EXHALE program tackles high incidence of asthma on Lower Shore

Salisbury Independent
Posted 5/16/22

When it comes to asthma and obstructive lung diseases like COPD, the Lower Shore has some of the highest incidence rates compared to other regions in Maryland, and it is resulting in record-making …

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EXHALE program tackles high incidence of asthma on Lower Shore

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When it comes to asthma and obstructive lung diseases like COPD, the Lower Shore has some of the highest incidence rates compared to other regions in Maryland, and it is resulting in record-making emergency department visits and hospital admissions and readmissions.

In fact, Wicomico and Somerset counties are third and fifth in the state for the rate of asthma emergency department discharges while Worcester is 10th. But, what if you could take a ground level view of a patient’s life by addressing triggers in the place where they should be the safest – their homes? That is the premise behind a $125,000 program of integrated interventions called the EXHALE Asthma Control Program, funded by Rural Maryland Prosperity Investment Fund grant.

EXHALE Asthma Control Program is a pilot program launched by TidalHealth Peninsula Regional, in partnership with Chesapeake Housing Mission and Habitat for Humanity. Based off a National Centers for Disease Control model, the Asthma Control Program peels back the layers of issues that contribute to the high rate of uncontrolled asthma and other obstructive lung diseases on the Lower Eastern Shore.

The pilot program focuses on six six strategies:

  • E: Education on available resources for asthma self-management;
  • X: X-tinguishing triggers like smoking and secondhand smoke via smoking cessation resources;
  • H: Home visit by community health workers to identify home-based issues;
  • A: Achievement of guidelines-based medical management, such as asthma inhalers and other medications and devices;
  • L: Linkages and coordination of care;
  • E: Environmental best practices to reduce indoor and outdoor asthma triggers through home repair assistance.

“Our interest in developing the EXHALE program happened during the pandemic,” said Kat Rodgers, Director of Community Health Initiatives at TidalHealth Peninsula Regional.

"Our community health workers were going into homes to connect with individuals who needed care," she said, "but who were basically cut off from access since they didn’t have Internet access or transportation.”

At the same time, there was a research project under way that was looking at the multifaceted issues that impact patients with asthma and respiratory diseases. “When we saw the RFP for the grant we thought it would be the perfect opportunity to go beyond screening and assessments to a point where we could make some long-term impact,” Rodgers added.

The way the program works is that a CHW does a home visit and a comprehensive assessment of the environment looking for possible asthma triggers like as dust mites, cockroaches, rodents, mold, and irritants like tobacco smoke and other indoor air pollutants from gas stoves or unvented portable heaters.

During the home visit, the CHW does an Asthma Self-Management Education session with the homeowner so they understand how environmental conditions impact respiratory conditions.

For one CHW the work is particularly meaningful as her own son suffers from asthma.

“My son, now 11, was diagnosed with asthma when he was four-years-old. His asthma was activity and seasonally induced,” says Keyana Kellam. “This work really helped me realize that there’s a lot more to asthma than you realize. I’ve been surprised about how many people don’t know about the resources available to help them as well as specific things like the different types of inhalers available and how to use a peak flow meter.”

The grant program doesn’t begin and end with education and the mitigation of triggers though, but instead it goes a step further by addressing the link between poor housing conditions, poverty and health on the Lower Shore and the high rates of children with asthma and adults with asthma, COPD or lung cancer.

Through the grant, some homeowners can qualify for up to $10,000 in no cost home repair services to fix issues that directly impact asthma and respiratory issues like excessive moisture, unvented appliances and pest management, but also energy efficiency problems and hazards for trips and falls. The overarching goal is to make housing healthier, safer and more energy efficient so that families have more money for necessities such as healthcare and healthy food.   

For Rodgers, the big picture is about creating a healthcare model that focuses on prevention and health promotion. TidalHealth Peninsula Regional is currently negotiating alternative payment models with Medicaid Managed Care Organizations based on the anticipated reduction in healthcare costs and improvement in health outcomes among MCO members.

“The EXHALE project was a perfect match with (RMPIF) grant goals,” said Charlotte Davis, Executive Director of the Rural Maryland Council (RMC), which administers the grants. “We particularly look for projects that not only address a community need, but also has legs to continue on once the grant ends.”

For more information visit rural.maryland.gov/Grant Opportunities, 410-841-5774, email rmc.mda@maryland.gov or connect with the Rural Maryland Council at facebook.com/RuralMaryland.

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