The State of Childhood Asthma: Introduction

STATE OF CHILDHOOD ASTHMA AND FUTURE DIRECTIONS: STRATEGIES FOR IMPLEMENTING BEST PRACTICES

In December 2006, MCAN convened a conference, “State of Childhood Asthma and Future Directions: Strategies for Implementing Best Practices,” at the Kaiser Family Foundation Barbara Jordan Conference Center in Washington, DC, in collaboration with the following organizations and advisors: Agency for Healthcare Research and Quality, Helen Burstin and Denise Dougherty; Centers for Disease Control and Prevention, National Center for Environmental Health, Paul Garbe and Elizabeth Herman; National Center for Health Statistics, Lara Akinbami, Jennifer Madans, and Edward Sondik; National Heart, Lung, and Blood Institute, Robert Fulwood and Virginia Taggart; National Institute of Allergy and Infectious Diseases, Peter Gergen; National Institute of Environmental Health Sciences, Mary Gant; US Environmental Protection Agency, Alisa Smith; advisors, Noreen Clark, Cara James, Marsha Lillie-Blanton, Soeren Mattke, Herman Mitchell, and Kevin Weiss.

CONFERENCE GOALS, OBJECTIVES, AND METHODS

The conference had 2 goals, that is, to (1) bring together experts and thought leaders from multiple disciplines to identify and to recommend priority implementation strategies for best practices with the greatest likelihood of closing the gap between recommended and actual childhood asthma treatment and management and (2) articulate related research and policy needs and approaches. The conference objectives were to (1) review the status of childhood asthma in the United States, (2) identify ongoing and latest developments in best practices, (3) identify priority strategies to implement best practices, (4) identify additional research and policy needs to support implementation of best practices, (5) develop consensus on the next steps, especially in addressing conference recommendations, and (6) promote conference recommendations through multiple outlets, including the news media, professional publications, and stakeholders. To achieve the goals and objectives, a 1.5-day conference program was structured around the following major topics.

I. Status of childhood asthma in the United States

1. National trends

2. New state surveillance activities

II. Development and management of asthma in children

III. Gene-environment interactions and the development of asthma

IV. Critical role of the environment and emerging risk factors

1. Complex interactions of indoor exposures

2. Outdoor air and genetic susceptibility

3. Social determinants

V. Quality care challenges and opportunities

1. Status of adoption/implementation of asthma guidelines

2. Childhood asthma quality care: estimating impact and implications

3. Paying for quality care

VI. Effectiveness of evidence-based interventions

1. Evidence for community-based interventions in asthma

2. Individualizing asthma interventions

3. Adherence

Fourteen experts were invited to provide a review of the current status of their assigned topic and to offer their best advice for priority strategies or recommendations to yield substantial progress. Speakers were encouraged to focus on 2 or 3 actionable recommendations. A moderated roundtable discussion followed each presentation. Approximately 60 respected thought leaders and authorities in childhood asthma, as well as other relevant public health, health care, and health policy disciplines, participated in the roundtable discussions with the conference chair, speakers, and moderator (see Acknowledgments).

During the evening on day 1, the speakers, conference chair, and moderator synthesized and prioritized the findings and recommendations that emerged from the 6 topic areas, 11 presentations, and roundtable discussions. The priorities were presented to all roundtable participants on day 2 for further discussion and refinement. The conference concluded with a “touchstone commentary” presented by Nicole Lurie, which offered an assessment of the policy implications of the findings and recommendations.

At the end of the conference, a call to action was issued, urging implementation of the priority recommendations that were identified as both urgent and actionable by the chair and participants. Immediately after the meeting, MCAN hosted a press conference and teleconference to begin disseminating the conference results.

CONFERENCE PROCEEDINGS

This supplement to Pediatrics is an edited proceeding of the State of Childhood Asthma and Future Directions conference. The presenters in the major topic areas agreed to write or jointly write an updated review or special article based on their presentations at the conference. Each article was peer reviewed by 2 external reviewers (see “Acknowledgments”). The articles reflect the wide range of topics and findings covered at the meeting; the commentary that follows the articles includes key findings and recommendations from the conference.