Asthma A Concern for Minority Populations, NIAID Fact Sheet: NIAID
Article title: Asthma A Concern for Minority Populations, NIAID Fact Sheet: NIAID
Conditions: Asthma
Source: NIAID
October 2001
Asthma: A Concern for Minority Populations
Overview
Allergic 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 Problem
Asthma 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
- coughing
- wheezing
- shortness of breath
- 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
start or worsen an asthma attack, including
- exposure to allergens
- viral respiratory infections
- airway irritants, such as tobacco smoke and certain
environmental pollutants
- exercise
Exposure of susceptible children to some of
these triggers in early childhood, notably allergens such as house
dust mites or cockroaches, may cause asthma.
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 Disparity
NIAID's
Strategic Plan for
Addressing Health Disparities identifies asthma as a key
research area. The plan seeks to resolve health disparities by
- Directing funding for research on diseases known to occur
disparately in a population.
- Identifying environmental, occupational, social, genetic, or
biochemical factors that increase susceptibility to infectious and
immunologic diseases.
- Increasing the participation and support of minority
scientists interested in research on health disparities, including
the number of minority scientists in training.
- Communicating research developments to the population groups
affected by health disparities.
The Impact of Asthma
After 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 Studies
To 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.
- 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
- 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. This investigation demonstrated that the
combination of cockroach exposure and cockroach allergy was a major
factor for asthma severity. The study developed and tested a
one-year comprehensive educational, behavioral, and environmental
intervention.
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
- high levels of indoor allergens, especially cockroach allergen
- high levels of tobacco smoking among family members and
caretakers
- high indoor levels of nitrogen dioxide, a respiratory irritant
produced by inadequately vented stoves and heating appliances
This study provided the most convincing data that
cockroach was the major allergen for inner-city children. Low
socioeconomic status and African descent 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.
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 Study
Based 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:
- 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
In
addition, through support of the U.S. Environmental Protection
Agency, an arm of the study will focus on evaluating the effects of
indoor and outdoor pollutants on asthma severity.
NIAID Research Centers
NIAID 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 Asthma
NIAID 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.
NIAID, a component of the National Institutes of Health,
supports research on AIDS, tuberculosis and other infectious
diseases as well as allergies and immunology.
Press
releases, fact sheets and other NIAID-related materials are
available on the NIAID Web site at http://www.niaid.nih.gov/.
Prepared
by:
Office of Communications and Public Liaison
National
Institute of Allergy and Infectious Diseases
National Institutes
of Health
Bethesda, MD 20892
U.S. Department of Health and
Human Services
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