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California Asthma Partners is managed and supported by California Breathing, a program of the California Department of Public Health

2.0 Objectives & Strategies

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2.1. Maintain and expand asthma surveillance in California at the state, county and sub county levels.

2.1.1. Maintain timely access to the most up-to-date asthma surveillance data in California including prevalence, morbidity and mortality by updating the Burden of Asthma in California: A Surveillance Report on a regular basis.

2.1.2. Survey asthma stakeholders (with special emphasis on community members) at least every two years to assess the current status of asthma surveillance, to consider gaps and limitations in existing surveillance, and to identify strategic priorities for the modification and/or expansion of asthma surveillance efforts.

2.1.3. Expand asthma surveillance in California (Figure 2. Potential Expanded Asthma Surveillance Areas).

2.1.4. Develop and adopt standardized measurements and definitions to characterize asthma prevalence, incidence, self-reported race/ethnicity, severity, morbidity, mortality, disability, asthma management measures, health care utilization, undiagnosed asthma, high-risk populations, and asthma triggers and risk factors. These measurements and definitions should be used for surveillance of asthma in children, adults and workers.

Figure 2. Potential Expanded Asthma Surveillance Areas

  • Regional information; county, sub-county, zip code, and address level of resolution.
  • Estimated prevalence of undiagnosed and underdiagnosed asthma.
  • Expanded information about individuals with poorly controlled and high-risk asthma.
  • Information about populations with small sample sizes (e.g., rural areas, ethnic subgroups).
  • Expanded information related to asthma disparities.
  • Prevalence of coexisting conditions such as rhinitis/sinusitis, obstructive sleep apnea, gastro-esophageal reflux disease, emphysema, chronic bronchitis, obesity, depression, and psychosocial stress.
  • Ongoing surveys on asthma knowledge, attitudes, beliefs and practices of representative samples of child care providers, teachers, coaches, school nurses, primary care doctors (e.g., pediatricians, family practitioners, internists, Ob\Gyn physicians, and emergency physicians), and other health care personnel.
  • Tracking of students in schools for students with diagnosed asthma, hospitalization during school hours, 911 calls, morbidity, and mortality together with school absences.
  • Surveillance of 911 calls from the community for asthma exacerbations.
  • Use of data from managed care organizations to better understand asthma prevalence, morbidity, and health care utilization.
  • Improved Medi-Cal and Medicare asthma data.
  • Environmental determinants, causes and triggers of asthma (e.g., criteria air pollutants from Air Resources Board; Toxic Air Contaminants from Office of Environmental Health Hazard Assessment; traffic related pollutants from Air Resources Board and Department of Transportation; and contaminated sites from Department of Toxic Substances Control).
  • Social determinants of health that influence asthma (e.g., community violence and crime statistics from California Department of Justice; inequalities in income, wealth and employment; and environmental justice).
  • Inventory of known asthma triggers (hazard surveillance).
  • Information added to existing data sources on adult asthma to capture occupation, industry and work-relatedness.
  • Information added to existing data sources (e.g., CHIS) to provide more detailed assessment of asthma management practices, history of documented allergies, and home and occupational exposures.
  • Information on physician adherence to NHLBI guidelines.
  • Surveillance of upstream (causes asthma) and downstream (aggravates asthma) risk factors.
2. 2. Use surveillance data to document disparities and target interventions that may eliminate disparities in asthma prevalence, diagnosis, treatment and outcomes, and monitor progress.
2.2.1. Identify and monitor disparities in asthma burden and care in California, including at the state, county and subcounty level, exploring differences by age group, gender, race and ethnicity groups and subgroups, income, education level, insurance status, geographic residence, occupation, primary language and literacy level.
2.2.2. Raise awareness of asthma disparities in California by highlighting this information in all electronic and written reports on surveillance findings
2.2.3. Identify strategies to collect data on work-related asthma among California's most vulnerable workers, including day laborers, and migrant workers, who may not be represented in current databases.
2.3 Develop necessary infrastructure in CDPH and DHCS that provides organization, accessibility, integration, management, evaluation, and linkage of asthma data.
2.3.1. Establish data exchange agreements and mechanisms between Departments within the State of California for data relevant to asthma surveillance (see Goal 1, Strategy 2.4).
2.3.2. Establish data sharing protocols and mechanisms for use of asthma data among private and public stakeholders.
2.3.3. Ensure public access to up-to-date asthma surveillance data and current peer reviewed literature through: a centralized, well-publicized website for all asthma surveillance data and findings; wide dissemination of the most current surveillance data and findings through annual reports and brief updates; and wide dissemination of the surveillance report, The Burden of Asthma in California, updated every three years (see Goal 1, Strategy 5.3).
2.3.4. Provide technical assistance to stakeholders in order to build capacity for understanding and using asthma data.
2.3 Develop necessary infrastructure in CDPH and DHCS that provides organization, accessibility, integration, management, evaluation, and linkage of asthma data.
2.3.1. Establish data exchange agreements and mechanisms between Departments within the State of California for data relevant to asthma surveillance (see Goal 1, Strategy 2.4).
2.3.2. Establish data sharing protocols and mechanisms for use of asthma data among private and public stakeholders.
2.3.3. Ensure public access to up-to-date asthma surveillance data and current peer reviewed literature through: a centralized, well-publicized website for all asthma surveillance data and findings; wide dissemination of the most current surveillance data and findings through annual reports and brief updates; and wide dissemination of the surveillance report, The Burden of Asthma in California, updated every three years (see Goal 1, Strategy 5.3).
2.3.4. Provide technical assistance to stakeholders in order to build capacity for understanding and using asthma data.
2.4. CDPH will establish collaborative partnerships with institutions** to identify a range of asthma research priorities, to study asthma and to evaluate and translate interventions for preventing and managing asthma.

** These include: health plans, health care providers, pharmacists, independent practic associations, medical groups, managed care providers, Medi-Cal and Medicare, community-based organizations, and others.

2.4.1. CDPH will facilitate the development of a research agenda targeted at prevention and management of asthma that could include:

  1. Reasons for asthma disparities and best practices for reducing or eliminating them.
  2. Workplace exposures that lead to asthma incidence, morbidity and mortality (Figure 3. Potential Workplace Asthma Research Areas).
  3. Indoor and outdoor environmental exposures that lead to asthma incidence, morbidity and mortality (Figure 4. Potential Indoor and Outdoor Research Areas).
  4. Asthma management strategies that lead to a reduction in asthma morbidity and mortality.
  5. Identification, translation and implementation of evidence-based best practices in health care service delivery, at the levels of the individual practitioner, group practice and insurance plan.

2.4.2. CDPH will convene an asthma research symposium every two years to summarize recent important research findings, to assess their implications and to address current interests, and research questions as suggested by stakeholders. The symposium will provide an opportunity to track etiologic research and foster communication among researchers to increase the chances of crosscutting research (Figure 5. Possible Research Areas for Future Research Symposia)

Figure 3. Potential Workplace Asthma Research Areas

  • Further define high-risk industries and occupations for asthma in California and focus research in these areas.
  • Refine estimates of the prevalence and incidence of new-onset asthma related to work.
  • More accurately estimate prevalence and incidence of exacerbations of pre-existing asthma related to work factors.
  • Investigate the economic impact of work-related asthma in California in terms of lost productivity, direct, and indirect health costs.
  • Identify and characterize new asthma triggers and asthma causing agents (i.e., asthmagens) and their threshold exposure levels.
  • Develop methodology to conduct surveillance of asthma hazards.
  • Evaluate the effectiveness and feasibility of asthma intervention and prevention strategies.
2.4. CDPH will establish collaborative partnerships with institutions** to identify a range of asthma research priorities, to study asthma and to evaluate and translate interventions for preventing and managing asthma.

** These include: health plans, health care providers, pharmacists, independent practic associations, medical groups, managed care providers, Medi-Cal and Medicare, community-based organizations, and others.

2.4.1. CDPH will facilitate the development of a research agenda targeted at prevention and management of asthma that could include:

  1. Reasons for asthma disparities and best practices for reducing or eliminating them.
  2. Workplace exposures that lead to asthma incidence, morbidity and mortality (Figure 3. Potential Workplace Asthma Research Areas).
  3. Indoor and outdoor environmental exposures that lead to asthma incidence, morbidity and mortality (Figure 4. Potential Indoor and Outdoor Research Areas).
  4. Asthma management strategies that lead to a reduction in asthma morbidity and mortality.
  5. Identification, translation and implementation of evidence-based best practices in health care service delivery, at the levels of the individual practitioner, group practice and insurance plan.

2.4.2. CDPH will convene an asthma research symposium every two years to summarize recent important research findings, to assess their implications and to address current interests, and research questions as suggested by stakeholders. The symposium will provide an opportunity to track etiologic research and foster communication among researchers to increase the chances of crosscutting research (Figure 5. Possible Research Areas for Future Research Symposia)

Figure 3. Potential Workplace Asthma Research Areas

  • Further define high-risk industries and occupations for asthma in California and focus research in these areas.
  • Refine estimates of the prevalence and incidence of new-onset asthma related to work.
  • More accurately estimate prevalence and incidence of exacerbations of pre-existing asthma related to work factors.
  • Investigate the economic impact of work-related asthma in California in terms of lost productivity, direct, and indirect health costs.
  • Identify and characterize new asthma triggers and asthma causing agents (i.e., asthmagens) and their threshold exposure levels.
  • Develop methodology to conduct surveillance of asthma hazards.
  • Evaluate the effectiveness and feasibility of asthma intervention and prevention strategies.
2.5. Policy regarding asthma in California will be informed by analysis and interpretation of data.

2.5.1. The determination of priority data to be collected will be guided by both availability and the need for developing and evaluating specific policies and interventions.

2.5.2. Data analysis, reports, and key findings will be disseminated to policy makers, health care providers, employers, community-based organizations and the public.

2.5.3. Data will be identified, analyzed, and interpreted to support policy development for goals 1-5 of this Plan.

2.5.4. When data is limited or unavailable, expert opinion and the best available evidence will be used to assess policy proposals and to guide policy development

Figure 4. Potential Indoor and Outdoor Research Areas

  • Research related to air pollution (e.g., traffic and industrial facilities); link data from the Air Resources Board and the Air Quality Management Districts.
  • Research on the parthways, drift patterns, and exposure levels of second hand smoke and the health effects associated with this trigger in multi-unit housing settings.
  • Research on the connections between global warming, air pollution, and asthma.
  • Research on specific asthma triggers, sensitizers, and irritants such as cleaning chemicals, pesticides, pollens, landscaping practices, and fragrances.

Figure 5. Potential Research Areas for Future Research Symposis

  • Asthma medication use (e.g., issues related to efficacy and compliance).
  • Safety and efficacy of asthma medication use during pregnancy.
  • The impact of asthma on educational performance.
  • Diet/nutrition and asthma.
  • Obesity and asthma.
  • Effectiveness of individualized student asthma action plans in the school setting.
  • Barriers to asthma treatment and management.
  • Longitudinal surveillance of asthmatics who have been through an asthma case management program.
  • Effectiveness of promotoras and community health workers in asthma home environmental assessments.
  • Effectiveness of clinical practice-based asthma care interventions.
  • New understanding of genetic, hormonal, gender, biomarkers, and other factors related to asthma expression and control.
  • New findings on the relationship of asthma to allergies, including food allergies.
  • Asthma co-morbidities.