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 about the disease and knowing they can manage asthma is a great help to patients and families, Muniz Valdez says.

After the program was implemented in eastern Colorado, spirometer use was up 10-fold, and more patients had asthma action plans and prescriptions for inhaled corticosteroid medicines, the most effective medicine to control asthma, Bender says, leading to a projected 33% drop in asthma hospitalizations.

“Our objective is to train all areas of Colorado,” says Bender, then other states. Vermont “has built their own asthma toolkit, using our materials and information.”

For how-to videos and information for logged-in providers, see Colorado Asthma Toolkit Program at

For patient-friendly information about CATP and a sample Asthma Action Plan, see


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