1. Asthma in Minnesota Slide Set
Asthma Program
Minnesota Department of Health
June 2010

2. Introduction
This slide set provides a cross-section of recent data on asthma in Minnesota and has been developed as a resource for our partners in the asthma community.
If you extract slides from this presentation, please reference the MDH Asthma Program. For technical assistance, please contact us at
This slide set provides a cross-section of recent data on asthma in Minnesota and has been developed as a resource for our partners in the asthma community. If you extract slides from this presentation, please reference the MDH Asthma Program. For technical assistance, please contact us at

3. Contents Background Asthma Prevalence Asthma Self-Management Education
Asthma Hospitalizations & Emergency Department Visits
Asthma Mortality
Summary
The MDH Asthma Program tracks different aspects of asthma – including the prevalence of asthma, rates of asthma hospitalizations and emergency room visits, quality of life and asthma mortality – in order to better understand the burden of asthma across the state.

4. Background

5. What is asthma? Asthma is a chronic respiratory disease
Symptoms include wheezing, chest tightness and coughing
Triggers of asthma episodes can include respiratory infections, allergens, cigarette smoke, air pollution, and exercise
Cause of asthma is unknown
Asthma is a chronic disease of the respiratory system that includes episodes of tightening of the muscles around the airways in the lungs (bronchoconstriction), swelling of the bronchial tubes and increased mucus production due to inflammation of the airways.
Symptoms of asthma can include wheezing, chest tightness and coughing.
A variety of factors can trigger an asthma attack (also known as an asthma episode or an asthma exacerbation), including viral respiratory infections, allergens (like pollen and dust mites), irritants (like cigarette smoke, wood smoke and air pollution) and exercise.
What causes asthma to develop in an individual in the first place is unknown.

6. Asthma Prevalence
Asthma prevalence is a measure of the proportion of people in a certain population (e.g., state) who have asthma.

7. Minnesota Adults and Asthma
Approximately 1 in 13 Minnesota adults has asthma
Adults in the Twin Cities metro area are more likely than adults in Greater Minnesota to have asthma
The percentage of adults with asthma has increased since 2000 as it has nationally
Due to new cases and/or increased awareness and diagnosis
According to data from 2008, approximately 1 in 13 (7.8%) of Minnesota adults (age 18 and older) currently have asthma. That translates to approx. 310,000 adults in Minnesota.
Adults in the Twin Cities are more likely than adults in Greater Minnesota to have asthma.
The percentage of Minnesota adults who report having asthma has increased since This trend has been seen nationally as well. It is unclear whether this increase is due entirely to an increase in new cases and/or increased awareness of asthma leading to increased diagnosis of the disease.
This information comes from the Behavioral Risk Factor Surveillance System (BRFSS), a joint state/Centers for Disease Control and Prevention (CDC) telephone survey about risk factors for chronic disease. The BRFSS survey is completed annually among a random sample of non-institutionalized adults age 18 and older residing in Minnesota.
Source: Behavioral Risk Factor Surveillance System

8. Asthma Prevalence, Minnesota and U.S. Adults, 2008
The question “Has a doctor or nurse ever told you that you had asthma?” is used to estimate the percentage of people with a history of asthma (lifetime asthma prevalence). The follow-up question “Do you still have asthma?” is used to estimate the percentage of people with current asthma.
Source: Behavioral Risk Factor Surveillance System

9. Current Asthma Prevalence, Minnesota and U.S. Adults, 2000-2008
The prevalence of current asthma among adults in Minnesota increased through the mid-2000s, but has stabilized over the past few years; a similar pattern has been observed at the national level.
Source: Behavioral Risk Factor Surveillance System

10. Current Asthma Prevalence by Residence, Minnesota Adults, 2000-2008
Residents of the 7-county Twin Cities metropolitan area (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, and Washington counties) are consistently more likely to report having asthma than residents of Greater Minnesota. In 2008, 8.8% of adults living in the Twin Cities Metropolitan area and 6.8% of adults living in Greater Minnesota reported having asthma.
Source: Behavioral Risk Factor Surveillance System

11. Current Asthma Prevalence by Sex, 2000-2008
Women are more likely than men to report that they currently have asthma. In 2008, the prevalence of asthma among Minnesota women was 9.2%, which is lower than that for US women (10.7%). The prevalence of asthma among Minnesota men in 2008 was 6.3%, slightly lower than that for US men (6.7%).
Source: Behavioral Risk Factor Surveillance System

12. Current Asthma Prevalence by Age, 2000-2008
Between 2000 and 2008, there have been no clear trends in adult asthma prevalence by age group in Minnesota. Some of the year-to-year variation may be due to the relatively small numbers of respondents in each age group. In 2008, 7.8% of year olds, 9.1% of year olds, and 4.7% of adults 65 and older reported having asthma.
Source: Behavioral Risk Factor Surveillance System

13. Minnesota Children and Asthma
Approximately 1 in 16 Minnesota children (age 0-17) currently has asthma
Asthma prevalence stable since 2003 when it was first measured
Nationally, asthma rates increased dramatically through the mid-1990s, but have stabilized in recent years
According to 2007 data from the National Survey of Children’s Health, 1 in 16 or 6.0% of Minnesota children (age 0-17) currently have asthma. That translates to approximately 76,000 Minnesota children.
The percentage of children with asthma in Minnesota has been stable since 2003 when it was first measured by the Behavioral Risk Factor Surveillance System.
Nationally, the percentage of children with asthma increased dramatically through the mid-1990s, but appears to have stabilized in recent years.
Sources: National Survey of Children’s Health
Behavioral Risk Factor Surveillance System

14. Asthma Self-Management Education
A key component of asthma care is self-management education. According to the Expert Panel Report 3 (EPR-3) Guidelines for the Diagnosis and Management of Asthma, released in 2007 by the National Asthma Education and Prevention Program (NAEPP), this involves teaching people with asthma how to monitor their level of asthma control, how to take medications correctly (e.g., inhaler technique) and how to avoid environmental triggers, as well as developing and providing a written asthma action plan for each person with asthma.

15. Asthma Self-Management Education Among Minnesotans with Current Asthma
Adults
Children
Taught to recognize early signs of an asthma episode
63.2%
78.2%
Taught how to respond to an asthma episode
77.4%
73.1%
Taught how to monitor peak flow
47.6%
50.7%
Ever given an asthma action plan
34.2%
51.4%
Taken a class on asthma management
7.7% *
Shown how to use inhaler by a health professional
97.3%
87.1%
Health professional observed inhaler use
75.8%
84.3%
This slide shows the proportion of Minnesota adults and children with current asthma who have received asthma self-management education.
Of note, only a third of adults with asthma have ever received an asthma action plan (AAP), while half of children have ever been given an AAP. Very few adults or children with asthma have ever taken a class on asthma management.
*Estimate is unreliable due to its high relative standard error (≥30%) and is not shown. In this case, only a very small number of parents reported that their children had taken a class on asthma management.
MN Asthma Callback Survey Self-Management Education questions: Has a doctor or other health professional ever taught you (your child) how to recognize early signs or symptoms of an asthma episode?
Has a doctor or other health professional ever taught you (your child) what to do during an asthma episode or attack?
Has a doctor or other health professional ever taught you (your child) how to use a peak flow meter to adjust your daily medications?
Has a doctor or other health professional ever given you (your child) an asthma action plan?
Have you (Has your child) ever taken a course or class on how to manage your (his/her) asthma?
Have you (Has your child) ever used a prescription inhaler? AND Did a health professional show you (your child) how to use the inhaler?
Did a doctor or other health professional watch you (your child) use the inhaler?
*Estimate is unreliable due to relative standard error ≥30%
Source: Minnesota Asthma Callback Survey, 2005

16. Emergency Department Visits and Hospitalizations for Asthma
The goal of asthma management is to decrease the likelihood of asthma exacerbations, which in turn should decrease the need for an Emergency Department (ED) visit or hospitalization. Thus, factors that are associated with asthma exacerbations, such as respiratory infections, are also risk factors for ED visits and hospitalizations.

17. Asthma Emergency Department Visit Rates by Age and Sex, Minnesota, 2008
Emergency Department (ED) visits for asthma are an indication that asthma may not be under control. They may also indicate the lack of a primary health care provider (i.e., going to ED for primary care).
Boys are more likely than girls to have an asthma-related emergency dept visit through the teenage years, after which, women are more likely than men to go to the ED for asthma.
This graph shows only those ED visits for asthma that did not result in a hospitalization.
Source: Minnesota Hospital Association

18. Asthma Hospitalization Rates by Age and Sex, Minnesota, 2008
Asthma hospitalizations are an indicator of the severity of the asthma exacerbation (even people with so-called mild asthma can experience severe exacerbations that require hospitalization) and barriers to regular asthma care (e.g., lack of health insurance). Hospitalizations for asthma are theoretically preventable with appropriate and timely asthma care.
Asthma hospitalization rates are highest among children under the age of 5, with rate for boys nearly double that for girls. Rates are higher for males than females until the late teenage years at which point rates are higher in females than males.
Source: Minnesota Hospital Association

19. Asthma Hospitalization Rates, Minnesota, 1998-2008
2008 MN rate = 7.6 per 10,000
2009 CDC target = 7.9 per 10,000 population
The Centers for Disease Control and Prevention (CDC) set a goal for state asthma programs of decreasing asthma hospitalization rates by 16% between 2000 and Asthma hospitalization rates have been decreasing in Minnesota, and in 2008, we met the target. This graph illustrates the data lag with hospital discharge data – we won’t know how we did in 2009 until late 2010 or early 2011.
Overall, asthma hospitalization rates in Minnesota have been decreasing since 1999.
Source: Minnesota Hospital Association

20. Asthma Hospitalization Rates by Age Group and Region, 1998-2008
Despite the statewide decline in asthma hospitalization rates, there are some differences in trends for Twin Cities metro area and Greater Minnesota adults and children.
Children in the 7-county Twin Cities metropolitan area (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, and Washington counties) have consistently had the highest rates of asthma hospitalizations in the state; although, their rates decreased dramatically between 1998 and 2008 (orange line).
Hospitalization rates for adults in the Twin Cities are also declining (light blue line), while rates for adults in Greater Minnesota (pink line) have remained relatively stable. Hospitalization rates for children in Greater Minnesota (dark blue line) rose through the mid-2000’s but have since declined.
Source: Minnesota Hospital Association

21. Seasonal Variations in Asthma Hospitalizations, Minnesota, 2008
The highest rates of asthma hospitalizations are seen in the Fall, with a smaller peak in the Spring. The lowest rates are always seen in June-August. The seasonal patterns are most pronounced in young people. A major cause of the fall increase in asthma hospitalizations is thought to be increasing rates of respiratory infections associated with children going back to school. The fall pollen season may be another contributor, as could the decreased use of controller medication by children over the summer.
Source: Minnesota Hospital Association

22. Asthma Mortality
Fortunately asthma deaths are relatively rare in Minnesota; although they still do occur. Asthma deaths should be preventable with timely and proper diagnosis and appropriate care. Known risk factors for asthma deaths include poor asthma control and asthma severity.

23. Asthma Mortality by Age, Minnesota, 2003-2008
The largest proportion of asthma deaths occur among Minnesota residents who are 65 and older. However, distinguishing asthma from other chronic respiratory conditions is difficult in this age group. An MDH Asthma Program review of deaths that had been attributed to asthma among Minnesota residents age 55 and older found that the majority of deaths were not in fact due to asthma. Difficulties in distinguishing asthma from other respiratory conditions, plus inconsistent reporting on the death certificates contributed to the inaccurate coding. Thus, it is likely that the true number of asthma deaths among seniors is lower than previously thought.
Source: Minnesota Center for Health Statistics

24. Age-Adjusted Asthma Mortality Rates, Minnesota, 1999-2008
Asthma mortality rates have decreased dramatically since 1999 with the largest decreases among those 65 and older. This decrease is not completely explained by the coding issues described in the notes for the previous slide.
Source: Minnesota Center for Health Statistics

25. Summary
Many of the measures of the burden of asthma have improved since the 2005 Asthma in Minnesota report
However, there is still much work to be done to improve quality of life for adults and children with asthma in Minnesota
In summary, many of the measures of the burden of asthma in Minnesota have improved since the 2005 Asthma in Minnesota report. However there is still much work to be done to improve the quality of life for adults and children in Minnesota who have asthma.

26. For more information Asthma in Minnesota 2008 Epidemiology Report
Available at: