A Comprehensive Public Health Approach to Asthma Control Through Evidence-Based Interventions

childhood asthma outcomes. Recipients will strengthen their existing organizational infrastructure and expand the reach of services by implementing six EXHALE strategies: Education on asthma self-management; eXtinguishing smoking and exposure to second-hand smoke; Home visits for trigger reduction and asthma self-management education (AS-ME); Achievement of guidelines-based medical management; Linkages and coordination of care; and Environmental policies or best practices to reduce indoor and outdoor asthma triggers. Key outcomes are increased capacity to deliver AS-ME, expanded services for those with the highest burden, improved asthma control, increased insurance coverage, coordinated care and reduced health disparities.[1] Long-term outcomes will contribute to the CCARE goal of preventing 500,000 hospitalizations and emergency department visits among children with asthma within five years. Asthma in the United States is both common and costly. According to recent estimates, more than 26.5 million Americans have asthma, including 6.1 million children and 20.4 million adults.[2] In addition, asthma accounts for 1.7 million emergency department visits, 11 million physician office visits and 439,000 hospitalizations.[3] Asthma is responsible for 13.8 million missed school days and 14.2 million missed workdays annually.[4] In spite of available drugs to treat and control asthma, 10 people die of asthma each day.[5] Asthma also places a significant economic burden on the United States. Estimates from 2008-2013 Medical Expenditure Panel Survey household data showed that the cost of treating asthma was $50.3 billion annually, while the total cost of asthma, including costs incurred by absenteeism and mortality, amounted to $81.9 billion.[6] Asthma affects certain groups disproportionately, rendering significant disparities. For example, asthma is more common and more severe among children, women, low-income, inner-city residents, African American and Puerto Rican communities, who have higher rates of emergency department visits, hospitalizations and deaths.[7] American Indian/Alaska Native children are 60 percent more likely to have asthma as non-Hispanic White children.[8]. The reasons for these disparities are complex, but cannot be attributed to genetic differences alone. Economic, social, and cultural factors, ranging from lack of access to quality health care to differences in health beliefs between patients and their doctors, add to the greater asthma burden among these groups. Individuals may also face housing and work conditions that place them at greater risk for frequent and prolonged exposure to environmental allergens and irritants that worsen asthma.[9] This NOFO builds upon work of state and territorial public health departments and their partners supported by CDC through funding opportunity announcements CDC-RFA-EH14-1404 and CDC-RFA-EH16-1606 as well as other entities. Given evidence that a multi-component approach to controlling asthma is more effective than individual strategies applied in isolation, this NOFO is based on a technical package known as EXHALE, comprised of six evidence-based strategies selected for their potential of having the greatest collective impact on controlling asthma.[10] Recipients will implement these strategies as a package, ensuring that all six strategies are conducted in the same, high-burden geographic location or population so that strategies complement and reinforce each other.