Increased self-management of asthma is a Maine State Health Improvement Plan 2018-2020 goal. In 2016, Maine had the highest adult prevalence of current asthma and 3rd highest adult prevalence of lifetime asthma in the United States (US). Adult populations with the highest rate of asthma include those who: identify as more than one race or American Indian or Alaskan Native; have less than a high school diploma; have household incomes of less than $15,000; and/or receive Medicaid. In 2016, Maine ranked 13th in childhood lifetime asthma prevalence and 21st in childhood current asthma prevalence. Children are more likely to report current asthma if they: are boys; live in Aroostook County; are part of low income households; are age 12+; or identify as more than one race or black or African American. In Maine, where one in two adults and one in four children have asthma that is not well controlled, asthma annually contributes to over 5,000 ED visits, 450 hospitalizations, and 13 deaths, plus more than 78,000 lost workdays. More than two in five children with asthma miss school or daycare annually due to asthma.
With 18 years of experience, Maine Center for Disease Control and Prevention’s (MCDC) Asthma Unit (AU) is well suited to provide leadership and coordination of evidence-based strategies to decrease the burden of asthma, particularly for those experiencing disparities and shortages of services. The AU will lead Maine’s effort to: (i) strengthen coordination across Divisions within MCDC and collaboration among agencies statewide; (ii) increase the knowledge and skills of asthma educators and medical professionals to deliver asthma self-management education (AS-ME) and guideline-based medical management; and (iii) increase access to high quality AS-ME aimed at providing adults and children/caregivers with knowledge, skills, and access to resources (e.g. tobacco cessation) to successfully manage their asthma.
MCDC will engage new and historical partners to enhance program infrastructure to prevent and control asthma among adults and children. They will convene a statewide Asthma Network, develop a five year strategic asthma plan, and work with program communication and evaluation contractors to develop companion communication and evaluation plans.
The AU will leverage strategic partnerships to expand EXHALE in Maine. In Year 1, Maine’s largest health system—MaineHealth—will implement AS-ME programs with healthcare providers and patients, promote guidelines-based asthma management with clinicians, and link patients to asthma management community resources. Their certified asthma educators will conduct asthma home visits. MCDC public health nurses will begin doing asthma trigger assessments as part of their home visits. The Center for Tobacco Independence will develop a system to track callers to the Maine Tobacco HelpLine who have asthma, and the Department of Education will assist the AU with providing resources and guidance on asthma management to school nurses and health centers. The AU will coordinate with additional partners such as the Partnership for Children’s Oral Health to address social determinants related to asthma.
As part of the Division of Disease Prevention’s Chronic Disease Program, the AU has established relationships with chronic disease programs that address asthma determinants. The AU’s epidemiology and evaluation teams have extensive experience tracking and monitoring asthma surveillance and evaluation metrics in Maine. Maine CDC’s AU serves a statewide population experiencing high rates of uncontrolled asthma and has a team of internal and external stakeholders prepared to implement evidence-based strategies to improve those rates.