EPA recognizes asthma program’s leadership

On May 3, the U.S. Environmental Protection Agency announced the King County Asthma Program as a recipient of the 2016 National Environmental Leadership Award in Asthma Management. The award honors local asthma programs for leadership in improving the lives of people with asthma, especially those in underserved communities.

Asthma is a chronic respiratory disease that makes breathing difficult. Nine percent of adults and five percent of children in King County have asthma, which can seriously impact quality of life and increase risk of death when left untreated.

KCAP photo
The asthma program’s Community Health Workers visit patients in their homes to support those with asthma in taking charge of this disease. Community Health Workers share language, culture, and lived experiences with the clients they serve.

“It is extremely gratifying to raise asthma awareness, and help make asthma care easier for low-income, diverse communities.” says Michelle Di Miscio, a Community Health Worker from the asthma program. “We are honored to accept this award on behalf of all of the health champions at Public Health and in the community who have made this work possible.”

On May 12, Di Miscio will accept the award on behalf of the program in Washington, D.C. She will be accompanied by the program manager Brad Kramer, and PHSKC Director Patty Hayes.

The award recognizes a body of work spanning nearly two decades. Since its original demonstration project began in 1997, the asthma program has reached over four thousand patients and their families through programs to help manage this illness. In honor of this outstanding effort, Public Health Insider took a look back at this program’s 20 year history and the dedicated health professionals and patients who have championed this program.

An emerging epidemic

dust mite
Microscopic dust mites, which thrive in dusty environments, are a common cause of asthma symptoms.

In the 1990s, healthcare professionals and community advocates recognized an alarming rise in uncontrolled asthma, especially in low-income communities and communities of color. Between 1988 and 1995, hospitalizations for asthma in low-income communities in Seattle and South King County more than doubled, and were twice the rate of the general King County population.

Growing evidence showed that indoor asthma triggers such as dust mites, smoke, mold, and roaches were major contributors to poor asthma control. Local data demonstrated that in King County, low-income people were more likely to live in substandard housing, exposing them to these triggers.

A new approach to asthma care

Alarmed by this rise in asthma, a coalition of clinicians, public health officials, the American Lung Association, and community health advocates designed a pilot project to help low-income families manage asthma triggers in their homes.

“While the cause [of the rise] was not clear, it was clear that people with asthma were having a hard time controlling it, and traditional methods of patient education and care were not working well,” says the program’s founding medical director Dr. Jim Krieger, who worked with this coalition to develop a new approach to asthma care.

Rather than focusing on asthma care solely in clinics and doctors’ offices, the Healthy Homes Project centered on home visits with Community Health Workers—trained paraprofessionals who have social and cultural connections and shared life experiences with the clients they serve. Over the course of a year, Community Health Workers visited low-income households of children with asthma several times, providing education, support, and encouragement to help children and their caregivers manage asthma. They also provided green cleaning kits, bedding covers, vacuum cleaners with HEPA filters, and other supplies to reduce indoor asthma triggers.

Healthy Homes was one of the first programs in the nation to show that home-based visits with Community Health Workers are effective in asthma management.

Better outcomes

Since this initial project, the coalition has evolved to support further research into the effectiveness of the Community Health Worker model. At every step, the program has been rigorously evaluated, and the program boasts many successes: demonstrated return on investment from savings to the healthcare system, increased number of symptom free days, improved quality of life for clients and their caregivers, decreases in asthma related urgent care visits and hospitalizations. Programs across the nation have adopted this model of asthma care—referring to it as the Krieger Model, referencing the founding medical director.

patient thank you letter
Decreasing ER visits for clients is one of the programs’s many successes. Above, a thank you letter from a client.

Undoubtedly, the program’s most important success has been empowering those with asthma to take control of their disease. “We work closely with families and individuals who are guiding themselves away from feelings of confusion, and even despair, to feelings of strength and effectiveness in their asthma self-management.” says Di Miscio.

Over two decades, thousands of patients have opened their homes to the asthma program’s Community Health Workers, working alongside them to make changes to achieve better health. “[Talking to a Community Health Worker] enabled me to see that I needed to be more active and not see my asthma as a hindrance, but as something that I could live with by making some changes to my lifestyle,” writes one client in a thank you letter to the program. “One day my asthma will not control me. I will have control of it.”