The prevalence of asthma has been on the rise over recent years and the condition is now considered the fastest-growing disease in the world. In 2010, asthma in the US grew by 15.1% (Chen et al., 2022). The growing prevalence of asthma in the US has substantially affected the state of Florida, which will be the focus of this paper. The high incidence of the disease has caused an increased economic and healthcare burden to the state. Statistics published by Florida Health Charts (2021) indicate that asthma related hospitalization in Florida cost $11,371,698 and the total cost for ED visits among the state’s residents was $431,459,458 in 2021. The epidemic affects individuals of all age groups, race, and ethnicity (Enilari & Sinha, 2019). However, ethnicity, race, and socioeconomic status affect the prevalence, morbidity, and mortality of asthma in Florida. While asthma’s mortality is low, the condition is among the leading cause of frequent healthcare resource use. Asthma is considered as the 28th cause of loss of years in full health and a major cause of emergency room visits (Enilari & Sinha, 2019). These adverse outcomes of asthma call for the need to investigate and implement appropriate interventions to control the disease in Florida. In this backdrop, this paper analyzes the prevalence, epidemiology, screening guidelines, and recommends appropriate interventions to control asthma incidence in Florida.
Background and Significance
Asthma is variously defined by different quarters. According to Pate et al. (2021), asthma is a chronic respiratory illness, which affects the lungs, and requires continuous medical management. Asthma causes inflammation and swelling of the airways, resulting in narrowing of the airways carrying air from the mouth and nose to the lungs (Goff, 2023). Some common signs and symptoms of asthma include wheezing, dyspnea, coughing, and chest tightness combined with variable expiratory obstruction (Enilari & Sinha, 2019). Typically, asthma begins during childhood when one’s immune system is still developing. Some factors that may cause asthma include environmental allergens, such as cigarette smoke and certain germs, viral infections affecting breathing, and family history (National Heart, Lung, and Blood Institute, 2022). Other risk factors for developing asthma include allergies, obesity, race, sex, and occupational hazards. Under race, non-Hispanic blacks and Puerto Rican have an increased risk of developing asthma compared to other races. Hispanic and African American children have a higher likelihood of dying from asthma-related complications compared to non-Hispanic white Americans (National Heart, Lung, and Blood Institute, 2022).
Asthma episodes are triggered by various environmental factors, such as outdoor and indoor allergens, including dust mites, pet dander/fur, mold, mold pollens, emotional stress, physical activity, and infections entailing colds, COVID-19, and influenza. Poor air quality and medications including aspirin can also trigger severe breathing problems (National Heart, Lung, and Blood Institute, 2022). Treatment of the condition depends on the severity of the asthma attack episode. Inhaled short-acting beta-agonists (SABAs), such as salbutamol, are the mainstay of managing acute asthma exacerbation (Chiumello, 2020). SABAs relax airway smooth muscle, resulting to a prompt increase in airflow. The drugs offer rapid relief of acute asthma symptoms in about 5-10 minutes (Chiumello, 2020). Ipratropium bromide, an anticholinergic drug, which offers bronchodilation, is used as an adjunct to SABAs, in managing moderate-to-sever acute asthma episodes and is administered by a metered dose inhaler (MDI) or by nebulization. Systemic glucocorticoids are used in children experiencing moderate-to-severe asthma exacerbations. Glucocorticoids’ anti-inflammatory action is effective in reducing the airway edema and bronchial secretions (Chiumello, 2020). In addition, biologic drugs, such as benralizumab are used in treating severe asthma episodes (National Heart, Lung, and Blood Institute, 2022). The varying drug medications help in controlling and preventing symptoms.
Recent statistics indicate that in 2017, asthma is attributed to causing about 1.6 million emergency department visits and an estimated 183,000 hospitalizations in the US (Pate et al., 2021). There has been a significant decrease in the incidence of asthma in Florida, moving from 8.7% in 2018 to 7.3% in 2020 (America’s Health Rankings, 2022). The national prevalence of asthma is significantly high, affecting 7.8% of the population, which is about 25,257,138 people (Centers for Disease Control and Prevention, 2022). The prevailing statistics illustrate that the prevalence of asthma in Florida (7.3%) is below the national average (8.7%).
Surveillance and Reporting
Asthma surveillance information entails gathering of data at both the federal and state level. At the state level, the Florida Asthma Program compiles and uses data to monitor the burden of the disease in the state. The organization also monitors and evaluates the impact and efficacy of efforts geared to manage the health problem in the state (Florida Health, a, 2022). The collected information is further distributed to other stakeholders, such as public health partners, healthcare professionals, and policy makers who use it to enhance asthma outgrowths and minimize the costs to people and healthcare organizations in the state. Data associated with asthma prevalence among adults and children and the related risk behaviors, ED visits, mortality, and program particulate information at the state and local levels (Florida Health, a, 2022). At the federal level, collected data is from the National Center for Health Statistics (NCHS) surveys and focuses on asthma incidence, lost work and school days, rescue and management drug use, self-management education, hospital visits, ED visits, hospitalizations, and deaths from the illness (Centers for Disease Control and Prevention, a, 2022). Notably, the NCHS is mandated to collect data regarding the disease, which is used to inform interventions and efforts to control asthma prevalence.
Epidemiological Analysis
Even though the prevalence of asthma in Florida is low than the national average, it imposes a significant burden to the state’s population, and disproportionately affects certain segments of the populace. Notably, asthma attacks all members of the population, irrespective of their age or gender. In this line, statistics from Florida Health (2022) indicate that an estimated 1 in 8 adults in Florida and 1 in 9 children in the state have asthma. However, the condition is increasingly prevalent and more severe among children, females, low-income individuals, inner-city residents, African Americans, and Puerto Ricans. The disproportionate burden of asthma on minority populations, such as African Americans and Latinx populations, stems from the various constructs of social determinants of health (SDoH) that contribute to health inequalities among race and ethnic minorities in Florida. Racism is a major SDoH that significantly contributes to the inordinate burden of asthma among ethnic minorities. Grant et al. (2021) opine that racism affects health via numerous pathways, such as socioeconomic status, healthcare access and quality, and environment, which are all SDoH risk elements for heightened asthma incidence, morbidity, mortality, and prevalence. The subsequent section of the paper discusses how income, wealth, employment, and education, which are SDoH rooted in structural racism, contribute to asthma disparities.
Income and Wealth
Low income is increasingly associated with elevated asthma incidence, hospitalizations, exacerbations, and intensive care unit admission. African American and Hispanic households have significantly low earnings compared to their white counterparts. In 2018, the US Census Bureau reported that African American families, Hispanic households, and White families had a median family income of $41,361, $51,450, and $70,642, respectively (Grant et al., 2021). A similar trend is observed in wealth gaps whereby in 2019, White households had an average wealth of $188,200, compared to African American and Hispanic families who had a reported median wealth of $24,100 and $36,100, respectively (Grant et al., 2021). The observed income and wealth gaps arise from structural racism and these markers of SDoH’s socioeconomic position is heavily associated with asthma. The Centers for Disease Control and Prevention reported that in 2019 the prevalence of asthma was 11.8% among persons with a household income below 100% of the poverty line and 8.5% for people with a household income 100% to less than 250% of the poverty line (Grant et al., 2021). On the other hand, the prevalence of asthma was 5.9% for individuals with a household income that is more than or equal to 450% of the poverty threshold, illustrating a dose-response association between asthma incidence and poverty level (Grant et al., 2021). Moreover, low income is a major risk element for asthma treatment failure, asthma exacerbations, and admission in the ICU.
Education and Employment
Racial and ethnic minorities have low education and employment levels, which significantly contribute to the continued asthma disparities. Low education qualification leads to limited health literacy that directly influences health. Research outcomes from a 2019 study established that low health literacy contributes to reduced asthma understanding and the perceived heightened requirement for asthma medication, reduced probability of being treated by a asthma action plan, inability to adhere to an asthma action plan, more missed schooldays, and elevated emergency department visits and hospitalization for asthma (Grant et al., 2021).
Environment
Environmental exposures are also crucial factors that affect the disproportionate asthma burden among ethnic minorities in Florida. Typically, individuals in the bottom economic stratum and ethnic minority households reside in neighborhoods characterized with heightened exposure to violence, reduced access to healthy foods, and elevated exposure to poor housing, mold, pollution, and pest infestation (Grant et al., 2021). Increased exposure to environmental allergens illustrates that low-income individuals in Florida have a heightened risk of developing asthma and triggers of asthma episodes for those living with the condition.
Healthcare Access and Quality
Poor healthcare access and quality is also another significant contributor to the high prevalence of asthma among Florida’s populace, especially ethnic minorities. Besides being more likely to be uninsured, African Americans and Hispanics have a higher likelihood of living in areas experiencing primary care physician shortages, restricting their access to proper asthma healthcare (Grant et al., 2021). Moreover, impediments to asthma specialty care and healthcare access results in the underutilization of asthma biologics among African American and Latin American patients. Public insurance patients and ethnic minority patients have a lower likelihood of being prescribed an asthma biological in comparison to their White counterparts (Grant et al., 2021). In 2019, the percentage of Florida residents having asthma who were unable to buy asthma medication or see a primary care physician was 24.4% and 10.4%, respectively (Florida Health Charts, 2021). Limitations in health insurance, access to primary healthcare, and fewer referral to asthma specialists result in increased emergency department visits for severe asthma episodes, heightened work and school absences, uncontrolled asthma, reduced provider consistency, and poor asthma care.
Financial and Social Cost Burden of Asthma in Florida
Similar to the national level, asthma has a significant financial cost to Florida’s healthcare system. In 2021, the total cost for asthma hospitalization charges in Florida was $11,371,698 and the total cost for ED visits among the state’s residents was
$431,459,458 (Florida Health Charts, 2021). The high incidence of asthma in Florida also has a substantial social cost whereby the state rate for missed workdays and school days for adults and children in 2019 was estimated to be 23.6% and 32.7%, respectively. Asthma mortality in the state was about 204 per 100,000 cases (Florida Health Charts, 2021). Most of these adverse outcomes are preventable if appropriate measures are implemented.
Screening and Guidelines
Screening and diagnosis of asthma is vital in its management. National guidelines for screening and diagnosis of asthma recommend clinicians to determine the presence of episodic clinical manifestations of airflow obstruction or airway hyper-responsiveness, airflow obstruction is partially reversible, and exclusion of alternative diagnoses. Moreover, a detailed medical history, physical examination, and a pulmonary function testing are recommended to establish a correct diagnosis. According to the American Family Physician (2020), a pulmonary function testing is required to confirm asthma diagnosis to avoid overtreatment and ensure that other diagnoses are not missed. A previous study established that 2% of adults diagnosed with asthma had severe cardiorespiratory complications that were missed (American Family Physician, 2020). A pulmonary function testing/spirometry is effective in the diagnosis of asthma because a previous study established that it has a high predictive value and sensitivity in identifying cases of obstructive lung diseases (Orts et al., 2020). Therefore, the pulmonary function testing is effective in determining a correct diagnosis of asthma.
Plan
Addressing the asthma problem requires a multifaceted approach involving collaboration among health professionals and patients. The primary intervention targets to reduce the prevalence of asthma among at-risk populations. To this end, the primary intervention will borrow from the fact that racism is a major contributor to increased asthma risk and will entail a push for the enactment of an anti-discrimination policy to fight against continued racism. Racism is the main reason for poor access to quality healthcare, low income and wealth, and lower education attainment, which are the main drivers for the heightened risk and inordinate prevalence of asthma among minorities in Florida (Grant et al., 2021). Nurse practitioners in their advocacy role need push for the legislation of an anti-discrimination policy to reduce risk factors for developing asthma among ethnic minorities. The outcomes of this intervention can be assessed throw the number of new cases of diagnosed asthma among at-risk populations.
As a secondary intervention, patient education on asthma management is an effective way of addressing the problem. Green (2021) reports that education, with a particular focus on recognizing early clinical manifestations of the condition and the use of an asthma plan, may aid lessen the need for emergency department visits and hospitalizations for children. Only 27.1% of Florida’s adults with asthma have ever received an asthma action plan (Florida Health Charts, 2021). Based on GINA guidelines, nursing practitioners ought to provide patient education and written, personalized asthma action plans, which help in ameliorating health literacy challenges among patients and promoting self-management. Patient education ought to incorporate information regarding asthma etiology and management (Welsh & Brooks, 2021). Moreover, education will also inform patients on how to individually identify and avoid triggers, monitor their peak flows, and appropriate use of medication. The primary parameter of monitoring the outgrowth of this intervention is the number of asthma episodes among patients living with the condition.
The tertiary intervention for nurse practitioners will entail the use of pharmacological therapy to reduce severe cases of asthma and death. This intervention seeks to achieve the optimal possible alleviation of permanent damage. In this line, Marks (2020) opines that inhaled corticosteroids are crucial in preventing attacks and deaths among individuals with asthma. Inhaled long-acting bronchodilators are also vital in improving outgrowths of chronic lung diseases. The outcomes of this intervention will be assessed through the number of emergency department visits, intensive care admissions, and death from asthma following the implementation of the tertiary intervention.
In summation, the prevalence of asthma in Florida is increasingly high and is a major cause of substantial morbidity. The disease imposes significant societal, economic, and healthcare system burden to the state. However, while asthma affects individuals of all ages in the state, it disproportionately affects low-income individuals, African Americans, and Latino populations. This inordinate trend is anchored in structural racism that affects SDoH markers, such as income and wealth, education, employment, and healthcare access and quality. National and state health organizations have adequate frameworks of collecting data on asthma, which is used in developing measures to contain the disease. In this line, nursing practitioners need to push for the enactment of anti-discrimination laws to address racism, provide patient education, and offer appropriate medical therapies to improve asthma outcomes in the state.
References
American Family Physician. (2020). Asthma: Updated diagnosis and management recommendations from GINA. American Family Physician Journal, 101(12), 762-763.
America’s Health Rankings. (2022). Asthma in Florida. https://www.americashealthrankings.org/explore/annual/measure/Asthma_a/state/FL
Centers for Disease Control and Prevention. (2022, December 13). Data, statistics, and surveillance. https://www.cdc.gov/asthma/asthmadata.htm
Centers for Disease Control and Prevention. (2022, December 13). Most recent national asthma data. https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm
Chen, C., Zhao, G., Lv, D., An, J., Tian, C., Zhao, Y., et al. (2022). Prevalence, economic burden, and neurophenotype of asthma. Exploratory Research and Hypothesis in Medicine, 000(000), 1-7. http://doi.org/10.14218/ERHM.2022.00104
Chiumello, D. (2020). Practical trends in anesthesia and intensive care 2019. Springer Nature Switzerland.
Enilari, O., & Sinha, S. (2019). The global impact of asthma in adult populations. Annals of Global Health, 85(1), 1–7. http://doi.org/10.5334/aogh.2412
Florida Health. (2022, June 27). Asthma data and surveillance. https://www.floridahealth.gov/diseases-and-conditions/asthma/data-surveillance.html
Florida Health. (2022, June 27). What is Asthma?https://www.floridahealth.gov/diseases-and-conditions/asthma/what-is-asthma.html
Florida Health Charts. (2021). Asthma profile. https://www.flhealthcharts.gov/ChartsReports/rdPage.aspx?rdReport=ChartsProfiles.AsthmaProfile
Goff, S. (2023, March). Asthma facts. Asthma and Allergy Foundation of America: https://aafa.org/asthma/asthma-facts/
Grant, T., Croce, E., & Matsui, E. C. (2021). Asthma and the social determinants of health. Annals of Allergy, Asthma, and Immunology, 128(1), 5-11. https://doi.org/10.1016/j.anai.2021.10.002
Green, C. (2021). Examining and solving health disparities in the United States: Emerging research and opportunities: Emerging research and opportunities. IGI Global.
Marks, G. B. (2020). Reducing the burden of respiratory symptoms and illness in the elderly and general population requires multi-pronged strategies. Respirology, 25(3), 232-233.
National Heart, Lung, and Blood Institute. (2022, March 24). Asthma: Causes and triggers. https://www.nhlbi.nih.gov/health/asthma/causes
National Heart, Lung, and Blood Institute. (2022, March 24). Asthma: Treatment and action plan. https://www.nhlbi.nih.gov/health/asthma/treatment-action-plan
Orts, L. M., Bech, B. H., Lauritzen, T., Thomsen, J. L., Bruun, N. H., Løkke, A., et al. (2020). Predictive value of spirometry in early detection of lung disease in adults: A cohort study. BJGP Open, 4(4), 1-10. https://doi.org/10.3399/bjgpopen20X101059
Pate, C. A., Zahran, H. S., Qin, X., Johnson, C., Hummelman, E., & Malilay, J. (2021). Asthma surveillance — United States, 2006–2018. Morbidity and Mortality Weekly Report, 70(5), 1–32. https://doi.org/10.15585/mmwr.ss7005a1
Welsh, M., & Brooks, S. (2021). Practical general practice nursing e-book. Elsevier Health Sciences.
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