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Asthma Quality Network Newsletter

September 2009

Table of Contents


Program Update

Community Asthma Education Specialists Are Helping Patients
Asthma Educators have seen over 520 patients for one-on-one asthma education in the past 11 months. Click here to see the current issue of AH! Asthma Annuals and the FAX referral form to connect your patients to the nearest asthma educator.

AH! Program Collaborates to Produce a PSA
The AH! Asthma Health Program has created a Public Service Announcement in collaboration with the American Lung Association in Maine and the Maine Center for Disease Control & Prevention. The PSA is currently airing on local TV and radio stations and will continue throughout most of September. The message encourages parents of children with asthma to work with their doctor or nurse to get their child a flu shot and have their asthma action plan updated. The PSA will support the school-based flu clinics that are being offered this fall through funding from the Maine CDC and the Maine Department of Education. Click here to view the PSA.
 
AH! Program Working with New Partners

  • In collaboration with MidCoast Hospital and CHANS Home Healthcare, the AH! Program is working to expand CHANS' asthma education services to include inpatients and outpatients at MidCoast Hospital. The plan is to expand gradually over the next two years.
  • Waldo County General Hospital's CardioPulmonary Manager, Paul Harlow, is leading the charge to offer asthma education services in their community.  We look forward to working with Paul to support the development of an AH! Program and improve the lives of people with asthma in the hospital's service area.

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Asthma News

 2009 COPD Educator Institute
The American Lung Association is sponsoring the third Chronic Obstructive Pulmonary Disease Educator Institute (COPDEI) on November 12th -13th, 2009.  The institute provides a complete overview of COPD to healthcare and health education professionals.  Specific attention will be given to tobacco treatment, spirometry, self-management of COPD, medication guidelines, psychosocial issues, and oxygen therapy. 

  • Dates:
    Thursday, November 12, 2009; 12:00 pm - 6:00 pm
    Friday, November 13, 2009; 8:00 am - 3:00 pm
  • Location:
    MaineGeneral Medical Center, Waterville, Maine
  • CEUs:
    All participants will receive a certificate of completion.
  • Registration Fee:
    $100 will cover all costs including resource materials
  • For more information contact Lee Gilman, 207-624-0309 or lgilman@lungne.org

 Meeting the Demand for Smoke-Free Housing
Free training presented by the Smoke-Free Housing Coalition of Maine, in collaboration with the Partnership For A Tobacco-Free Maine  regarding smoke-free policies in multi-unit buildings. Training will be split into specialized sessions for both health and housing professionals with the goal of helping allied professionals successfully advocate for and implement effective smoke-free policies in their communities and on their properties.

  • Date:
    Thursday, October 29th, 2009; 1:00 pm - 3:30 pm
  • Location:
    Wyndham Airport Hotel, South Portland, Maine
  • Registration:
    To register for the training, or to learn more about smoke-free housing, please visit www.smokefreeforme.org/training.  You may also contact Amy at (207) 874-8774 or info@smokefreeforme.org.

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Clinical Update

 Spirometry Don't Blow It! CHEST 2009; 136:608-614

  • Abstract:
    Spirometry is a useful test of pulmonary function and can be safely performed in a variety of clinical situations. Although the technique for performing the maneuver is straightforward, there are many sources of variability in results. Specific criteria must be met in order for the test to be considered valid. For the best results, proper instruction and coaching is essential, and patient understanding and effort must be maximized. Appropriate interpretation of spirometry requires several steps, including recognition and reporting of technically sound maneuvers, comparison to an appropriate reference population, and finally application of a well-developed interpretation scheme utilized in the context of patient symptoms and findings. Failure at any point along this path from performance to interpretation can yield misleading results that may ultimately poorly imact patient care. A clear understanding by the provider of proper coding and billing for spirometry is necessary to receive appropriate reimbursement from payers.

Safety of Long-Acting B-Agonists: Are New Data Really Required? CHEST 2009; 136:604-607

  • Abstract:
    Despite 20 years of debate, several US Food and Drug Administration (FDA) hearings, black-box warnings, and many descriptive articles and metaanalyses, controversy regarding the safety of long-acting -agonist (LABA) treatment in asthma patients continues. This has resulted in a recent call for another large and definitive safety study. This commentary focuses first on data provided in the metaanalysis recently undertaken by the FDA of safety outcomes among 60,954 individuals in 110 LABA trials, and second on the sample size that would be required for a new definitive study of LABA safety in the presence of mandatory treatment with an inhaled corticosteroid (ICS). A critical stratified analysis in the FDA report involving 15,192 individuals indicates that a LABA used with mandatory ICS therapy was not associated with an increased risk of asthma-related mortality, intubations, or exacerbations (risk difference [RD], 0.25 per 1,000 individuals; 95% confidence interval [CI], -1.69 to 2.18). Using the same stratified data to calculate the sample size required to prove or disprove an association between the use of LABA with mandatory ICS therapy and adverse outcomes, assuming the RD is exactly 0.25, and ignoring the 95% CI, which includes 0.0 or even a negative risk, such a study is both logistically and scientifically impossible. A new study is not practictable, nor is one needed in the light of current analyses of existing data. It is time to learn from the past, to rigorously avoid LABA monotherapy in asthma and to use a LABA (when indicated) always in mandatory combination with appropriate doses of an ICS.

For copies of the complete articles, please contact Angela Mowatt.

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Asthma Tools and Resources

New Healthy Home Quiz developed for people with Asthma
The Maine Asthma Council Homes Workgroup with support from the Maine CDC Asthma Program has created a brochure to help people with asthma and their families to take steps to reduce asthma triggers in their homes.  The brochure has a question and answer format and includes make-at-home cleaning recipes.  For copies of the brochure, please contact
Desi-Rae Severson.

Spirometry Learning Lab is available on-line this fall
The University of Washington has designed an on-line interactive course for primary care providers and their support staff who are interested in incorporating and improving spirometry in their practices.  The training takes place once a week between October 19th and November 20th.  Go to: http://www.spirometrytraining.org/ to learn more and sign up for this course.

 American College of Preventive Medicine

  • MaineHealth AH! Program was highlighted on a recent Indoor Air Quality Webcast.  To view the presentation, A Systematic Community-Based Approach to Practicing Effective Asthma Management go to: http://www.acpm.org/education/IAQ/index.htm.
  • On September 29th, 2009  ACPM presented an Indoor Air Quality CME/MOC webcast: Using Technology and Media to Improve the Reach of Asthma Prevention in At-Risk Populations. To view this presentation, go to the website above.

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