House Joint Resolution (HJR) 729, agreed to by the 1999 General Assembly, directs the Joint Commission on Health Care (JCHC) to study the incidence, prevalence and impact of asthma on the Commonwealth's citizens. Specifically, HJR 729 requires JCHC to evaluate:

• the growing incidence and prevalence of asthma;

• the disease's adverse impact on African-Americans and other minority populations;

• the health costs associated with the treatment and management of asthma;

• the need for comprehensive asthma education programs for individuals, parents, and the medical and health care community

• barriers to patient access to asthma medical care, including any recently developed medications;

• factors that may cause increases in asthma incidence, symptoms, and episodes in Virginia and the relative importance of such factors; and

• the need for an asthma public awareness campaign supported by the Virginia Department of Health.

HJR 729 also states that particular attention shall be paid to "the impact of asthma on Virginia's children and ways to educate parents, teachers, physicians, and children in the management of childhood asthma."

Based on our research and analysis during this review, we concluded the following:

• asthma is a serious and sometimes fatal chronic illness, particularly among children and African-Americans;

• asthma is the most common reason for hospitalization among young children but most hospitalizations for asthma can be avoided through appropriate management of the illness;

• the appropriate management of asthma, utilizing patient assessment and education, drug therapy, and environmental controls, is an emerging trend within the health care industry and the medical profession;

• there are many examples of successful asthma management programs, but a recent national study concluded that asthma management is falling far short of diagnosis and management guidelines;

• the United States Centers for Disease Control has recommended the development of state-level asthma control programs but only limited funding has been made available;

• the Virginia Department of Health has made some initial efforts to develop a coordinated asthma control plan, but a greater level of resources are needed;

• asthma management, including the administration of medication, is an issue within Virginia's schools; and

• an effective asthma management strategy for Virginia needs to be broadly-structured, based on sound disease surveillance techniques, and utilize well-designed interventions.

A number of policy options were offered for consideration by the Joint Commission on Health Care regarding the issues discussed in this report. These policy options are listed on pages 47-48. Our review process on this topic included an initial staff briefing, which comprises the body of this report. This was followed by a public comment period during which time interested parties forwarded written comments to us regarding the report. The public comments (attached at Appendix B) provide additional insight into the various issues covered in this report.