Federal health cuts expected to harm asthma patients

Key takeaways:

• The National Asthma Control Program and Office on Smoking and Health have been shut down.
• Research funding has been cut, and changes to Medicare and Medicaid have been proposed.

As the federal government lays off workers at CDC and NIAID, shutters programs, cuts research grants, and considers changes in Medicaid and Medicare, asthma patients will experience worse outcomes, according to experts.

“The cuts are really worrisome because they’re very much across the board,” Andrea Pappalardo, MD, FAAAAI, FACAAI, associate professor of medicine and pediatrics at University of Illinois College of Medicine, told Healio.

Lynda Mitchell, MA, CAE, CEO of Allergy & Asthma Network (AAN), said those at the nonprofit are “very concerned” about what these cuts mean for the implementation of lung health programs at the federal level.

“These could, in turn, adversely impact lung health and outcomes of people nationwide, especially for people with asthma,” Mitchell told Healio.

National Asthma Control Program

Layoffs have included staff at the CDC’s National Asthma Control Program (NACP), which supports asthma education, prevention and research programs conducted by 29 state, territorial and municipal health departments via 5-year cooperative agreements.

“The National Asthma Control Program is a program that is funded by the federal government to facilitate asthma programming in over 29 programs across the United States to improve the uptake of evidence-based strategies to improve asthma outcomes,” Pappalardo, who also is a member of Healio’s Women in Allergy Peer Perspective Board, said.

Lynda Mitchell

According to Kenneth Mendez, MBA, president and CEO of Asthma and Allergy Foundation of America (AAFA), Aug. 31 is the current end of funding for states and non-government organizations (NGOs).

“Without continued NACP funding, many programs are at risk nationwide. For the NGOs, like AAFA, their current grant cycle ends on that date,” Mendez told Healio.

Mendez also noted that a reorganization of health-related federal agencies included in the President’s proposed budget completely eliminates the National Center for Environmental Health, agency that includes the NACP. This would mean the NACP would no longer exist and would not be part of CDC or HHS programming going forward, he continued.

The numbers of asthma-related ED visits, hospitalizations and deaths all have fallen because of the NACP’s collaboration with state and local health departments as part of community-based care models, according to an AAFA press release.

Kenneth Mendez

For example, the release detailed that deaths fell by 45% between 1999 when the program was launched and 2018. NACP also saves an average of $71 for each dollar spent, the release continued.

Pappalardo noted that the NACP funds the Illinois Department of Public Health’s statewide asthma programming to support Illinois citizens with asthma. The IDPH conducts the strategic planning for treating asthma across the state, tracks data, determines needs and collaborates with local offices to provide care.

In addition to educational resources for patients, programs funded by NACP connect patients with asthma home visits and assessments, Mendez said, along with other treatment and care.

“Data from AAFA’s Health Equity Advancement and Leadership program, which works with local asthma programs to support interventions like home visits and assessments, show that participants feel more comfortable understanding their symptoms and have a better understanding of when to see their specialist,” Mendez said.

AAN also has a long-standing relationship with NACP, Mitchell said.

“The funding we have received from NACP since 2001 has enabled us to produce free, high-quality, evidence-based patient education resources in English and Spanish that benefit people of all ages living with asthma,” Mitchell said.

AAN provides these resources, which include bilingual materials as well, to hospitals, schools, community health workers, asthma coalitions and state asthma programs across the nation.

Programs funded by NACP use the EXHALE strategy, Mendez said, which includes education about asthma self-management (E), extinguishing smoking and exposure to secondhand smoke (X), home visits for trigger reductions and self-management education (H), achievement of guidelines-based medical management (A), linkages and coordination of care (L) and environmental policies or best practices to reduce triggers (E).

“These programs do things like home assessments, support tobacco cessation, help connect people with a provider and prescription for asthma medicine, help schools implement asthma management plans, etc,” Mendez said.

The current cooperative agreement between AAN and NACP “focuses on the implementation of the EXHALE technical package,” Mitchell explained.

“EXHALE is proven to reduce emergency department visits, hospitalizations and deaths due to asthma,” she added.

“Without the NACP, it is hard to image that the CDC will open up new 5-year cooperative agreements with nonprofit organizations to continue support for asthma health programs,” Mendez said.

Smoking, vaccines

The CDC’s Office on Smoking and Health (OSH), which funds local and state prevention, cessation and education programs, also has seen a reduction in force.

“Smoking we know is a huge problem, and it’s an evolving problem,” Pappalardo said. “We will lose the strides being made in the reduction of smoking rates and in the control of tobacco companies to not target their media and advertisements to young children.”

Mitchell called OSH a key partner for educating patients and the community, adding that cigarette smoke and secondhand smoke are common triggers of asthma.

“We are monitoring this situation closely and we are in touch with state asthma programs, also funded in part by NACP, and other partners in asthma care to offer support and to ensure we continue working together during this uncertain time,” she said.

Beyond NACP and OSH, “CDC’s monitoring, surveillance and communications have been gutted,” Mendez said.

“At a time when we just experienced the worst flu season in a decade and have the threat of avian flu spreading to humans, these cuts put everyone at risk,” he added.

Further, “vaccine uptake rates have plummeted” since the COVID-19 pandemic, and the CDC has shut down its flu vaccine communication program, Mendez continued, with impacts on other vaccine programs as well.

“Steep federal funding cuts have forced public health officials in one of Texas’ most populous counties, Dallas, to cancel dozens of vaccination clinics and lay off 21 workers on the front lines of combatting the state’s growing measles outbreak,” Mendez said.

Similar cuts at the state and local levels are likely as federal support for vaccine outreach and response declines, he continued.

“Clinicians may see more uncontrolled asthma, increased smoking and vaping, more vaccine hesitancy, and fewer community and public programs to help support patients with prevention and management of asthma, among other diseases,” Mendez said.

Cuts in research

NIAID funding for research also has been reduced.

“The NIAID encompasses many lines of research, one of which includes infectious disease like HIV, and the others are everything we do as allergist-immunologists — food allergy, asthma, immunologic disease, studies of rare diseases, hereditary angioedema, among others,” Pappalardo said.

Although there have been significant breakthroughs over the past decade, she continued, these advances came after an average of 17 years of research.

“If we take away the ability to do that research, that gap from research to everyday practice widens,” Pappalardo said. “If cuts continue, research operations across the nation will abruptly cease. The innovation we as the U.S. have become known for will be no more, and our citizens will suffer from not having these technologies available to us when we get sick.”

Universities also rely on indirect funding to “keep the lights on” and pay for office space, administrative personnel, and data and specimen collection and storage, Pappalardo said.

“That’s a major loss,” she said. “If it is not reversed, it will basically erase a lot of the infrastructure for research to be completed.”

Pappalardo acknowledged that restructuring like that underway at HHS including these departments requires change, but this change should be conscientious.

“When that doesn’t happen, that allows for significant disruption, and significant disruption affects lives,” she said. “These are the lives of Americans who deserve the cutting edge of research that will not be possible if it’s all cut.”

Cuts in aid

Mendez also noted that the House of Representatives proposed $880 billion in cuts to Medicaid over the next 10 years in its budget resolution, increasing the number of patients with no insurance and preventing them from accessing asthma and allergy care.

“These cuts would drastically undermine Medicaid coverage for more than 80 million low-income individuals, meaning millions of children and adults with asthma and allergies who rely on Medicaid for access to lifesaving medications, specialist care and emergency treatments,” he said.

Further, Mendez said, Medicaid is critical in managing asthma, which he called the most common chronic disease among children. Medicaid and the Children’s Health Insurance Program cover nearly half of all children with asthma, he added, making these programs essential for access to lifesaving treatments.

“Medicaid cuts or policy changes that restrict eligibility, increase out-of-pocket costs, or limit access to specialists would disproportionately harm asthma patients, particularly in low-income and medically underserved communities,” Mendez said.

Pappalardo agreed that cuts to Medicaid as well as Medicare could lead to worse outcomes.

“That might even strap our resources further, so we may be seeing more severe presentations and uncontrolled disease states than we’ve had before,” she said.

Taking action

Mendez said that AAFA will continue to provide updated information about the status of clinical programs.

“However, there is no viable replacement for the CDC’s programs,” Mendez said. “The work they do cannot be replicated by private corporations, state health departments or nonprofit organizations. These critical programs must be restored.”

AAFA is encouraging people to act, Mendez said, with an online form that connects people with legislators. AAFA is also hosting a briefing at the U.S. Capitol on World Asthma Day, which is May 6, to highlight the impact of cuts to NACP and other programs. Mendez noted that the time to take action to protect and preserve these programs is now.

“Call on Congress to stop harmful cuts and restore critical public health programs,” Mendez said.

AAN also is asking members of the asthma community to specifically ask their legislators to reinstate NACP via its advocacy website.

AAN will make its case as it meets with members of Congress on May 7 during Allergy & Asthma Day Capitol Hill in Washington, D.C.

“We will address all of our policy priority areas, including adequate funding for federal programs that benefit people living with asthma, allergies and related conditions,” Mitchell said.

Rep. David Valadao (R-Calif.) will attend AAN’s lunch briefing during the event, and Rep. Debbie Dingell (D-Mich.) has been invited to the briefing and offer remarks as well.

Pappalardo agreed that physicians and other health care providers should make their voices heard.

“Continue to do what you do well, but also realize that you are a testimony for so many people that might not have a voice,” she said. “That voice that you have and that you’ve been given the privilege to use could be used for the good and the health of our nation. Now is the time to speak up.”

As these cuts roll out, Pappalardo also encouraged physicians not to give up as patients lose access to up-to-date care and providers no longer have the resources they used to have.

“We need to realize our strength and power as physicians,” she said.

Mitchell encouraged physicians and other members of the asthma community to continue their work as well.

“Now more than ever, asthma education, control and self-management are essential to stay out of the emergency room or hospital,” she said. “Health care providers can work with people with asthma to make sure their asthma is under optimal control.”

Mitchell also encouraged patients to discuss their current medications with their doctors, request updates to their asthma action plans and talk about symptoms that do not resolve on their own, in addition to learning more about asthma self-management.

“Allergy & Asthma Network offers a free Virtual Asthma Coaching Program to help teach skills for asthma self-management,” she said. “We invite health care professionals to refer patients to our free program, and we welcome patients to self-refer.”

Mitchell encouraged members of the asthma community to stay connected with AAN and other organizations as well.

“We are committed to support patients, caregivers, families and health care professionals and to advocate for the asthma community to ensure access to quality care for all,” Mitchell said.

Multiple queries to HHS, CDC and NIAID about the status of these programs have not been returned.

References:

For more information:

Andrea Pappalardo, MD, FAAAAI, FACAAI, can be reached at pappalardo.andrea@gmail.com. Lynda Mitchell, MA, CAE, can be reached at lmitchell@allergyasthmanetwork.org. Kenneth Mendez, MBA, can be reached at kmendez@aafa.org.