Last Updated: February 2023

Author: Asthma Program, Vermont Department of Health

The data for this performance measure was available through 2010, then graduated from the survey.  The current data reflects preliminary data for 2015/2016 after the question was reinstated into the ACBS survey.  The percent of Vermont’s children with a written asthma management plan has fluctuated considerably within the time period of data available (2006-2010), with the Healthy Vermonters 2020 goal in Vermont set at 65% of children with an asthma action plan. The numbers fluctuated between 46% and 66%. In recent years, there has been a decreasing number of respondents for the Child Asthma Callback Survey; this is a problem that several other states are also facing and accounts for why the the question was suspended temporarily in 2010.

The achievement of 59% of up-to-date asthma action plans in 2017 reflects work of the Vermont Asthma Program to work with the Asthma Advisory Panel to update the Asthma Action Plan drawing more attention to its purpose and importance. The Program also worked to target specific regions and schools with higher hospitalization and/or emergency room visits in an effort to improve action plan use in areas of disparate asthma burden.  The importance of asthma action plans was reinforced through an annual school nurse training for those interesting in implementing Open Airways for Schools (OAS), an interactive self-management education program for children. The Vermont Asthma Program also works to disseminate Asthma Action Plans to school nurses and providers and promote them on their webpages and associated asthma media campaigns.  The spike from 2006-2007 is thought to coincide with the release of the National Guidelines for the Diagnosis and Management of Asthma (EPR-3 Guidelines).

Asthma self-management education is essential to reducing asthma-related adverse health effects. Asthma education also improves a patient’s quality of life by reducing urgent care visits, emergency department visits, hospitalizations, and healthcare costs.¹

Healthcare professionals should provide asthma self-management education to patients with asthma and their families or caregivers. This education should include a discussion of environmental triggers. 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. A major emphasis of the Program is to promote guideline-based care and having an up to date asthma management plan.¹ Overall in the United States, children (49%) were more likely to report having an asthma action plan compared with adults (27%).² Vermont children had a significantly higher receipt of asthma action plans compared to children nationwide (2006-2010 combined data).³

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.
2. http://www.cdc.gov/asthma/pdfs/asthma_facts_progra...
3. www.cdc.gov/asthma/acbs/acbstables.htm

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• 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. Providing copies to school nurses and to parents of children with asthma can also help support having Asthma Action Plans completed and shared with schools and caretakers, including coaches, school nurses, daycare facilities, and family.

The Vermont Asthma Program works with clinicians and practices around the state to ensure adherence to best practice guidelines and to increase development and sharing of Asthma Action Plans – a validated tool that translates treatment plans into steps to take with changing asthma symptoms. The Asthma Action Plan can also support educating patients on how to manage asthma. Additionally, 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 development of up-to-date Asthma Action Plan a key quality improvement metric. 

The Vermont Asthma Program also works with clinical partners to expand guideline care, which has included the development and implementation of the M.A.P.L.E plan initiative in Rutland and Springfield aimed to help lower rates of hospitalization readmission by forming plans for asthma management post hospital discharge, and work with the Vermont Chronic Care Initiative to enhance their case managers' home visiting asthma education, including use of asthma action plans, as well as administering an asthma control test and provide key messaging and demonstrations to improve medication adherence and technique. The development of an Asthma Action Plan is a required best practice for these clinical partners, and the Vermont Asthma Program works to disseminate Asthma Action Plans for clinical settings who need them.

The Program supports expansion of asthma self-management education in various settings in high-burden areas, including to the Rutland Pediatric to support its home visiting program, Springfield Regional Hospital, and more recently the University of Vermont Pediatrics to enhance remote educational services. The development of an Asthma Action Plan is a required best practice for these clinical partners. Lastly, the Asthma Program works with schools to train school nurses on asthma self-management and proper medication use so that school nurses can pass that knowledge onto those students who have missed school due to asthma. The Vermont Asthma Program works to disseminate the Asthma Action Plans to school nurses who request parents to have health care providers complete them for children with asthma.  

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