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 2004 Asthma Awareness Day Capitol Hill VIP Speakers
Remarks from recognition dinner, May 4, 2004 I am pleased to be here this evening to celebrate the exciting work that all of you are doing across the country to protect Americans from asthma. EPA values our partnership with AANMA and salutes their annual sponsorship of Asthma Awareness Day on Capitol Hill, which has been so successful in generating much-needed attention to this serious health issue. Over the past 4 years, EPA and AANMA have accomplished great work together. AANMA has been extremely effective in helping EPA raise awareness around environmental management of asthma. Through your local asthma efforts, awareness is being raised in communities across the country. Even more importantly, we are beginning to see positive health outcomes from community-based interventions and EPA is pleased to be lending support to your programs. I would like to encourage all of you to use the outreach and education materials EPA has developed to enhance your current asthma programs. In closing, you are the ones out on the front lines working to help those impacted by this disease. You can and are making a difference. However, it is your personal leadership that will make the difference in the fight against asthma. I applaud your efforts! Elizabeth Cotsworth, EPA Remarks from Capitol Hill Briefing, May 5, 2004 I am pleased to be here today in partnership with AANMA, an organization that has been such a strong leader in the effort to protect Americans from asthma. EPA values our partnership with AANMA and salutes their annual sponsorship of Asthma Awareness Day on Capitol Hill, which has been so successful in generating much-needed attention to this serious health issue. Asthma affects millions of families across the country and it takes the hard work of all of us to empower these families to effectively manage their asthma. While we do not know everything about asthma, we do know enough to make a difference. Children's health, particularly asthma, is a major priority for EPA. We are committed to working with the asthma community to improve asthma care for people across the country. EPA is working closely with Federal agencies and non-governmental organizations through the National Asthma Education and Prevention Program and I want to thank Nancy Sander and her staff for their leadership on asthma. Since people spend approximately 90% of their time indoors, the indoor environment often contributes significantly to the frequency and severity of asthma symptoms. Indoor triggers such as secondhand smoke, mold, animal dander, dust mites and cockroaches are often found in homes and schools. Outdoor air pollutants such as ozone can also trigger asthma attacks. In addition to the traditional ambient air regulatory programs that EPA implements, we have launched a national multifaceted outreach and education program which stresses comprehensive asthma management including both medical and environmental management of asthma. In particular, EPA's focus is to complement the work of the medical community by helping to educate the public about the role the environment plays in exacerbating asthma symptoms. We are also working to educate the public about practical steps people can take to help reduce exposures to environmental triggers of asthma. Studies such as the National Inner City Asthma Study have shown that properly designed and delivered asthma programs, which incorporate both the medical and environmental management of asthma are effective in reducing the burden of asthma. Thank you. Elizabeth Cotsworth, EPA
Remarks from recognition dinner, May 4, 2004 Good Evening. I am pleased to be at this event and would like to offer my congratulations to tonight's award recipients and to AANMA itself for hosting this event and for its important efforts in asthma and allergy advocacy and education. At the Center for Drug Evaluation and Research, our Mission Statement is to ensure that safe and effective drugs are available for the American Public. We certainly take that mission seriously and are ever more proactive about the mission. In my 10 years at the FDA, I have seen more and more that we no longer just think of the drug approval process as what we need to do to fulfill this mission, but we see the important need to continue to work post-approval to ensure that the drugs are marketed and are used in a manner that continues to ensure those approved drugs remain safe and effective. While FDA certainly does NOT seek to, in any way, restrict the practice of medicine, we do want to ensure that those who prescribe and those who take medications approved by the Agency understand how to best use them so that benefits can be maximized. This endeavor of informing the public on the best use of their medications, however, is not something the FDA can or should do alone. That is why we find it valuable to work in partnership where we can and where appropriate with professional organizations, patient advocacy groups, other government agencies and other entities. Ms. Sander and her staff at AANMA certainly constitute a valuable ally in the FDA's efforts to ensure asthma and allergy patients have effective medications available for treating their conditions. While there are many good asthma and allergy medications available, these medications are not always intuitively easy to use. When and how to choose the right medications itself can be vexing, though guidelines provided by the National Asthma Education and Prevention Program of the NHLBI and other treatment guidelines are very useful indeed in helping to address this challenge. However, even when the medications are optimally selected and prescribed, challenges to maximum benefits remain. One notable example in this regard is the metered-dose inhaler or MDI. The MDI is a wonderful drug delivery system that is economical, reliable, portable and can effectively deliver medication to the site of action. Yet, MDIs are complex in terms of using them right and even well-instructed, long-time users may not be using them right. Having advocates like AANMA is a tremendous help to patients so they can best understand their medications and how to properly use them. One MDI issue I know Ms. Sander feels passionately about is the need for dose-counters or indicators on MDIs. To my knowledge, the MDI is the only common dosage form in the Agency where the patient cannot reliably tell if they have medication left as they continue to use it. With pills or syrup, it is obvious when one is running out or getting low on medicine. With an MDI, it is not obvious, particularly when the medicine is only taken as needed. Popular ways of testing the can such as shake testing, test spraying and float testing either do not reliably work or, in the case of the float test, may actually damage the MDI's performance. So patients are left to guess, either discarding a medication earlier than needed or using it beyond where they are getting assured doses. Prompted at least in part by advocacy from AANMA, FDA has issued a guidance to industry last year calling for future MDIs and those recently approved to develop dose-counters or indicators to rectify the uncertainty of when the inhaler is no longer providing its reliable metered doses. With the ongoing transition away from the use of the ozone-damaging chlorofluorocarbons in MDIs to safer technologies, this is an opportune time for manufacturers to be addressing the dose uncertainty issue as well. Getting manufacturers to adopt these additions to MDIs will provide an important benefit to patients that will make their already safe and effective medications even better. I again thank AANMA for the opportunity to be here and share in this event and I look forward to continuing to work with them and other organizations to continue to improve the US public's health regarding control of asthma and allergies. Thank you. Robert Meyer, MD
Remarks from Capitol Hill Briefing, May 5, 2004 It is a pleasure to be here and help raise awareness of the problem of asthma, and to highlight what can be done to bring this important public health problem under control. If there is one thing that I would like everyone to remember, it is this: Asthma is a problem that can be controlled. As you have already heard this morning, asthma is a huge problem for our country. Over 30 million people have been diagnosed as having asthma [in their lifetime] and over 20 million still report having the disease. [Yearly] There are nearly 2 million emergency room visits for asthma and just under half a million hospitalizations. Most tragically, over 4 thousand people die each year from asthma. As a result of the nationwide response to the problem of asthma, there is some evidence that the steady increases in deaths, hospitalizations and emergency room visits have stopped. And for some of these measures, we appear to be making progress in bringing down the rates. It is hard to attribute these declines to any specific action or program, but I believe that Asthma Awareness Day and the Allergy & Asthma Network Mothers of Asthmatics are part of the solution. Today I will describe the five components of CDC's efforts to achieve the goal of reducing the burden of asthma. I will provide a rationale for each component and then a brief example of something that we are implementing as part of that component. First, CDC is working on improving our capacity to track asthma. This tracking capability is the key in being able to plan and evaluate the effectiveness of our programs. We have used the Behavioral Risk Factor Surveillance System to collect data on the prevalence of asthma in adults from every state since 2000. In addition, 17 states will be using an optional set of questions to determine how well controlled asthma is in their state. States asking these questions will have detailed information on the extent of their local asthma problem. The second component of our strategy is to implement scientifically proven programs. We believe that implementing programs that have been shown to be effective is more likely to bring success than implementing programs without evidence of effectiveness. For an example, I will describe the Inner City Asthma Intervention [program]. We worked with the National Institute of Allergy and Infectious Diseases, an NIH institute, to translate their research program, the National Cooperative Inner City Asthma Study, into a public health intervention. This research study showed that children who received the intervention, advice and training from a trained social worker experienced a 20% reduction in days with asthma symptoms compared with children who did not get this intervention. After converting the research protocol into a training curriculum, we funded 23 sites to implement the intervention. The third component of our strategy is to work in partnership and to conduct trainings. Asthma is a problem with many dimensions and solving it will require bringing together people and organizations with different, complementary strengths. The best example here is our partnership with state health departments. We currently fund 33 states, the District of Columbia and Puerto Rico. All these grantees have been funded to develop statewide plans to control asthma, with the important task of bringing together the groups within the state that are working on asthma or could be. This partnership work within the state broadens the workforce beyond the state health department, a broadening we believe to be critical to success. Plans differ from state to state, but all include partnering with nonprofit organizations and with provider groups and most include work with the school system. For six states, we are also funding implementation of the statewide plan. I will not go into detail on the final two elements of the strategy; other parts of CDC are primarily responsible for them. The Division of Adolescent and School Health is working toward integration of asthma control activities into the Coordinated School Health that they have been implementing over the past decade. This integration is being achieved through funding of State and Local Education Agencies that are working with their counterparts in Public Health at the State and Local level. The next component of the strategy is to control work-related asthma, and the National Institute of Occupational Safety and Health is leading this effort. They are coordinating a substantial research effort to identify and control exposures and are working with State Health Departments on a surveillance and intervention to identify and eliminate work exposures that are contributing to asthma. I have described the public health approach to asthma that we are implementing: improving tracking for asthma, implementing proven programs, working in partnership and training, working within the educational system to include asthma as part of a coordinated approach to school health, and addressing work-related asthma. It is encouraging that we are already seeing some success in bringing the asthma problem under control, but it is also clear that there is much more to be done. Stephen Redd, MD |
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Elizabeth A. Cotsworth
Robert J. Meyer, MD
Stephen Redd, MD