Vol. 18 •Issue 23 • Page 12
Meet the Asthma Police
Certified Educators Work Hard to Keep ERs Asthmatic Free
Imagine six-year-old Billy sitting in a classroom, watching the other children file out for recess. It is a beautiful fall day, warm and breezy, and the trees are clothed in vibrant hues of yellow, orange and red. Billy’s best friends are playing their usual game of cops and robbers, but he can’t go outside because he is being held hostage by his asthma.
Needless to say, asthma educators are working hard to separate the child from villainous triggers—ragweed, dust, mold spores—locked securely in a vault cordoned off behind yellow and black police tape.
For a well-controlled asthmatic, the sky is the limit when it comes to participating in something as routine as a childhood game of cops and robbers. “But sadly, many asthmatics are not properly managed, and their disease controls and limits their lifestyle,” said Mark T. O’Hollaren, MD, director of the Allergy Clinic LLC, and a clinical professor of medicine at Oregon Health & Science University, Portland.
Nearly 20 million Americans currently have asthma, according to National Center for Health Statistics estimates.1 Despite that huge number, there appears to be some good news shining through on the asthma front, thanks to interventions of the tough asthma police. After years of escalating mortality and morbidity rates due to asthma, data collected starting in 2002 suggest we may be reaching a plateau in terms of severity.
There were 4,261 deaths attributed to asthma in 2002 (a decline over prior years), pointing to a rate of 1.5 per 100,000.2 What is not declining is asthma’s huge economic burden. The estimated cost of asthma annually is $16.1 billion. That includes direct health care costs of approximately $11.5 billion and indirect costs of $4.6 billion. Of these expenditures, prescription drugs alone are in the $5 billion range.3 Close to 1.9 million emergency room visits were attributed to asthma in 2002.4
“When an asthmatic ends up in the emergency room, the system has failed them,” said O’Hollaren. “Patients should be educated on how to identify their symptoms and prevent their disease from worsening before it gets to that point.”
Asthma education has long been tricky. Though numerous studies have demonstrated patients need it and education has resulted in improvements in outcomes, education efforts were often hampered by budget constraints and questions of who should provide it. As a result, much-needed education was not provided. That has changed in recent years, thanks to a growing movement for patient education and self-management in a variety of chronic diseases, including breathing disorders.
“With asthma, I think we are lagging behind our colleagues in other chronic disease education programs like diabetes,” said Thomas Lotz, MEd, RRT, CPFT, executive director of the American Lung Association of Louisiana. “But we do have a chance to change things.”
And things are moving rapidly in this direction. Asthma education entered the new millennium with lightning speed, and organizations like the American Lung Association (ALA) are partnering with the mainstream health care industry to improve the quality of what our patients are taught. Practitioners need to remember that asthma education is now reimbursable.
Asthma Educator Certification
In January 1999, the ALA met with representatives from more than 50 groups to discuss the need for an asthma educator certification program. From that session emerged a board composed of 17 individuals representing allergy/immunology, behavioral science, emergency medicine, nursing, patient advocacy, environmental health, health education, medicine, pediatrics, pharmacy, public health, pulmonary care and respiratory therapy.
Because of the efforts of this group to establish a credentialing standard, practitioners can now validate their skills by taking the National Asthma Educator Certification Board (NAECB) exam.
The first asthma educator examination was offered in the fall of 2002. Since then, NAECB has awarded 1,310 certificates to caregivers who can use the AE-C® credential. The exam has a 70 percent national pass rate.
The ALA maintains the NAECB executive office in Washington, D.C., but the ALA is just one of many stakeholders supporting the program.
“Certification provides a level of credibility to the asthma educator and also serves as a resource for the general public to let them know the practitioner has met a certain standard,” said Antoinette Gardner, MEd, RN, AE-C, chair of the NAECB. The board has additional programs in development, including a self-assessment exam for practitioners and a public service announcement that is available now.
Voluntary Computer Exam
The NAECB examination is voluntary and can be taken via computer, much the same way NBRC exams are taken. Candidates may submit an application and fee at any time and take their exam by appointment Monday through Friday. The time limit to complete the 175-question exam is three-and-a-half hours. The NAECB examination costs $275.
Should a practitioner need to retake the examination, the retake fee is $150. Re-certification by examination is required every five years at a cost of $275. For those with a financial hardship, there is some financial help available. The Linda B. Ford, MD, Scholarship is available to pay the fees of two individuals, for example.
Applications and more information on these requirements can be found on the NAECB Web site at http://www.naecb.org/index.asp.
To take the exam, the candidate must be a licensed or credentialed health care professional. Those eligible include physicians, physician assistants, nurse practitioners, nurses (RNs and LPNs), respiratory therapists (RRT or CRT), pulmonary function technologists (CPFT or RPFT), pharmacists (RPh), social workers (CSW), physical therapists and occupational therapists.
Non-licensed individuals can sit for the exam as well if they have at least 1,000 hours of providing asthma education, counseling or coordination services.
The content of the exam covers asthma as a disease, (20 percent of the test), patient and family assessment (26 percent), asthma management (43 percent) and organizational concerns like outcomes monitoring, referrals and third-party payers (11 percent). There are review programs available to assist practitioners who are considering taking the exam.
Is Testing Right for You?
It may not make sense for some practitioners to take the NAECB exam. Their job description may not warrant certification. But the initiatives surrounding the exam and other programs to standardize asthma education still provide useful tools for those in subsidiary positions.
The National Asthma Education and Prevention Program (NAEPP) started in March 1989 works with major medical associations, volunteer groups, community groups and health professionals on several asthma education fronts. Among the resources they offer are downloadable palm pilot programs and slide sets that can be used as part of school education programs. Information is available on the NAEPP Web site at http://www.nhlbi.nih.gov/about/naepp.
The ALA offers an interactive decision-support tool for patients and a personalized treatment option report tailored to their diagnosis. The program provides a report with the pros and cons of each treatment, side effects and questions to ask practitioners. It also provides access to summaries of clinical studies. It can be reached via the ALA Web site at http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=38472.
At a recent meeting, members of the American Academy of Pediatrics introduced a seven-item asthma-control questionnaire for children ages 4 to 11 years who have inadequately controlled asthma.
The Childhood Asthma Control Test, or Childhood ACT as it is called, was designed as a screening tool to assist practitioners. It is similar to a test already available for children 12 years or older. The tests were developed by specialists in pulmonology, asthma and immunology. This specific program is sponsored by GlaxoSmithKline in association with the ALA.
At the End of the Day
Numerous studies continue to document some dismal statistics, namely that asthma is still poorly controlled in this country. One study reported that as many as 72 percent of men and 86 percent of women with asthma had symptoms 15 years after they were first diagnosed with the disease, yet only 19 percent of these individuals were still seeing a doctor and only 32 percent were using medication to regularly manage their asthma.5
This can all change provided caregivers take advantage of some opportunities offered them in terms of patient education. “Respiratory therapists have an ideal background and are naturals for teaching asthma education,” said Lotz. He is right. We just need to go out and do it. Our patients need the skills only breathing specialists like RTs can provide. Children should not be held hostage by their disease.
1. National Center for Health Statistics. Raw Data from the National Health Interview Survey, U.S., 2003. (Analysis by the American Lung Association, Using SPSS and SUDAAN software.
2. National Center for Health Statistics. Report of Final Mortality Statistics, 2002.
3. National Heart, Lung and Blood Institute. Chartbook. U.S. Department of Health and Human Services, National Institute of Health, 2004.
4. National Center for Health Statistics. Report of Final Mortality Statistics, 2002.
5. University of Maryland Medicine. Asthma in Adults. March 2002. www.umm.edu/patiented/doc04full.html.
Margaret Clark is a Georgia practitioner.