Advancing Health Equity in Asthma Control through EXHALE Strategies

The CDC National Asthma Control Program is announcing a new, FY24 non-research notice of funding opportunity (NOFO) designed to improve the health and quality of life for people living with asthma. This NOFO builds upon the work of state, local and territorial public health departments and their strategic partners supported by CDC through funding opportunity announcement CDC-RFA-EH19-1902.Asthma is a complex, highly prevalent chronic disease. It is consistently one of the top five most costly health conditions. According to 2021 asthma prevalence estimates, almost 25 million Americans have asthma, including about 4.7 million children and 20.3 million adults. There were 986,453 emergency department visits for asthma in 2020, 94,560 hospitalizations in 2020, 13.8 million missed school days in 2013, and 14.2 million missed workdays in 2018. In 2013, the estimated cost to the U.S. economy was $81.9 billion in medical expenses, missed school and workdays, and deaths. Despite available drugs and approaches to treat and control asthma, in the United States on average 10 people die of asthma each day.There are significant disparities in asthma outcomes by race, ethnicity, and income level. In the U.S., the burden of asthma falls disproportionately on non-Hispanic African American, Hispanic, and American Indian and Alaska Native populations. Disparities persist in asthma prevalence and outcomes in the United States. Non-Hispanic African American people are nearly three times as likely to die from asthma than white individuals. People from Puerto Rico have higher asthma prevalence compared to other people in the United States.Given evidence that a multi-component approach to controlling asthma is more effective than individual strategies applied in isolation, this NOFO is based on a technical package known as EXHALE (https://www.cdc.gov/asthma/pdfs/exhale_technical_package-508.pdf). EXHALE represents six evidence-based strategies selected for their potential of having the greatest collective impact on controlling asthma. These strategies include: Education on asthma self-management, eXtinguishing smoking and exposure to second-hand smoke; Home visits for trigger reduction and asthma self-management education (AS-ME); Achievement of guidelines-based medical management; Linkages and coordination of care; and Environmental policies or best practices to reduce indoor and outdoor asthma triggers. This NOFO aims to address the systems-level, environmental, and social drivers of disparities by leveraging and expanding strategic partnerships to implement EXHALE strategies. Recipients will strengthen existing organizational infrastructure (i.e., leadership and program management, strategic partnerships, surveillance, communication, and evaluation) and leverage existing partnerships with different sectors (e.g., community- and faith-based organizations, racial and ethnic minority-serving organizations, tribal communities, school and transportation systems, housing and healthcare systems, nongovernmental organizations) and community members to expand the reach and sustainability of asthma control services through implementation of EXHALE.