Asthma is a major public health problem in Hawaii. This chronic disease of the airways is characterized by recurrent and distressing episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. Asthma affects approximately 20 million people across the nation; nearly 6.5 million (9% of all children) are under the age of 18. Costs of asthma total $14 billion, including $9.4 billion in direct costs and $4.6 billion in indirect costs (missed school and work days). People with difficult-to-control asthma comprise the majority of asthma-associated costs, with 80% of asthma-associated costs driven by 20% of the asthma population. Children with at least one asthma attack in the previous year (nearly 4 million children) missed a cumulative total of 12.8 million school days due to asthma.

In Hawaii, over 106,000 people are affected by asthma, and approximately one third are children. Each year approximately 5,000 people in Hawaii are rushed to the emergency room because of asthma; infants and very young children (0 - 4 years of age) continue to make up the majority of emergency room visits and hospitalizations due to asthma. Another 1,500 people are admitted to hospitals for asthma each year. Although the asthma mortality rate has declined over the past 10 years, in Hawaii it remains above the national average, and in 2004, accounted for 23 deaths.

An asthma episode can be brought on by exposure to allergens and irritants such as dust mites, mold, cockroaches, pet dander and secondhand smoke, as well as cold or flu virus and changes in the weather such as vog. Although asthma cannot be cured, most people with asthma can control it so that they have fewer symptoms and can live healthy, active lives. There are simple actions people can take to have asthma diagnosed, treated and controlled.

To learn more about asthma, contact the American Lung Association of Hawaii. The Hawaii State Department of Health (DOH) website also provides current information about vog.

---

Hawaii State Asthma Control Program

Asthma is a complex disease that requires long-term and multifaceted solutions. These include educating, treating, and providing ongoing medical care and monitoring people with the disease, changing behaviors that may lead to asthma or make it worse, and eliminating or avoiding triggers. The DOH established the Hawaii State Asthma Control Program (HSCAP) in September 2002 by successfully secured funding from the Centers for Disease Control and Prevention (CDC). Upon receipt of this cooperative agreement, the DOH dedicated resources to initiate a program to address asthma from a public health perspective in order to bring about:

• Focus on asthma-related activity within the state
• Increased understanding of asthma-related data and its application to program planning through the development of an ongoing surveillance system
• Increased recognition of the potential to use a public health approach to reduce the burden of asthma
• Linkages of the state to many agencies and organizations addressing asthma in the population
• Participation in intervention program activities

The state's public health response to asthma has several key components that include surveillance, education, coalition and workgroup building, advocacy, interventions, and evaluation. To address asthma from a public health perspective, the HSACP will continue to focus its efforts on the following three main content areas: (1) Surveillance; (2) Partnerships; and (3) Interventions. The following content areas continue to be driven by an explicit set of guiding principles outlined in the Hawaii Asthma Plan.

• Surveillance:

  Develop, manage, track, and analyze a uniform set of asthma health status indicators that are derived from a variety of sources (e.g. hospitals, insurers, DOH) and accommodate state and local asthma related data needs through the expansion of the existing Comprehensive State Asthma Surveillance System.

• Partnerships:

  Engage community partners to increase community readiness to identify gaps in the delivery of asthma-related programs and services in order to improve Hawaii's existing asthma system of care. The workgroups and taskforces have been established statewide to effectively mobilize and carry out the strategies laid out in the Hawaii Asthma Plan.

• Interventions:

  The HSACP workgroups have developed specific, evidence-based activities aligned to the Hawaii Asthma Plan to meet the needs of Hawaii communities throughout the state. This process has built leadership capacity statewide by encouraging organizations to identify their areas of strength, their roles and responsibilities and their contribution to Hawaii's asthma health system.

The HSCAP is a program of the DOH Community Health Division, Chronic Disease Management and Control Branch (CDMCB). The CDMCB works to build social and health equity by addressing disparities to enable everyone the opportunity for optimum health through community-based participatory approaches. The programs in the Branch include:

• Asthma Control
• Bilingual Health Services
• Breast and Cervical Cancer Control
• Comprehensive Cancer Control
• Community Resources and Development
• Diabetes Prevention and Control
• Heart Disease and Stroke Prevention
• Tobacco Prevention and Education

---

Hawaii Asthma Initiative

The Hawaii Asthma Initiative (HAI) is a broad-based, multi-organizational, statewide community collaborative whose goal is to bring the public and private sectors together in an effort to increase the quality and years of healthy life for people impacted by asthma, and eliminate health disparities in Hawaii. This initiative is supported by the HSACP and the CDC.

The HSCAP has mobilized community support and a dedicated group of enthusiastic partners willing to commit their professional expertise and resources towards the implementation of activities outlined in the Hawaii Asthma Plan. The HSACP will continue to broaden the circle of collaborating partners by continually seeking involvement of organizations and agencies that serve ethnic populations and high-risk groups, as well as health agencies serving rural communities.

Asthma Workgroups

The HAI is comprised of four workgroups charged to provide statewide technical assistance and support to asthma stakeholders and partners in the following content areas: (1) Data and Surveillance; (2) Individual, Family and Community; (3) Health Professional; and (4) Environmental.

These workgroups are open to all asthma stakeholders and include volunteer representatives from the various sectors and disciplines of Hawaii's State Asthma Health System: physicians, public health professionals, respiratory therapists, pharmacists, emergency medical care providers, managed care directors, state health department staff, nurses/nurse practitioners, community health specialists, health educators, school personnel, community organizations and coalitions, program administrators and planners, and health policy officials.

(1) Data and Surveillance Workgroup

The goal of the Data and Surveillance (D&S) Workgroup is to increase Hawaii's asthma-related surveillance capacity through the construction of a Comprehensive State Asthma Surveillance System (CSASS). The D&S Workgroup provides statewide technical assistance and support in developing strategies to accomplish the following objectives:

• Develop, manage, track, and analyze a uniform set of asthma health status indicators that are derived from a variety of sources (e.g., hospitals, insurers, and the Hawaii State Department of Health). The CSASS will accommodate state and local asthma-related data needs and identify at-risk and, or disparate populations
• Share all available and relevant asthma-related data with stakeholders statewide
• Develop and support implementation of policies and procedures related to asthma surveillance

(2) Individual/Family/Community Workgroup

The goal of the Individual/Family/Community (IFC) Workgroup is to ensure: (1) residents of Hawaii will be aware of asthma and opportunities for individuals with asthma, their families, and communities to identify and manage the disease; and (2) Hawaii's individuals with asthma and their families will be empowered to effectively manage this disease. The IFC Workgroup provides statewide technical assistance and support in developing strategies to accomplish the following objectives:

• Residents of Hawaii will have an increased awareness about asthma including asthma triggers, early detection, and the importance of having regular asthma care
• Hawaii's individuals with asthma and their families will be empowered to effectively manage this disease
• Develop and support policies and procedures that improve the quality and years of healthy life for individuals with asthma, their families, and the community

(3) Health Professional Workgroup

The goal of the Health Professional (HP) Workgroup is to ensure Hawaii's health professionals will provide quality asthma care based on the most consistent, appropriate and current evidence-based disease management guidelines. The HP Workgroup provides statewide technical assistance and support in developing strategies to accomplish the following objectives:

• Hawaii's health professionals will understand the role of appropriate disease management in lowering the burden of asthma in Hawaii
• Hawaii's health professionals will have a better understanding of the National Asthma Education and Prevention Program (NAEPP) four essential components of care and the ten key clinical activities for providing quality asthma care
• Hawaii's health professionals will have increased awareness of the wide range of clinical research projects and findings, and public health interventions, as well as the need to address disparities through targeted strategies focused on asthma in Hawaii
• Policies and procedures that improve the state asthma health system will be developed and supported

(4) Environmental Workgroup

The goal of the Environmental (ENV) Workgroup is to ensure that Hawaii's individuals with asthma are able to work, go to school, and live in environments with good air quality. The ENV Workgroup provides statewide technical assistance and support in developing strategies to accomplish the following objectives:

• Create and advocate for an agenda that addresses environmental issues related to asthma
• Align existing agencies that focus on indoor, outdoor, and worksite air quality
• Reduce exposure to air pollutants among individuals with asthma in the workplace, in schools, and in the environment
• Align existing agencies that focus on tobacco related issues (e.g. prevention, education, and policy)
• Reduce tobacco use and exposure to secondhand smoke among individuals with asthma and their caregivers
• Develop and support environmental policies and procedures related to asthma

Asthma Coalition and Workgroup Members

Hawaii Island Kauai Molokai and Lanai Maui   Oahu

---

Resources and Data