Updated: February 2023

Author: Asthma Program, Vermont Department of Health

NOTE: Since the nearest hospital for many Vermont residents is out-of-state, the approach of the Vermont Asthma Program is to report full data including Vermont residents treated in adjacent states.  Due to changes in data collection and processing technologies, updated data from NY and NH has been delayed and so the most recent data available for this indicator is from 2016.  This indicator will be updated when more recent data is available.

The rate of hospitalizations for asthma among Vermonters 65 years and older has been decreasing between 2005‐2015. In 2015, the VT rate was 8.1 per 10,000, going lower for the first time than the Healthy Vermonters target of 9.3 per 10,000. The VT rate of hospitalization for asthma among older adults is lower than the U. S. rate. The most recent U. S. data available is from 2010 when the VT rate was 10.8 per 10,000 compared to the U.S. rate of 25.5 per 10,000.

Many factors are likely to contribute to this reduction in hospitalization rate and may include modifications to asthma medications and delivery technology, increased patient education, and increased promotion and usage of guidelines-based care for asthma.  Additional factors contributing to this decrease in asthma hospitalizations may be the increased awareness of guideline based treatment, the efforts of Blueprint for Health in collaboration with practices and community health teams, and efforts to mitigate environmental triggers that can exacerbate asthma. Another reason for the general decrease over time could be from the myriad of other initiatives that hospitals and federal programs, including Centers for Medicare and Medicaid Services, are employing to reduce costs associated with hospitalization. The decrease may also be due a national program that provided a CDC grant to the Vermont Asthma Program to initiate a comprehensive program of asthma control efforts starting in 2009, and being renewed in 2014 to work with valued partners to develop and expand best practice strategies in asthma care.

In the United States in 2010, there were approximately 439,000 inpatient discharges with asthma as a primary diagnosis. These inpatient stays for asthma averaged 3.6 days in duration. Although inpatient hospitalization for asthma is less frequently used than outpatient and pharmaceutical services, its cost is substantially higher. As of 2010, an estimated 18.7 million adults, or 8.0% of the adult U.S population had asthma. In the U.S., there were 1.8 million total ED visits with asthma as primary diagnosis in 2011. ¹

Hospitalizations due to asthma could be reduced if asthma is managed according to established guidelines. Effective management includes control of exposure to factors that trigger exacerbations, adequate pharmacological management, continual monitoring of the disease, and patient education in asthma care. Read more about asthma management from the National Heart, Lung, and Blood Institute.

This indicator is part of Healthy Vermonters 2020 which 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.

1. CDC/National Center for Health Statistics, FastStats-Asthma.

• 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.

• Department of Vermont Health Access 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.

• OneCare Vermont 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.

A declining rate of hospitalizations may indicate that the Health Department’s Asthma Program’s focus on promoting the new asthma national guidelines of care, supporting best practice reinforcement and expansion through learning collaboratives, piloting and expanding home visiting for asthma trigger identification and elimination, and providing resources to improve Vermonter’s self-management is working to keep their asthma under control. 

The Vermont Asthma Program engages with lung health experts, partners, insurers, healthcare providers, hospitals, and schools to improve asthma control. Efforts focus on providing asthma self-management education in schools, clinics, and community settings, promoting use of Asthma Action Plans and proper use of spacers and inhalers, and assisting people to quit smoking and avoid tobacco smoke. Priorities include supporting in-home asthma education among populations with highest burden. The Asthma Program promotes other protective measures including receiving the annual flu shot, using clean burning stoves, and minimizing exposures to common triggers.

The Asthma Program is working with other New England state programs through the Asthma Regional Council to explore if there is a provider training program that all states could collaborate. Additionally, the Program organizes an Asthma Learning Collaborative each year to provide guideline care education for quality improvement practices in areas with higher hospitalization and/or emergency room visits due to asthma. The Vermont Asthma Program also works to disseminate Asthma Action Plans which are a validated tool for educating patients on how to manage asthma. The Program supported clinical partners to develop and expand use of the M.A.P.L.E Plan in Rutland and Springfield – a protocol aimed to help lower rates of hospitalization and readmission by forming plans for asthma management post hospital discharge. The Vermont Asthma Program also continued to support the Rutland Pediatric in home visiting program and efforts to expand those services in other high burden areas, including the Springfield area. The Program implemented the Easy Breathing initiative that contributes to diagnosing asthma sooner. The Asthma Program worked with the Vermont Chronic Conditions Initiative (VCCI) to develop/educate their case managers with the goal that the case managers administer an asthma control test, provide key messaging and supports to improve medication adherence. Lastly, the Asthma Program worked 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.

Data is updated as it becomes available, and timing varies by data source.

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. In cases where age adjustment was noted as being part of the statistical analysis, the estimates were adjusted based on the proportional age breakdowns of the U.S. population in 2000. For more detailed information on age adjustment see the Healthy People 2010 Statistical Notes.