative in Rutland and Springfield that aimed to lower rates of hospitalization readmission by forming plans for asthma management post hospital discharge. The Vermont Asthma Program worked with the Vermont Chronic Care Initiative to enhance their case managers' home visiting asthma education, including use of asthma action plans, as well as promoting administration of an asthma control test, and providing key messaging and demonstrations to improve medication adherence and inhaler device technique.

Data is updated as it becomes available, and timing varies by data source. For more information about this indicator, click here.

This indicator is age-adjusted to the 2000 U.S. standard population. In U.S. data, age adjustment is used for comparison of regions with varying age breakdowns. In order to remain consistent with the methods of comparison at a national level, some statistics in Vermont are age adjusted.  The estimates were adjusted based on the proportional age breakdowns of the U.S. population in 2000. For more detailed information on age adjustment visit /www.cdc.gov/nchs/data/statnt/statnt20.pdf.

Due to BRFSS weighting methodology changes beginning in 2011, comparisons between data collected in 2011 and later and that from 2010 and earlier should be made with caution. Differences between data from 2011 forward and earlier years may be due to methodological changes, rather than changes in opinion or behavior.