Tufts' School of Medicine
Dept of Family & Community Health

Boston, Mass – Heath Maintenance Organizations (HMO's) can help control the steady increase in asthma in Massachusetts by focusing on the environmental triggers of asthma attacks, according to a report recently released by Tufts University researchers.

   In the first major report on the role of HMOs preventing the incidence of asthma attacks, a research team from Tufts University's School of Medicine recommends that the medical treatment of asthma should be complemented by environmentally based prevention. Specifically, the report "Asthma Prevention and Control: HMO Policy in Massachusetts, " says that HMO practices can better control asthma severity by advocating the importance of controlling environmental factors such as smoking, dust, mold and emissions.

   According to Dr. Douglas Brugge, co-author of the report and a professor at the Tufts School of Medicine's Department of Family and Community Health, "HMOs need to partner with the Environmental Protection Agency (EPA) to provide household environmental allergy assessments for all patients diagnosed with asthma."

   Currently, only one-half of HMOs in the state provide home visitation by nurses for those patients with severe asthma.

   "As the public health community works to prevent asthma, and not just treat it, we at EPA have an important role to play," said John P. Devillars, EPA's New England Regional Administrator. "Our agency is committed to improving the quality of the air we breathe outside our homes at the same time we educate the public about how to reduce pollutants that contaminate the air inside our homes, schools and offices. The recommendations of this report are important ones, and we plan to continue our work to address them."

   Over 17.3 million people in the United States are afflicted by asthma, a rate that has risen steadily in the past couple of decades. The Tufts researchers note that HMOs, primary sources of medical care in Massachusetts, are geared towards prevention rather than treatment after the fact. Previous research has shown that asthma can often be controlled by preventative measures.

   "We think that we have found opportunities for constructive development of health care policy with respect to asthma," said Dr. Brugge. "It is necessary that HMOs and environmental agencies and professionals work closer around environmentally-related illnesses such as asthma. The data in this report suggests that only half of the HMOs interviewed conduct household visits to find environmental asthma triggers and that their environmental evaluations do not address all known asthma triggers. "

   The report also recommends that HMOs: Form alliances with environmental agencies such as the EPA to use their expertise in assisting HMOs with their asthma trigger reduction strategies Increase the number of home inspections of people with asthma in an effort to reduce the number of asthmatic episodes, ideally reducing the reliance on medication Convince smokers who live with asthmatics to quit or avoid smoking around their children. For example during home visits smokers could be counseled and given tips on how to avoid smoke exposure for asthmatics in the household.