Asthma Clinical Trial
Official title:
Center for Reducing Asthma Disparities - Meharry/Vanderbilt Centers
The purpose of this study is to determine the mechanisms underlying the disparities in asthma and to improve asthma care in pregnant women, a targeted group at high risk for asthma-specific maternal and perinatal complications.
BACKGROUND:
Asthma is a serious chronic condition affecting over 14 million Americans. Data indicate
that rates of asthma are higher in certain populations. In fact, African Americans and
Hispanics from the Northeast are twice as likely to die from asthma as whites. African
Americans are four times as likely to be hospitalized for asthma and are five times more
likely than whites to seek care for asthma at an emergency department. Reasons for these
higher rates are not certain, and most likely result from an interaction of risk factors
such as environmental exposures, genetic predisposition, access to appropriate medical care,
socioeconomic status, and cultural health practices. The National Heart, Lung, and Blood
Institute (NHLBI) supports a variety of activities to address the pressing public health
problems posed by asthma. However, progress in reducing disparities has been disappointingly
slow. Separate, independent research projects have generated important clues for
understanding the nature and scope of the problem, but a more coordinated,
interdisciplinary, and comprehensive approach to research is needed. By fostering
partnerships among minority medical centers, research intensive institutions, and the
communities in which asthma patients live, cooperative research centers can help increase
the capacity to improve health outcomes among minority and economically disadvantaged
populations.
DESIGN NARRATIVE:
This study will comprise three groups: pregnant women with asthma, children requiring
intensive care unit (ICU) admission for asthma, and asthmatics requiring emergency care. In
one part of the study, researchers will randomly assign pregnant women with asthma of
African American or Hispanic race/ethnicity to one of two culturally sensitive asthma
education and smoking cessation programs. At the same time, investigators will examine
asthma-related morbidity in a large cohort of pregnant asthmatic women utilizing
administrative data and vital records. Perceptions of asthma severity and ways to describe
it appear to differ in African Americans compared to whites. Therfore, asthmatic patients
attending the emergency room, along with their families, will be invited to participate in a
focus group to validate a culturally sensitive instrument to allow improved descriptors of
asthma severity for African Americans. Estimates by the patients of asthma severity will be
matched to objective measure, and compared with those of whites. This methodology will then
be used to extend the hypothesis to children admitted with severe asthma to the region's
only pediatric ICU. In the pediatric ICU, the admission rates and outcomes will be
associated with the potentially important genetic variations in the beta 2 adrenergic
receptor (BADR2). Using parents and non-affected siblings as case controls, a novel
computational method will test for gene-gene interactions that explain a genetic basis for
asthma disparities in severe asthma.
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Observational Model: Cohort
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