Last Updated: February 2023

Author: Asthma Program, Vermont Department of Health

The percent of adults with asthma who are advised to change things in their environment from years 2006-2019 has remained relatively stable with a peak in 2016 at 45%. In the last year data is available (2019), 40% of adults were advised to change something in their environment while the goal was 45%.

This gap between current values and the target line of improving self-management is identified as an area to work on including provider education. Through home visiting and asthma self-management education programming, particularly in Rutland and Springfield, individuals with asthma have been encouraged to eliminate or reduce exposures to asthma triggers.  The Asthma Trigger Brochure was developed and is regularly sent to individuals referred from weatherization partners who are identified as having asthma.  This brochure lists the most common triggers for Vermonters, and simple steps that can be taken to eliminate them to help families breathe easier.  For adults in particular, the work site is a place of common exposure; in a 2018 Asthma Advisory Panel the focus was on the trends seen in exposure and exacerbation at the workplace and programs or strategies to address it.  Individuals working in health care support occupations had a significantly higher asthma prevalence and twice the statewide rate. The Department of Health has an active Work Site Wellness Program that seeks to support adoption of wellness and health policies and has worked together with Department of Labor and the WorkSafe Program to identify some of the risks of exposures in health care settings, and to identify key steps employees should know to eliminate or avoid exposures, or how to file a report and claim if they are impacted by an exposure. In 2016 the Asthma Program contributed toward a Vermont Children's Health Improvement Program learning collaborative on asthma measures which included using asthma control tests and Asthma Action Plans that can inform and include trigger reduction guidance.

Health care professionals play an important role in helping asthma patients recognize and limit their exposure to asthma triggers. The National Heart, Lung, and Blood Institute (NHLBI) EPR-3 recommends that medical professionals advise their patients with asthma to reduce or avoid exposure to indoor and outdoor asthma triggers.¹ Reduction of exposure to asthma triggers can improve asthma symptoms and reduce asthma episodes. A large part of having an asthma self-management plan is recognizing triggers and then taking steps, when possible, to remove those triggers from the home or to avoid them. It is not always possible to remove or make dramatic changes in an environment because of a myriad of factors (workplace factors, cost, time, family pets, rental homes) but it is usually possible to make small changes that can alleviate the health impact of environmental triggers. An example would be that while getting rid of a pet that triggers asthma is not always possible, it is possible to reduce their impact by keeping pets out of the bedroom, and to make homes and cars smoke free-zones.

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. Clark, N. Self-management of asthma by adult patients. Patient Education and Counseling. 1997. pp. S5-S20.

• Environmental Health is a partner that works with the Vermont Asthma Program on school based environment assessments.
• Vermont Department of Labor is a partner that works on the worksite wellness program.
• OneTouch is a partner that works with the Vermont Asthma Program on linking individuals to education and environmental remediation based on home visits. Other partners in the OneTouch program include Healthy Homes and Weatherization.
• 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 has worked with the Vermont Asthma Program on home visiting programs, the MAPLE hospital discharge protocol and community education, including tobacco screening, cessation and treatment and referrals.
• 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 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 Chronic Care Initiative has worked with the Vermont 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 reviewed best-practice approaches for making clinical decisions about asthma care.

There are several strategies that work. Asking providers to implement the asthma clinical practice guidelines is shown to work. Other educators and clinicians, including certified asthma educators, delivering community education and school nurses providing self-management supports on how to manage and control asthma result in lower hospital readmissions. In most cases, people should not have to go to the hospital if they have properly controlled and managed asthma.

The Vermont Asthma Program works with clinicians and practices around the state to ensure adherence to best practice guidelines. The Vermont Asthma Program also works with partners to increase the usage of Asthma Action Plans and education provided to people with asthma. Specific to environmental triggers, the Asthma Program promotes and is a partner within the OneTouch system – a  system for referrals primarily between home energy and weatherization contractors and health and other service providers. OneTouch reflects an important effort to strengthen coordinated care and linkages for individuals with asthma.  The Asthma Program has collaborated with the Vermont Chronic Care Initiative to assist and enhance their case managers' home visits with the goal that they will be able to address environmental triggers, administer an asthma control test, provide key messaging and supports to improve medication adherence high risk asthma individuals, and help prevent costly asthma-related hospitalizations or work disruptions. The Asthma Program will also worked with HMC advertising and more recently with HARK, to increase awareness of asthma triggers.

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 are 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.