Last Updated: May 2020

Updated by The Vermont Asthma Program

Among youth, 28% with current asthma have been advised by their health professional to change things in their environment at home, school, or work to improve their asthma.  Eliminating or reducing exposure to asthma triggers reduces asthma exaccerbations that may lead to missed days of school or work, and preventable ED visits and hospitalizations.  Following the release of the National Guidelines on the Diagnosis and Management of Asthma (EPR-3) in 2007, the data reached an all time high of 49% just below the target of 50% in 2008.  Unfortunately, the trend reversed direction with a steep trend downward over the next two years. Through a targeted digital and social marketing campaign, and distribution of an Asthma Triggers Brochure, the Vermont Asthma Program was able to help draw attention to the topic and help slow this trend.  Focus was also placed on identifying the triggers most common to Vermonters, including removing pets from the bedroom.  However, more work needs to be done to have providers increase their advise to youth on changing things in their environment to improve asthma control. The last data point is 2015/2016. There has been a change in data source since 2010 so caution must be exercised in drawing direct conclusion from the prior data point and the current data point.

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 or Asthma Action Plan is recognizing triggers and then taking steps, when possible, to remove those triggers from the home or avoid them. It is not always possible to remove or make dramatic changes in an environment because of a myriad of 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 symptoms is not always possible, it is possible to reduce the impact of pets by keeping them out of the bedroom.

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.

• Environmental Health Division is a partner that works with the Vermont Asthma Program on school based assessments to reduce triggers and improve indoor air quality.
• 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 is a partner that works 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 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 is a partner that will work 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) reflects the latest scientific advances in asthma drawn from a systematic review of the published medical literature by an NAEPP-convened expert panel. It describes a range of generally accepted best-practice approaches for making clinical decisions about asthma care. By asking providers and care coordination teams to implement the clinical practice guidelines for asthma and to educate people with asthma on how to manage and control their asthma will result in more questions asked about the home and school environment and potential triggers. We have also seen that the Rutland Pediatric In-Home Visiting Program supported through the Blueprint Community Health Team is an effective way to gain access to homes and advise individuals to change their environment. People can self refer to this program or can be referred, but it is targeted at those with uncontrolled 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 is beginning to expand its work with the OneTouch system. This system will allow for referrals to organizations that deal specifically with environmental causes for asthma and asthma education. As OneTouch becomes more extensive in the state and the Asthma Program works to disseminate the service more broadly, the amount of people who will be referred will increase. We will continue to support the Rutland Pediatric In-Home Visiting Program and are working to recreate a similar program in the Springfield area. The Easy Breathing initiative in Burlington contributes to assessing asthma triggers by surveying parents and asking questions about the home environment. The provider then can follow up on any risk that may be contributing to asthma exacerbations. Lastly, the Program works with the Environmental Health Department on the Envision Program which conducts school environmental assessments in an effort to reduce asthma triggers.

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