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Special Edition, 2011

NACI Breaking News

Asthma Experts Gather to Share Lessons Learned and Chart Next Steps to Improved Asthma Care and Control

“This is your program. You’re like a thousand points of light,” declared Denise Simons-Morton, M.D., M.P.H., Ph.D., Director of the Division for the Application of Research Discoveries (DARD) at the National Heart, Lung, and Blood Institute (NHLBI), as she welcomed participants to the 2011 National Asthma Education and Prevention Program (NAEPP) Coordinating Committee Meeting.

Underscoring the importance of collaboration and communication in improving quality of life for some 25 million Americans who have asthma, Dr. Simons-Morton encouraged all participants to share their ideas without hesitation over the course of the gathering on September 26–27 in Baltimore, MD. She also reaffirmed the NHLBI’s commitment to supporting the NAEPP—launched by the NHLBI 22 years ago—emphasizing, “The NHLBI works to ensure that everything we do, from scientific research to its application in practice, is evidence-based.”

Dr. Denise Simons-Morton, DARD Director, NHLBI, at right, confers with Rachael Tracy, Acting NAEPP Coordinator, NHLBI
Dr. Denise Simons-Morton, DARD Director, NHLBI, at right, confers with Rachael Tracy, Acting NAEPP Coordinator, NHLBI

The meeting brought together 80 professionals from around the country, all dedicated to working with one another and with the NAEPP to improve asthma care and control nationwide.

Over the course of the conference, presenters reflected on the NAEPP’s history; the NACI’s present role in uniting patients, families, health care providers, schools, employers, insurers, and other asthma stakeholders around the common goal of advancing asthma control; and how to use lessons learned from all NAEPP activities to expand future efforts.

“The NACI falls under the umbrella of the NAEPP,” said Rachael Tracy, M.P.H., Acting NAEPP Coordinator for the NHLBI’s DARD. “It is a multi-component, mobilizing, and action-oriented initiative to engage diverse stakeholders in using the recommendations of the NAEPP’s Expert Panel Report 3: Guidelines for Diagnosing and Managing Asthma (EPR-3) and Guidelines Implementation Panel (GIP) Report to bring about meaningful change in asthma clinical care practices and quality of life for people who have asthma.”

The meeting began with a review of the current state of asthma. Floyd J. Malveaux, M.D., Ph.D., Executive Director of the Merck Childhood Asthma Network, Inc. (MCAN) and former Dean of the College of Medicine and Professor of Microbiology and Medicine at Howard University, highlighted the extent of the asthma problem and the persistent gaps in asthma care and control among certain racial and ethnic groups.

Dr. Floyd J. Malveaux, Executive Director, MCAN, at right, with Stephen J. Teach, MD, MPH of Children's National Medical CenterDr. Floyd J. Malveaux, Executive Director, MCAN, at right, with Stephen J. Teach, MD, MPH of Children's National Medical Center

“Things change, but not always for the better, especially with disparities where the gap is not closing,” he underscored. Dr. Malveaux also presented examples of several evidence-based interventions that demonstrated improved asthma outcomes in medically underserved communities. He concluded, “We have both challenges and opportunities to implement what we know ‘works.’ Asthma disparities will not ‘go away’ unless we address the issue directly.”

James Kiley, Ph.D., Director of the NHLBI’s Division of Lung Diseases, spoke about the capacity of the Coordinated Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities as one way to address this challenge. The plan is being developed by the President’s Task Force on Environmental Health Risks and Safety Risks to Children, and aims to enable federal agencies—and their community, state, and national partners—to mount a focused effort to address this problem.

Dr. James Kiley, Director of the NHLBI's Division of Lung DiseasesDr. James Kiley, Director of the NHLBI's Division of Lung Diseases

Dr. Kiley also thanked his colleagues in attendance, David Rowson, M.S., Director of the Center for Asthma and Schools, Indoor Environments Division, U.S. Environmental Protection Agency and Paul Garbe, D.V.M., M.P.H., Chief, Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, for their leadership on the task force. He added that he and his colleagues looked forward to receiving participant input during the NAEPP meeting and to collaborating with participants to put the final plan into action.

A panel of representatives from each of the three core, funded programs of the NAEPP’s National Asthma Control Initiative—Demonstration Projects, Strategic Partners, and Clinical Champions—provided participants with an overview of how these projects are addressing the disparities challenge and also putting the six GIP Report messages into practice. At the invitation of the panel’s moderator, Gloria Ortiz, M.S., Program Analyst for the NHLBI’s DARD, participants divided into four breakout discussion groups, sharing additional insights, lessons learned, areas for collaboration, and ways to better communicate and advance the goals of the NAEPP’s NACI, before coming back together to share the top three responses from each group.

At every turn there was proof of participants’ eagerness to work together. Lively conversations between NAEPP members and representatives from the NAEPP’s NACI Demonstration Projects, Strategic Partners, and Clinical Champions continued to bubble up not just at the meeting-room tables, but also in the hallways and registration area.

As participants prepared for the next round of breakout discussions, specifically to more fully review aspects of the NAEPP—its structure, organization, and future directions—Noreen Clark, Ph.D., Director of the Center for Managing Chronic Disease at the University of Michigan, and one of the first NAEPP Coordinating Committee members, urged them to devise “a comprehensive, creative, and innovative game plan” that finds new ways to build stakeholder capacity and to put asthma guidelines into action. She envisioned it as a multi-lane highway where “…all lanes lead to asthma control.”

Kurt Elward, M.D., a family physician, Assistant Professor of Research in Family Medicine at the University of Virginia, and member of the NAEPP Coordinating Committee and Guidelines Implementation Panel, joined Dr. Clark in encouraging participants to think about the future course of the NAEPP.

"The NAEPP has had great success, and today’s challenge is how the NAEPP should move forward," said Dr. Elward. “We need to identify the strategies that will make meaningful change in asthma care and control.” Following the breakout discussions, participants came back together to report out each group’s recommendations.

On day two, participants began with a presentation and lively discussion of the plan for evaluating the NAEPP’s NACI, which will examine both successes and lessons learned since the program’s launch in December 2008. They expressed particular enthusiasm for widely disseminating the findings, strategies, tools, and other helpful resources produced by the NACI projects. Participants then reviewed both the process for developing and updating the asthma guidelines and recent scientific advances that will guide that update by the NAEPP.

“The progression and implementation of the guidelines since 1991 has resulted in reduced mortality and hospitalization, an emphasis on control with a stepwise approach to treatment, and improved understanding of the importance of early intervention,” stated Stanley J. Szefler, M.D., NAEPP Expert Panel 3 member; Helen Wohlberg and Herman Lambert Chair in Pharmacokinetics, National Jewish Health; and Professor of Pediatrics and Pharmacology, University of Colorado School of Medicine. Looking ahead to the next guidelines update, Dr. Szefler also summarized results from recently published randomized control studies that offer new information about asthma therapies and medications, and new insights into asthma progression, co-morbid conditions, and other relevant factors.

Dr. Denise Simons-Morton returned to the podium to present a detailed overview of the NHLBI’s updated process for developing clinical guidelines. After an objective, transparent, and scientifically valid review of the latest published research, evidence-based recommendations are developed consistent with pre-specified criteria and then refined with input from external reviewers. The NAEPP will continue to play a pivotal role in reviewing, disseminating, and implementing asthma guidelines recommendations.

Changes are in store for more than just the guidelines. Several NAEPP members are retiring from the NAEPP Coordinating Committee.

Lani Wheeler, M.D., the American School Health Association’s representative to the Coordinating Committee and longstanding chair of the NAEPP’s School Subcommittee, received a plaque in recognition of her many years of outstanding service.

Others who also received recognition for their service with the NAEPP included:

  • M. Beth Benedict, J.D., Dr.P.H., Centers for Medicare and Medicaid Services
  • Robyn Schuloff, M.A., Health Resources and Services Administration
  • Elizabeth Wasilevich, M.P.H., Ph.D., Blue Cross Blue Shield (formerly with the Michigan Department of Community Health)
  • Darryl Zeldin, M.D., National Institute of Environmental Health Sciences

The meeting concluded with a round-robin session, in which participants had a chance to share additional updates and exciting news about their programs and activities.

Last Updated October, 2011

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