Jake’s Story

by Jake Cohn I almost died at birth. For more than a month I was in intensive care before coming home to live in Telluride, Colorado. As a result of the high elevation in Telluride, I was on oxygen 24/7 for the first few years of my life. I spent my first three birthdays in the hospital due to asthma complications. What really helped me though was staying active as a child – my parents never stopped me from doing anything. I was sick a lot, but my parents tried to manage my asthma with a plan from National Jewish Health. National Jewish Health was a life saver because the doctors in Telluride were not asthma specialists; they were always reacting to my asthma issues rather than trying to prevent them. My childhood would probably have been easier if my doctor had known how to properly manage my asthma. In my teenage years, I was not proactive in my asthma prevention. I kept thinking I would outgrow my asthma as so many people say they do, but I never did. Whenever I got sick I would get a chest infection and learned to deal with intense coughing in the weeks to follow. In 2007, I was hospitalized in Hawaii due to an asthma attack –this opened my eyes to how serious my asthma was, and I began to be more proactive in managing my asthma; however, I was still on high doses of prednisone at least once a month due to severe coughing. Today I manage my asthma by a plan set out by my doctor at National Jewish... read more

How To Fix Our Public Health

by Peggy J. Noonan Too many Americans are fat. Too many have diabetes, heart disease and other chronic problems, or are well on their way to developing them. Our leaders debate solutions, but a nationwide health remedy remains elusive. The good news? State and local solutions already are making a difference in people’s lives. Here’s a sample of impressive results: Colorado: Simple tool kit controls asthma Don’t hold your breath waiting to see an asthma specialist if you live in a poor, rural, Hispanic area of Colorado. And don’t assume the nearest primary-care doctor knows the latest in asthma care. Result: The chronic lung disease is under-diagnosed and undertreated. But a simple tool kit, delivered to rural doctors, has improved diagnosis and treatment and is projected to cut costly asthma hospitalizations by 33%. Training rural doctors in best practices for asthma would help, but research shows that traditional training via lectures “doesn’t actually change provider behavior,” says Bruce Bender, a professor of pediatrics and psychiatry at National Jewish Health, a Denver hospital specializing in respiratory care. Bender is director of the 6-year-old Colorado Asthma Toolkit Program, in which nurses travel to rural medical practices and teach the entire staff the latest care. Tools they leave behind include spirometers (which measure lung function and are crucial to asthma diagnosis) and peak flow meters (a self-test for patients). Eva Muniz Valdez, a nurse, is the program coordinator for 16 counties in rural southeast Colorado. She understood how terrifying asthma can be because her son was diagnosed with asthma at age 2 — and she was recently diagnosed with asthma herself. Learning... read more

Respiratory Care Training for Safety-Net Primary Care Practices

Bruce G. Bender, PhD, Meg Burke, MHSA, Andrew H. Liu, MD, Deborah Fending, RN, Barry Make, MD Funding source: This program was funded by an unrestricted educational grant from GlaxoSmithKline Address correspondence to: Bruce G. Bender, Ph.D. Professor and Head, Pediatric Behavioral Health National Jewish Health 1400 Jackson St. Denver, CO 80206 Telephone: 303 398-1697; Fax: 303 270-2141; E-mail: ABSTRACT Introduction: Programs designed to enhance the diagnosis and management of asthma and chronic obstructive pulmonary disease (COPD) in primary care settings have had variable success and have not been broadly implemented. Methods: The Respiratory Toolkit Program, a two-year program designed to provide primary care training in both asthma and COPD care, was conducted in an urban federally qualified health center with 13 clinics and 87 staff. The program included interactive training with multidisciplinary teams; in-clinic follow- up training visits; electronic medical record (EMR) tools; and patient-centered educational resources. Results: For asthma patients, use of spirometry increased from 7% of visits before to 43% after training; severity assessment from 13 to 29%; asthma action plans from 2 to 8%; and prescription of inhaled corticosteroids from 33 to 42%. For COPD patients, spirometry use increased from 21 to 35% of visits, and of long-acting beta2-agonist from 19 to 26%. Among undiagnosed smokers, use of the COPD screener increased from 0 to 11% of visits; of spirometry from 4 to 36; and of advice-to-quit from 74 to 79%. Discussion: The Respiratory Toolkit program produced significant changes in guidelines-based care for patients with asthma or COPD, including large increases in administration of spirometry. INTRODUCTION Many patients with asthma and chronic obstructive pulmonary... read more

The Colorado Asthma Toolkit Program: A Practice Coaching Intervention from the High Plains Research Network

by Bruce G. Bender, PhD, Perry Dickinson, MD, Allison Rankin, MPH, Frederick S. Wamboldt, MD, Linda Zittleman, MSPH and John M. Westfall, MD, MPH. Abstract Introduction: Asthma is often under-diagnosed and under-treated in primary care. The Colorado Asthma Toolkit Program was initiated to establish a method for improving asthma care by providing to primary care practices coaching, training, and support for (1) evidence-based asthma diagnosis and treatment, and (2) education and activation of patients toward effective self-management of their illness. Methods: A collaborative program was initiated involving 2 academic medical institutions and the High Plains Research Network, a primary care practice-based research network in eastern Colorado. Focus groups were conducted with rural Colorado patients and health care clinicians to assess need and determine the most effective intervention strategies. Two intertwined training programs, or “toolkits,” were subsequently developed, one each for health care clinicians and patients. Clinicians received 3 coaching sessions conducted by 2 nurses in the practice that included training in guideline-based methods for evaluation and treatment of asthma, coaching to assist practices in implementing these methods, and training in communication techniques to promote asthma self-management. Practices were also given a spirometer and trained in its use and interpretation. Patient self-management toolkits were provided to clinicians, who were trained to use the materials to educate patients and increase treatment adherence. Evaluations were based on practice interviews 1 to 3 months after coaching. Results: Coaching occurred in 57 of the 58 primary care offices in eastern rural and semirural Colorado. Practices reported changes in their asthma management behaviors: (1) 40.4% of practices increased their use of inhaled corticosteroids, with the median percent of patients taking inhaled corticosteroids... read more

Asthma ToolKit On TV

National Jewish Health is taking their successful Asthma Tool Kit Program into Denver-metro communities to help train health care providers on asthma diagnosis and care. National Jewish Health has partnered with Metro Community Providers Network, who work with underserved populations, to raise the level of asthma care. The program is is available thanks in part to a grant by... read more

Primary Care + Public Health

This video, produced by the Institute of Medicine, highlights a recent report on the integration of primary care and public health. The integration of primary care and public health can enhance the capacity of both sectors to carry out their respective missions and link with other stakeholders to catalyze a collaborative, intersectoral movement toward improved population... read more

Asthma Toolkit II Offers Free Training to Area Medical Professionals

The occurrence of asthma is particularly high in Colorado, but asthma patients in Pueblo and El Paso counties are getting expert help thanks in part to efforts of Southeastern Colorado Area Health Education Center, National Jewish Health and Kaiser Permanente. The Asthma Toolkit II program is able to continue work in these counties thanks to a grant from Kaiser Permanente. The program delivers up-to-date equipment, training and materials to medical professionals via a free NIH evidence-based training package that includes spirometry equipment, classroom and in-office training along with patient education materials. The training allows medical staff to learn exactly how to use the EasyOne spirometers and interpret the results. Additionally they learn how to use the patient education materials to help better diagnose and manage asthma symptoms. A good example of how the program works can be found at the Cripple Creek –Victor Mountain Health Center. This school-based clinic is affiliated with Peak Vista Community Health Center, a Federally Qualified Health Center based in Colorado Springs. “People come here from lower elevations and they experience exercise induced asthma,” notes Lorrie Grube, PA-C at the clinic. The clinic has 25 young asthma patients who are being treated and monitored with the Asthma Toolkit spirometers. “We are thrilled with the spirometry because we can keep closer progress on each child. We can track it very closely to see if they are maintaining or if we need to add inhalers. “We give the parents the toolkit materials and then they do some of the teaching as well. Children who are being treated are more stabilized and miss fewer school time hours than... read more

Sterling Wheat Farmer Knows How to Control His Asthma

STERLING – Imagine trying to perform your daily routine while sucking on a straw. That’s how Del Northrup, of New Raymer, describes living with asthma. A lot of people don’t understand what asthma is, he said. Asthma is the inflammation and narrowing of the airways, often triggered by pollutants such as dust and smoke. Northrup has had asthma for 47 years, since he was 8 years old. One day at school he was sitting on a hay bale and he started having shortness of breath; he went to the doctor and that was when he was diagnosed with asthma. Keeping his asthma under control can be difficult because his triggers are mold and wheat dust and he is a wheat farmer. One thing he does to keep his asthma under control while working is to stay upwind. Northrup also wears a respirator and tries to stay out of moldy and dusty places when he can. Northrup said it’s important to know what your triggers are and to stay away from them. Also, if you do have an attack, stay calm, don’t panic. He is an at-risk patient, so he keeps a nebulizer at home which he uses when he has an outbreak. Northrup has also taken daily medications for asthma for most of his life, starting in high school. He pointed out that asthma used to be treated with a lot of steroids, but now there are a lot of newer medicines that don’t have the side effects the old one’s did. If you think you have asthma you should see a specialist. Every year, approximately 5,000 people are... read more

Local Boy, Mom Team Up Beat Asthma

While talking with Heather on the phone, I hear Ty running around the room, calling to his mother, and basically sounding like a typical little boy. This is great to hear, and I wonder how Heather and Ty work together to help him live this active childhood. Although Ty is only three and a half, asthma has been a problem since his first year. His asthma became apparent as he started playing more. “I noticed he would have trouble breathing and would cough,” says Heather. Today Ty’s asthma is as controlled as possible, according to Heather. One of his bigger challenges is the congestion each morning caused by his asthma. But he has successes, too. Success to Heather is the fact that her son can play and run around — inside and outside. Heather gladly reports, “Before medications, Ty would run around the table once and start coughing. Now, it takes a lot more activity for him to start coughing, if he does.” Heather and Ty work as a team to manage his asthma. He uses a medicine called Advair twice a day plus other longer- lasting medicines to help prevent attacks. He also uses inhalers to help treat attacks when they happen. Ty also has his Asthma Toolkit. Toolkits are available at local clinics across eastern Colorado, including the clinics in Akron, Brush, Fort Morgan, and Sterling. Toolkits include a peak flow meter to help monitor breathing daily. Given Ty’s young age, he wasn’t quite ready to use the peak flow meter. Until he is a little older, he and Heather use a different trick that uses the... read more

Support for Asthma Sufferers Improves Quality of Life

Linda Zittleman is the Associate Director for the High Plains Research Network. This is the last in a series of articles for an asthma awareness project in eastern Colorado by the High Plains Research Community Advisory Council. Asthma attacks are caused by swelling of the airways in the lungs, which leaves people struggling to get their breath. That adds up to a lot of time feeling sick, missed work and school, and money for emergency room visits. Many people with asthma have feelings of anxiety and sadness. Children with asthma may have trouble keeping up in school and may be left out of activities when they are not feeling well. With the right support, life can be normal for people with asthma. A new program called Asthma Toolkits provides this support. A number of clinics in Fort Morgan have participated in the program, including Salud, Fort Morgan Medical Group, Fort Morgan Internal Medicine, Family Care Practice and Dr. Stephen Godar. The program is a partnership between National Jewish Health and the High Plains Research Network. The Asthma Toolkits program includes training and equipment for doctors to better diagnose and treat asthma, including spirometry. Spirometry measures lung function. Family Care Practice is doing eight to 10 more spirometry tests each month, helping patients to have better control of their asthma. “Spirometry allows me to provide more effective treatment for patients,” Dr. Stephen Godar commented. “I can determine therapy and discuss the results with the patient; it really changes what I can accomplish in a single office visit.” The Toolkit program also includes a free “toolkit” for patients, with helpful information... read more