Updated: February 2018

Author: Health Promotion and Disease Prevention, Vermont Department of Health

The trend line shows a decrease in the percent of adults (≥ 18 years) currently diagnosed with lung disease (Asthma/Chronic Obstructive Pulmonary Disease (COPD)) to 13% (2017) compared to previous years reported (2011 – 2015).  The program has recently added interventions to assist the adult asthma population that may be contributing to these reductions.  For example, efforts are underway to encourage individuals to make small changes at home that might mean a big difference for families (adults and children) to live and breathe better. Vermont has a robust weatherization program which can result in improved home conditions with fewer lung irritants including moisture, mold, old carpeting and other triggers. Grants and loans are made available for lower and middle-income families to support these weatherization efforts.

Despite the recent positive trend, the rate of adults with current asthma in Vermont (10%) remains statistically higher than the U.S. overall (9%), with nearly twice as many women likely to report current asthma compared to men (2016 BRFSS Report, September 2017, p.26).  The data showed statistically significant higher adult prevalence rates for lung disease (Asthma/COPD) in Bennington and Orleans counties, as well as the Newport Health District and Hospital Service Area, with asthma alone impacting heavily in these same areas.  Hospitalizations for asthma for Vermont’s elderly population has remained below 13% throughout the state since 2009, but in Rutland the rate of hospitalizations for 65+ years of age has rates as high as 22%.  While this rate has steadily declined since 2009, finding additional ways to bring down the risks of asthma related hospitalizations for seniors in Rutland remains a big challenge.  About one in twenty (6%) of Vermont adults have Chronic Obstructive Pulmonary Disease (COPD), the same as the U.S. rate.  Adults with less education and lower annual household incomes are more likely to have asthma or COPD. 

Adult Vermonters with current asthma were significantly more likely to rank their general health as poor or fair compared to those without asthma. Most importantly, data show that fewer than half of adults cannot carry out normal activity because of their asthma.  The main biological risk factors among adult Vermonters with asthma are allergies, genetics, smoking, exposure to secondhand smoke and pollutants, and being overweight. The co-occurrence of chronic conditions include cancer, heart disease and stroke, type 2 diabetes, and COPD. 

In Vermont, three out of ten (30%) adults with lung disease (Asthma/COPD) currently smoke.  Current tobacco smokers or those who ever smoked were also exposed to second hand smoke and therefore also more likely to have severe persistent asthma and poorly controlled asthma than those who never smoked and were not exposed to second hand smoke.  Between 80% and 90% of COPD is due to tobacco use, which is evident when looking at COPD diagnosis by smoking status among Vermont adults.  Although the primary cause of COPD is smoking, an increasing number of studies have reported associations between indoor and outdoor air pollution exposures and COPD.  Indoor exposures include smoke from tobacco (second hand smoke), biomass fuels, while outdoor environmental exposures are particulate matter (PM10 & PM2.5), ozone, and sulfur dioxide from automobiles and industrial sources.  Occupational exposures such as fumes, gases, and both inorganic and organic dusts can also be accounting for some of the COPD cases.  Current asthma diagnosis was the most significant risk factor for COPD, even higher than cigarette smoking.

Asthma is a chronic (long-term) disease in which the lungs become inflamed and airways narrow and react to "triggers." The most common environmental trigger for both adults and children at home was the presence of an indoor pet.  Other common indoor triggers for Vermonters included carpeting in the bedroom and pets allowed in the bedroom.  Chronic Obstructive Pulmonary Disease (COPD) is a large group of lung diseases characterized by airflow obstruction. COPD is often associated with symptoms related to difficulty in breathing, but can be present without any symptoms. The most important and frequent conditions of COPD are chronic bronchitis and emphysema, but COPD also includes other diagnoses. 

Improperly managed chronic diseases are associated with poor health, low quality of life, limitations to normal activities, and are also tied to high medical costs that can impact a family’s and the entire state’s economic future.

• Northeast American Lung Association is a partner that works with the Vermont Asthma Program on supplying education materials to asthma educators within the state.
• 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.
• Springfield Health Center is a partner that works with the Vermont Asthma Program on community education, clinical integration of asthma educators into practice, the MAPLE hospital discharge protocol and potential home visiting programs.
• HMC Advertising is a partner that works with Vermont Asthma Program creating a digital media plan with the goal of increasing awareness of asthma symptoms, triggers and referrals to 802Quits.
• 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.
• Asthma Regional Council is a partner that works with the Vermont Asthma Program on facilitating meetings between the different New England Asthma Programs.
•  Asthma Advisory Panel is a partner that works with the Vermont Asthma Program on developing strategic goals and relationships to advance respiratory health in the state.
•  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.
•  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.
• 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 lung health.
• Vermont Department of Labor is a partner that works on the worksite wellness program, Project WorkSAFE
• OneTouch is a partner that works with the numerous programs and social service agencies including the Vermont Asthma Program on linking individuals to valuable. Resources. Other partners in the OneTouch program include Healthy Homes and Weatherization.          

Lack of physical activity, poor nutrition and tobacco use are three behaviors that contribute to the development and severity of chronic disease.  Lung disease is one of the four major chronic disease that impact Vermonters.  See http://www.healthvermont.gov/3-4-50.

Guidelines for the Diagnosis and Management of Asthma (EPR-3), is an Expert Panel Report that describes a range of best-practice approaches for making clinical decisions about asthma care. This expert panel was convened in 2007 by the National Asthma Education and Prevention Program (NAEPP) and was coordinated by the National Heart, Lung, and Blood Institute (NHLBI), with the guidelines reflecting the latest scientific advances in asthma drawn from a systematic review of the published medical literature.  For more information see https://www.nhlbi.nih.gov/health-pro/guidelines/current/asthma-guidelines.

Some of these best practices include:

• Health care providers who implement asthma clinical practice guidelines
• Other educators, including asthma educators, delivering community and in-home education
• School nurses providing self-management supports to students and families on how to manage and control asthma
• Linkages and referrals within and across the system of care to provide Vermonters with the best support to control their asthma

Self-Management: The main strategy of the program is to educate and empower the patient and their families in self-management of their chronic condition.  The program works with a variety of partners to build a comprehensive system of asthma control and other chronic care services that deliver guideline based care and promotes self-management.  http://www.healthvermont.gov/wellness/asthma/asthma-facts-individuals-and-families

802 Quits: Helps Vermonters successfully quit smoking and prevent other serious lung diseases.  See http://802quits.org/.

MAPLE Plan: works to lower rates of hospitalization and readmission by developing plans and providing follow-up support in the education and self-management of asthma. 

Community and In-home Education: to provide education on guideline based self-management strategies for individuals and families, including understanding asthma, identifying the signs and symptoms of asthma, avoiding asthma triggers, and making small changes that make a big difference in a family’s breathing.

Clinical Guideline-based Asthma Care: Supporting efforts that improve guideline based asthma care in clinics. See https://www.nhlbi.nih.gov/health-pro/guidelines/current/asthma-guidelines.

Open Airways for Schools: training and support of education by school nurses in schools through a fun interactive curriculum for students 8-11 years in asthma self-management.  See http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/asthma-education-advocacy/open-airways-for-schools/. Environmental efforts like Envision and OneTouch that work to improve air quality at work, in schools and at home.  See http://www.healthvermont.gov/health-environment/healthy-schools/envision-program

Data is updated as it becomes available and timing may vary by data source.