Asthma - Description

Asthma: A Concern for Minority Populations

Overview

Asthma is a growing concern in this country, particularly in inner-city African-American and Latino populations. Asthma is a chronic lung disease characterized by episodes of airflow obstruction. Symptoms of an asthma attack include coughing, wheezing, shortness of breath, and chest tightness. Asthma occurs in people who are predisposed to develop asthma because of genetic and environmental factors that determine susceptibility. A variety of "triggers" may initiate or worsen an asthma attack, including viral respiratory infections, exercise, and exposure to allergens or to airway irritants such as tobacco smoke and certain environmental pollutants.

Once asthma sufferers learn what conditions prompt their attacks, they can take steps to control their environment and avoid these triggers. However, medical treatment with anti-inflammatory agents (especially inhaled steroids) and bronchodilators is usually necessary to prevent and control attacks. With optimal management, control of asthma is usually an attainable goal.

The Impact of Asthma

Asthma affects nearly 15 million Americans, more than 5 percent of the U.S. population. In 1991, asthma claimed approximately 5,000 lives. After a decade of steady decline in the 1970s, the prevalence of asthma, hospitalizations for asthma, and mortality due to asthma each increased during the 1980s.

In 1993, among children and young adults, African Americans were three to four times more likely than whites to be hospitalized for asthma, and were four to six times more likely to die from asthma. Poverty, substandard housing that results in increased exposure to certain indoor allergens, lack of education, inadequate access to health care, and the failure to take appropriate medications may all contribute to the risk of having a severe asthma attack or, more tragically, of dying from asthma.

The scope of the health care problem caused by asthma lies not only in the large number of Americans with the disease, but also in the limitations that asthma can impose on daily life. Asthma is the leading cause of school absenteeism due to chronic illness and is the second most important respiratory condition as a cause of home confinement for adults. Each year, asthma causes more than 18 million days of restricted activity, and millions of visits to physicians' offices and emergency rooms. A recent study found that children with asthma lose an extra 10 million school days each year; this problem is compounded by an estimated $1 billion in lost productivity for their working parents. In 1990, asthma-related health care cost our nation approximately $6.2 billion.

National Cooperative Inner-City Asthma Studies

In 1991, to address the concerns about asthma in the inner city, the National Institute of Allergy and Infectious Diseases (NIAID), a component of the National Institutes of Health, launched the first National Cooperative Inner-City Asthma Study. The primary aim of the study was to identify factors responsible for the rise in asthma among inner-city children and to test new strategies for asthma intervention. The eight centers funded by NIAID included:

Albert Einstein School of Medicine, New York, NY;

Case Western Reserve University, Cleveland, OH;

Children's Memorial Hospital, Chicago, IL;

Henry Ford Hospital, Detroit, MI;

Howard University, Washington, DC;

The Johns Hopkins University, Baltimore, MD;

Mt. Sinai Medical Center, New York, NY;

Washington University, St. Louis, MO.

Phase I of the first National Cooperative Inner-City Asthma Study (1991-1994) was designed to identify factors associated with severity of asthma in children ages 4-11. The second phase, completed in February 1996, studied the effectiveness of a comprehensive program to develop improved knowledge about asthma, to promote better asthma self-management skills, and to eliminate or decrease exposure to environmental factors associated with increased morbidity from asthma.

Phase I enrolled 1,528 children and their families. The study population was 73 percent African American, 20 percent Latino, and 7 percent Caucasian. Asthma risk factors found to be present in these urban families included: high levels of indoor allergens, especially cockroach allergen; high levels of tobacco smoking among family members and caretakers; and high indoor levels of nitrogen dioxide, a respiratory irritant produced by inadequately vented stoves and heating appliances. Many patients also reported difficulties in obtaining follow-up care for their asthma. Low socioeconomic status and African-American race were independent risk factors for allergic sensitization to cockroach allergens. Thus, new approaches to reduce exposure to cockroach allergens may be very useful in controlling asthma.

More than 1,000 children were enrolled in Phase II of the study. Several sites used a Spanish language program in addition to the standard English language program. These sites employed bilingual counselors and modified the intervention to account for cultural issues unique to a Latino population. A key component of the Phase II intervention was the use of an "asthma care counselor" whose primary role was to teach and monitor acquisition of asthma self-management skills. While the results are still preliminary, children in the intervention limb of the study had striking reductions in major symptoms, in school absenteeism, in hospitalizations, and in emergency room visits for asthma.

Based on the success of the first National Cooperative Inner-City Asthma Study, NIAID and the National Institute of Environmental Health Sciences (NIEHS) recently initiated a second cooperative multicenter study. A major objective is to extend and disseminate the findings of the first National Cooperative Inner-City Asthma Study. This continuation includes new educational programs for patients and physicians, and focuses on community-specific interventions and on the relationship between asthma morbidity and the environment. The seven Centers funded in FY1996 are:

Albert Einstein School of Medicine, New York, NY;

Boston University, Boston, MA;

Children's Memorial Hospital, Chicago, IL;

Mt. Sinai Medical Center, New York, NY;

University of Arizona Health Sciences Center, Tucson, AZ;

University of Texas Southwestern Medical Center, Dallas, TX;

Odessa Brown Children's Clinic, Seattle, WA.

NIAID Asthma Demonstration and Education Research Projects

NIAID also supports 15 extramural Asthma, Allergic, and Immunologic Diseases Cooperative Research Centers to conduct basic and clinical research on mechanisms of disease and ways to prevent asthma, allergic, and immunologic diseases. Each Center supports a Demonstration and Education Research Project to study educational, behavioral, and environmental interventions in underserved populations, especially ethnic minorities. All but one of these projects focus on asthma. Additional Demonstration and Education Research Projects have been established at university and clinic sites in Atlanta, Boston, Miami, Dallas, and San Diego. At several of these sites, researchers are developing interactive video games about asthma as well as other educational and computer-based clinical management tools for inner-city health care providers. These projects focus on different inner-city populations and explore interventions other than those of the National Cooperative Inner-City Asthma Study.

Studies on the Genetic Basis of Asthma