Strategic Plan for Asthma in Massachusetts 2009-2014
Jean Zotter, Director
Carrie Huisingh, Epidemiologist
Asthma Prevention and Control Program
Massachusetts Department of Public Health

Asthma Interferes with Daily Life Economic Cost of Asthma 
•	Nationally, total cost was $19.7 billion in 20071
•	In Massachusetts, total charges for acute care hospital utilization for asthma were over $136 million in 20062 
•	Public insurance was primary source of payment for 53.0% of visits

Asthma Prevention and Control Program
In one year, APCP has:
•	Funded Boston, Brockton, Fall River, New Bedford, Springfield to reduce disparities
•	Coordinated development of two documents: 
•	The Burden of Asthma in Massachusetts
•	A Strategic Plan for Asthma in Massachusetts 2009-2014

Aggressively pursued additional funding to build program

Asthma Burden Document: Prevalence of Lifetime and Current Asthma among Adults in MA and US, 2000-2007

Prevalence of Current Asthma among MA Adults, 2005-2007
Prevalence is higher among:
•	Females vs. males (12.1% vs. 7.4%)
•	Individuals with lower vs. higher household incomes (11.0% vs. 8.3%)
•	Current smokers vs. never smokers (12.9% vs. 8.9%)
•	Individuals with disability vs. no disability (18.7% vs. 7.3%)
Similar across race/ethnicity subgroups

Work-related Asthma among Massachusetts Adults
Among MA adults with current asthma:
•	40.2% reported that their asthma was either caused or made worse by exposures at any job they had ever had (13.9% current job)
•	10.0% reported discussing relation to work with health care provider
•	5.1% reported changing or quitting jobs because of their work-related asthma

Measures of Impairment among Massachusetts Children with Current Asthma 
•	10.3% of MA children have current asthma*
•	Among MA children with current asthma:
•	50.9% had activity limitations due to asthma, past year
•	44.2% had an asthma attack or episode, past year
•	40.5% experienced symptoms of asthma at least once, past 30 days
•	16.9% had sleep disruption due to asthma, past 30 days
•	16.6% used an inhaled short-acting beta agonist 1 or more times per day 

Level of Asthma Control among Massachusetts Adults and Children with Current Asthma, 2006-2007

Magnitude and Trends of Hospital Treatment for Asthma in Massachusetts
On an average day in Massachusetts, asthma was associated with:
•	102 emergency department visits (57.8 per 10,000 residents; n= 36,146 in 2005)
•	 25 inpatient hospitalizations (14.7 per 10,000 residents; n=9,457 in 2006)
•	 8 observation stays (3.4 per 10,000 residents; n=2,101 in 2005)

Annual age-adjusted rates for asthma remained:
•	 Stable for emergency department visits (2002-2005)
•	 Stable for inpatient hospitalization (2000-2006)
•	 Decreased 35% for observation stays (2000-2005)

Age-Specific Rate of Inpatient Hospitalization due to Asthma in Massachusetts, 
2000 and 2006

Age-adjusted Rate of Inpatient Hospitalization for Asthma by Race/Ethnicity in Massachusetts, 2000-2006

Age-adjusted Rate of Inpatient Hospitalization due to Asthma by Community Health Network Area of Residence, 2004-2006

Age-adjusted Rate of Inpatient Hospitalization due to Asthma by City/Town of Residence, 2004-2006

Strategic Plan for Asthma in Massachusetts, 2009 - 2014
Socio-ecological Model 

Strategic Plan Goals
•	 Enhance asthma surveillance
•	 Improve asthma management 
•	 Reduce exposure to environmental factors that cause and/or exacerbate asthma
•	 Better understand the causes of asthma and the role of primary prevention
•	 Increase capacity of the statewide and local partnerships
•	 Evaluate Massachusetts’ progress

Goal 1: Enhance Asthma Surveillance
Selected highlights:
•	 Add occupation and industry questions to the BRFSS to better understand  work-related asthma
•	 Prepare bulletins to explain and document the burden of asthma among priority populations, such as older adults and certain race/ethnic groups

Goal 2: Improve Asthma Management
6 objectives that include:
•	Reduce disparities
•	Improve standards of care
•	Improve environmental management of asthma in the clinic
•	Improve asthma self-management
•	Increase sustainability of asthma care
•	Improve integration of care outside clinic

Goal 2, Objective 5: Increase sustainability of  asthma care 
Inconsistent coverage of:
•	Asthma education
•	Case management
•	Controller medications (tier 3)

Selected highlight: Promote coverage of asthma care recommended in the national guidelines

Goal 3: Reduce Exposure to Environmental Factors that Cause and/or Exacerbate Asthma
5 Objectives include reducing exposure to environmental factors in the following:
•	Outdoor or ambient air
•	Schools, child care and child recreational areas
•	Homes
•	Work places 
•	Chemicals, such as cleaning agents
•	
Goal 3, Objective 4: Reduce Exposures to Factors that Cause and/or Exacerbate Asthma in the Work Place
In partnership with MDPH Occupational Health Surveillance Program: 
•	Track cases and recommend work site changes
•	Raise awareness
•	Advance (or implement) policy initiatives to decrease exposures to hazardous products in worksites 

Community Collaborators
ABCD Head Start
American Lung Association 
Asthma and Allergy Foundation of America, New England Chapter
Asthma Regional Council of New England 
Boston Medical Center
Boston Medical Center HealthNet Plan
Boston Public Health Commission
Boston Urban Asthma Coalition
Boston University 
Brockton Neighborhood Health Center
Cambridge Health Alliance 
Cape Cod Regional Tobacco Control Program
Children's Hospital Boston 
Clean Water Action 
Committee for Boston Public Housing
Community Engagement through Public Broadcasting/WGBH 
Dorchester House Multi Service Center
Fitchburg Lead Action Group
GlaxoSmithKline
Greater Brockton Asthma Coalition 
Greater Lawrence Family Health Center
Greater New Bedford Community Health Center  
Harvard Pilgrim Health Care 
High Street Health Center
MA Association for the Chemically Injured
MA College of Emergency Physicians 
MA School Nurse Research Network 
MA Teachers Association
Mason Square Health Center 
Massachusetts Asthma Advocacy Partnership Massachusetts Coalition for Occupational Safety and Health 
Massachusetts Health Quality Partners 
Metropolitan Area Planning Council 
Neighborhood Health Plan
Massachusetts Nurses Association 
Northborough Southborough Schools
Old Colony Planning Council Area Agency on Aging 
Pioneer Valley Asthma Coalition
Pioneer Valley Planning Commission
Schering-Plough
Self Help, Inc.
Springfield Partners for Community Action
Springfield Public Schools
Springfield, Department of Parks, Buildings, and Recreation Management 
Square One 
Stanley Street Treatment and Resources 
The Medical Foundation
Tobacco Free Mass
Toxic Use Reduction Institute
Tufts Medical Center
UMass Lowell Center for Family, Work, and Community
UMass Lowell, Lowell Center for Sustainable Production
Viz Health Consulting

State Agency Collaborators
Department of Early Education and Child Care
Department of Elementary and Secondary Education 
Department of Environmental Protection
MA Operational Services Division 

MDPH Collaborators 
Bureau of Environmental Health
Early Childhood Comprehensive Systems Project (MECCS)
Essential School Health Services
Health Survey Program
Healthy Aging and Disability Unit 
Immunization Program
MassCHIP 
Occupational Health Surveillance Program
Office of Statistics and Evaluation
Tobacco Control Program
Wellness Division

Resources
View www.mass.gov/dph/asthma
•	The Strategic Plan for Asthma In Massachusetts, 2009-2014
•	Burden of Asthma in Massachusetts

Jean Zotter, Director
jean.zotter@state.ma.us 
617-944-9807

Carrie Huisingh, Evaluator
carrie.huisingh@state.ma.us 
617-624-5489

Kathleen Fitzsimmons, Epidemiologist
Kathleen.fitzsimmons@state.ma.us
617-624-5624

Questions

Additional Goals and Objectives
•	Increase linkages between health care providers and schools and child care settings
•	Promote safer alternatives to chemicals
•	Develop a roadmap for primary prevention
•	Increase the capacity of statewide and local partnership to implement the state asthma plan
•	Evaluate our progress