 October 2001 Asthma: A Concern for Minority PopulationsOverviewAllergic diseases, including asthma, are among the major causes of illness and disability in the United States. Illness and death from asthma have been increasing in this country for the past 15 years and are particularly high among poor, African-American inner-city residents. Although asthma is only slightly more prevalent among minority children than among whites, it accounts for three times the number of deaths. Low socioeconomic status, exposure to urban environmental contaminants, lack of access to medical care, and lack of self-management skills all contribute to the increase in deaths in minority communities.The National Institute of Allergy and Infectious Diseases (NIAID), a component of the National Institutes of Health (NIH), supports basic, preclinical and clinical research to prevent, diagnose, and treat infections and immune-mediated illnesses, including asthma and allergies. Through basic and clinical research, as well as intervention programs, NIAID seeks to improve the diagnosis, treatment, and management of asthma, particularly in the minority populations disproportionately affected by this disease. Growing Health ProblemAsthma is a growing health problem in the United States, 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
Once asthma sufferers learn what conditions prompt their attacks, they can take steps to attempt to control their environment and avoid these triggers. Medical treatment with anti-inflammatory agents (especially inhaled steroids) and bronchodilators, however, is usually necessary to prevent and control attacks. With optimal management, people usually can control their asthma. People living in inner cities, however, cannot always get optimal care. Even currently available treatments do not control severe asthma in some patients, such as children in inner cities. Asthma: A Health DisparityNIAID's Strategic Plan for Addressing Health Disparities identifies asthma as a key research area. The plan seeks to resolve health disparities by
The Impact of AsthmaAfter a decade of steady decline in the 1970s, the prevalence of asthma, hospitalizations for asthma, and death due to asthma each increased during the 1980s and 1990s. Asthma affects an estimated 17 million Americans or 6.4 percent of the U.S. population. Children account for 4.8 million of the nation's asthma sufferers. Asthma affects slightly more African Americans (5.8 percent) than Americans of European descent (5.1 percent). In 1993, however, blacks were 3 to 4 times more likely than whites to be hospitalized for asthma. In 1994, there were 451,000 asthma-related hospitalizations in the United States. Children accounted for 169,000 of these. In 1995, asthma caused more than 1.8 million emergency room visits.Asthma claims approximately 5,000 lives annually in the United States. Asthma deaths have increased significantly during the past two decades. From 1975 to 1979, the death rate was 8.2 per 100,000 people. That rate jumped from 1993-1995 to 17.9 per 100,000. Particularly alarming, the death rate from asthma for children ages 5 to 14 doubled from 1980 to 1993. African Americans were 4 to 6 times more likely than whites to die from asthma. The increasing prevalence of asthma in inner-city children underscores the need for new therapies to prevent asthma and reduce its prevalence. Poverty, substandard housing that increases exposure to certain indoor allergens, lack of education, inadequate access to health care, and the failure to take appropriate prescribed medications may all increase the risk of having a severe asthma attack or, more tragically, of dying from asthma. Uncontrolled asthma can also impose serious limitations on daily life. Asthma is the leading cause of school absenteeism due to chronic illness and the second most important respiratory condition to cause 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. One 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. Asthma-related health care costs our nation approximately $10.7 billion in 1994, including a direct health care cost of $6.1 billion. Indirect costs, such as lost work days, added up to $4.6 billion. National Cooperative Inner-City Asthma StudiesTo address the special concerns about asthma in the inner city, NIAID launched the first National Cooperative Inner-City Asthma Study in 1991. The primary aim of the study was to find out why asthma disproportionately affects inner-city children and test new treatment and prevention methods. NIAID funds eight inner-city asthma study sites.
Phase I enrolled 1,528 children and their families. The study population was 73 percent African American, 20 percent Hispanic, and 7 percent Caucasian. Ninety-three percent of the participants completed the study. Asthma risk factors found to be present in these urban families included
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, especially cockroach allergen, associated with increased morbidity from 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. This highly successful program reduced by approximately 30 percent major asthma symptoms, hospitalizations, and emergency room visits. These improvements continued during the second year of the follow-up without the assistance of an asthma counselor, suggesting that the intervention guided the children and their families to acquire self-management skills, which had a long-term benefit to their asthma. This model of asthma intervention in the inner city, if adopted nationwide, could substantially reduce emergency room visits, hospitalizations, and healthcare costs. In February 2001, based on this scientifically proven intervention, the U.S. Centers for Disease Control and Prevention announced the awarding of 23 grants, totalling $2.9 million, to enable community-based health organizations throughout the United States sites to implement the NIAID model asthma intervention program. Second Multicenter StudyBased on the success of the first National Cooperative Inner-City Asthma Study, NIAID and the National Institute of Environmental Health Sciences (NIEHS), another NIH component, initiated a second cooperative multicenter study in 1996. This study recruited nearly 950 children with asthma, ages 4-11, to test the effectiveness of two interventions. One intervention entails a novel communication/physician education system. Information about the children's asthma severity is provided to the asthma patients' primary care physicians, with the intent that this information will optimize the care provided by the physician.The other intervention involves educating families about reducing exposure to passive cigarette smoke and to indoor allergens, including cockroach, house dust mite, and mold allergens. Researchers will assess the effectiveness of both interventions by their capacity to reduce the severity of asthma in these children. They also will test protocols for the duration of effectiveness after one year of active intervention is completed. The seven Centers are:
NIAID Research CentersNIAID also supports 12 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.Studies on the Genetic Basis of AsthmaNIAID supports a research program to identify genes associated with allergy and asthma, and to search for related genes in mice. This program was the first to link high IgE levels (high allergic response) to a region of human chromosome 5, near genes for IL-4, and other cytokines.
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