In addition to basic research on asthma biology and genetics ongoing in many Chicago centers, Chicago has been an important center for clinical studies in asthma in the past 10 years.
The School-based Pediatric Asthma Research in Chicago investigators analyzed the social, behavioral, environmental, and biological factors influencing racial and ethnic disparities in childhood asthma in Chicago. School-based ASMA program helps adolescents improve asthma management, quality of life. A short questionnaire, completed by parents, was used to screen > 11,000 children in 14 Chicago public elementary schools for asthma or symptoms consistent with asthma, followed by a series of telephone and home interviews. Evaluation included allergy testing for children and a household dust analysis for common aeroallergens. Physicians were surveyed to understand the nature of asthma practice patterns in this population. Results were shared with families and communities.
The Impact of Air Purifiers on Pediatric Asthma Outcomes in the Inner City study observed the effect of high-efficiency particulate air (HEPA) filters on asthma in Chicago children. There were no significant differences between homes with HEPA or placebo filters. The study concluded that while air purifiers may be easy to use and affordable, their benefit was not clear in low-income populations. Further study of HEPA filter efficacy is needed before advocating widespread adoption.
The Relationship of Life Stressors and Maternal Depression to Pediatric Asthma Morbidity in a Subspecialty Practice project interviewed caregivers of children with asthma aged 18 months to 12 years to explore the relationships among demographics, caregiver life stressors and depressive symptoms, and asthma outcomes in children. Children were more likely to have difficulty with their asthma if they had caregivers with increased depressive symptoms and negative life stressors and if the child was female, after controlling for race, residence, and Medicaid status.
This study offers an important insight into the complex modifiers of asthma morbidity in the urban poor.
The Development and Validation of a Brief Pediatric Screen for Asthma and Allergies project revised a validated asthma screen (Brief Pediatric Asthma Screen) by adding an allergy component and establishing the sensitivity and specificity with a low-income, African-American population. Three predominantly low-income, African-American, elementary schools were screened. A sample of children and parents participated in the validation, consisting of an examination by a pediatric allergist who estimated the probability of an asthma or allergy diagnosis. The asthma portion of the Brief Pediatric Asthma Screen Plus (BPAS ) had 73% sensitivity and 74% specificity. The allergy portion had 71% sensitivity and 77% specificity.
Validation of Spanish and English versions of the asthma section of the BPAS was conducted in four low-income, Hispanic, elementary schools. Students were screened for the prevalence of asthma and asthma symptoms using the BPAS in both English and Spanish languages. Two bilingual clinicians conducted interviews and examinations and classified students as to the likelihood of an asthma diagnosis: no further evaluation warranted, possible evaluation warranted, further evaluation definitely warranted. In Hispanics, the Spanish BPAS had 74% sensitivity and 86% specificity, compared to the English version (61% sensitivity and 83% specificity).
The American Lung Association established the Asthma Clinical Research Center (ACRC) network to conduct multicenter clinical trials. The ACRC network has grown to include 20 research centers. The Chicago center includes investigators from Northwestern University, University of Chicago, Rush University and University of Illinois at Chicago. The ACRC has completed an important study demonstrating the safety and efficacy of influenza vaccine in asthmatics. The “Lodo” placebo-controlled trial compared low doses of theophylline with the leuko-triene receptor antagonist montelukast as add-on therapy in patients symptomatic despite use of inhaled corticosteroids. While both medications led to modest improvements in airway physiology, neither significantly reduced asthma exacerbations compared to placebo. In patients not receiving inhaled corticosteroids, the addition of low-dose theophylline resulted in symptom improvement.
Articles that have previously been published on this subject, see below:
Targeting Improvements in Asthma Morbidity in Chicago: Consortia
Targeting Improvements in Asthma Morbidity in Chicago: Quality Improvement
Targeting Improvements in Asthma Morbidity in Chicago: Legislative Activities
Targeting Improvements in Asthma Morbidity in Chicago: Disparity Initiatives
Targeting Improvements in Asthma Morbidity in Chicago: Education Initiatives
Targeting Improvements in Asthma Morbidity in Chicago: Surveillance Initiatives