Abstract
The demographic study published in this issue of Pediatric Allergy, Immunology, and Pulmonology describes a subgroup of asthma educators who have held their certification for at least 7 years and have completed the recertification process. Similar to the certified diabetes educator (CDE), the certified asthma educator (AE-C®) is most likely to be an experienced and licensed healthcare professional. Although the CDE is most likely to come from the disciplines of either nursing or nutritional science, the AE-C® generally has either a nursing or respiratory therapy background. The survey results suggest an association between personal and family experience with asthma and the choice to select the AE-C® as a career opportunity. As the nation faces rising prevalence rates of asthma, particularly in children, pediatric providers will need to identify competent personnel to assist them in educating individuals with asthma about key messages and to teach skills that will allow them to participate in their own care. The National Asthma Education and Prevention Program in its third expert panel report recommends that education take place with every patient encounter. 4 However, given the prevalence of asthma in Pediatrics, where it has been reported in up to 17% in non Hispanic Black children, 1 and the average time of 8 min spent during the pediatric visit, 5 it is unlikely that asthma education will occur on a consistent basis.
One of the strongest predictors of health status is health literacy. However, only 12% of adults in the United States have been shown to be proficient in health literacy. 6 In fact, statistics show that only about 50% of all patients take medications as they were directed. 7 Low literacy rates are seen with greater frequency in immigrant, minority, and impoverished populations and have been associated with higher hospitalization rates and higher healthcare costs. 8 These data highlight not only the importance of education, but also the need for culturally and linguistically tailored, disease-specific materials and providers who can effectively communicate and discuss key content. By virtue of their certification, AE-Cs® have demonstrated competency in evidenced-based asthma knowledge, skills, and communication techniques necessary to perform these tasks.
The survey presented in this issue, although limited by its numbers, highlights the disparity in access to AE-Cs®. It showed that AE-Cs® are more frequently found in outpatient specialty programs, showing a trend away from the earlier report of Wasilewski et al., 9 where the inpatient setting predominated. Nonetheless, more individuals with asthma are cared for in primary care than specialty practices, 1 and significant numbers of children with asthma do not have a primary care provider. 10 Therefore, efforts should be made to position educators in areas where there is the greatest need.
As the number of children with asthma continues to rise, the need for educational services for these children and those who care for them will necessarily increase. This is particularly true for high-risk groups, such as African American children in the United States, where asthma prevalence rates have increased by almost 50% from 2001 to 2009. 1 Proper use of controller medications, such as inhaled corticosteroids, has been associated with decreased asthma episodes, 11 yet adherence and compliance with controller medications in children with persistent asthma remains a problem. 12 The impact of environmental triggers is well known. Environmental tobacco smoke exposure, for example, is a potent trigger for asthma symptoms in children, yet studies have shown that significant numbers of children with asthma are exposed to tobacco smoke in their homes. 13 Children who live in homes where there are adult smokers are more likely to smoke; 14 and if these children also have asthma, then their asthma symptoms can be expected to be worse. 15 Further, this is more problematic for children from low income families, where their living situations are more likely to include adult smokers. 16 Clearly, educational services for children with asthma need to focus not only on the affected child but also on the home environment and family.
If we are to provide educational services for the children in need, we should develop new and innovative ways to maximize our AE-Cs® as resources until the numbers of educators can be increased to meet the demand. Our challenge is to increase public awareness of the burden of asthma and the importance of education in asthma management. Education empowers children to learn about their disease, to make healthy choices, and to become active participants in their own care. During this time of economic crisis in our country and with limited numbers of AE-Cs® available, employers and managed care organizations may need to explore using AE-Cs® as group leaders, supervisors, and professional resources for pediatric practices, health centers, and schools. Telephone, computer, and social media can be used to extend the reach of AE-Cs®, but no matter which venue is chosen there should be mechanisms to financially support these interventions.
The NAECB seeks to promote health literacy for children with asthma by supporting opportunities for healthcare professionals and those interested in asthma education to prepare for and complete the credentialing process. We believe that AE-Cs® can make a difference in clinical outcomes for children with asthma. However, a critical mass of certified educators, well distributed across the population is needed. By increasing our numbers, we can provide more individuals with asthma with the skills and knowledge necessary for them to communicate more effectively with their providers and improve their health outcomes. Financial support for asthma programming and services continues to be a challenge. The NAECB encourages pediatricians to support the certified asthma educator as a valuable resource to the healthcare team.