NHLBI Workshop SummaryReducing disparities in asthma care: Priorities for research—National Heart, Lung, and Blood Institute Workshop Report☆,☆☆,★
Section snippets
Education of patients about asthma management
A number of randomized trials have demonstrated that education about asthma and encouragement for self-management substantially reduces the risk of emergency department visits, hospitalizations, and lost days of work when compared with usual care.22 Characteristics of effective programs are (1) teaching patients to self-monitor, (2) giving patients a written treatment plan that allows self-adjustment of medications, and (3) offering or providing regular appointments to review the progress of
Gene-environment interaction
Asthma is a heritable trait, but genetic factors alone cannot explain the rise in asthma prevalence, morbidity, or mortality.43 However, a small change in the prevalence of relevant environmental exposures could explain a significant rise in disease prevalence among genetically susceptible individuals.44 Gene-environment interaction, defined as the coparticipation of genetic and environmental factors,45, 46 is particularly relevant to the cause of asthma morbidity in racial-ethnic minorities
Rethinking the framework of asthma care
Various strategies can improve asthma management, including asthma-education interventions focused on building patient self-efficacy and self-management skills, diagnostic and treatment support, and use of specialty services. In addition, system performance measurement and more complex strategies, such as case-management interventions and disease-management programs, have been and continue to be tested. These differing types of health care delivery strategies have begun to form the foundation
Evaluation designs for community-based behavior-change interventions
Because disparity in the outcome of asthma care is a public health problem, approaches to reduce disparities are often studied at a community level. Such approaches are complex and ever changing, operating on multiple levels with multiple strategies and often changing as community members work together. Research on community-based behavior-change interventions should not only identify ways to improve asthma care but should also increase understanding of the processes associated with program
Definition of risk factors underlying disparity
Although asthma is a heritable trait, it is unlikely that genetic factors alone explain either the rise in asthma prevalence or the disparities in outcome. However, gene-by-environment interactions likely play a role in determining disease severity and possibly prevalence. Two fundamental environmental areas, psychologic and social factors, as well as physical environment, were discussed, and their interactions were considered. Psychosocial factors, such as stress, depression, cultural beliefs,
References (87)
- et al.
Inner-city asthma: the epidemiology of an emerging US public health concern
Chest
(1992) - et al.
Investigation of a cluster of deaths of adolescents from asthma: evidence implicating inadequate treatment and poor patient adherence with medications
J Allergy Clin Immunol
(1989) - et al.
Emergency department visits by urban African American children with asthma
J Allergy Clin Immunol
(2000) - et al.
Heart, body, and soul: impact of church-based smoking cessation interventions on readiness to quit
Prev Med
(1996) - et al.
REACT theory-based intervention to reduce treatment-seeking delay for acute MI
Am J Prev Med
(1999) The pharmacogenetics of β2-adrenergic receptors: relevance to asthma
J Allergy Clin Immunol
(2000)- et al.
Beta 2-adrenergic receptor gene polymorphism and body mass index are associated with asthma in sedentary women
Chest
(2001) - et al.
The diagnosis of potentially fatal asthma in hospitalized adults. Patient characteristics and increased severity of asthma
Chest
(1992) - et al.
Risk factors for death from asthma. Prairie Provinces Asthma Study Group
Ann Allergy Asthma Immunol
(1999) - et al.
Quality improvement in chronic illness care: a collaborative approach
Jt Comm J Qual Improv
(2001)
Respiratory diseases in minorities of the United States
Am J Respir Crit Care Med
Impact of childhood asthma on health
Pediatrics
National trends in the morbidity and mortality of asthma in the US: prevalence, hospitalization and death from asthma over two decades: 1965-1984
Chest
Asthma United States 1980
MMWR Morb Mortal Wkly Rep
Changing patterns of asthma mortality: identifying target populations at high risk
JAMA
Patterns of asthma mortality in Philadelphia from 1969-1991
N Engl J Med
Surveillance for Asthma–United States, 1960-1995.CDC Surveillance Summaries, April 24, 1998
MMWR Morb Mortal Wkly Rep
Geographic variations in U.S. asthma mortality: small-area analyses of excess mortality, 1981-1985
Am J Epidemiol
Environmental risk factors of childhood asthma in urban centers
Environ Health Perspect
Variations in asthma hospitalization and deaths in New York City
Am J Public Health
Examining issues in health care delivery for asthma: background and workshop overview
Med Care
Asthma among minority children: a growing problem
Chest
Recent trends in the prevalence and severity of childhood asthma
JAMA
Changing patterns of asthma hospitalization among children: 1979 to 1987
JAMA
Wheezy illness without asthma: the burden of illness in an inner-city pediatric population
Am J Dis Child
Childhood asthma and poverty: differential impacts on utilization of health services
Pediatrics
Medications used by children with asthma living in the inner city
Pediatrics
Quality of care for preschool children with asthma: the role of social factors and practice setting
Pediatrics
Self-management education and regular practitioner review for adults with asthma (Cochrane Review)
Enhancing care for people with asthma: the role of communication, education, training, and self-management
Eur Respir J
Health outcomes among African American and Caucasian adults following a randomized trial of an asthma education program
Ethn Health
Inhaled steroids and the risk of hospitalization for asthma
JAMA
Impact of education for physicians on patient outcomes
Pediatrics
Long-term effects of asthma education for physicians on patient satisfaction and use of health services
Eur Respir J
Long-term effects of asthma education for physicians on patient satisfaction and use of health services
Eur Respir J
Changes in adult cigarette smoking prevalence after 5 years of community health education: the Stanford Five-City Project
Am J Epidemiol
Changes in adult cigarette smoking in the Minnesota Heart Health Program
Am J Public Health
Community education for cardiovascular disease prevention: risk factor changes in the Minnesota Heart Health program
Am J Public Health
The results of the COMMIT trial. Editorial
Am J Public Health
Helping women quit smoking: results of a community intervention program
Am J Public Health
Neighbors For a Smoke Free North Side: evaluation of a community organization approach to promoting smoking cessation among African Americans
Am J Public Health
Trial of an asthma action plan in the Maori community of the Wairarapa
N Z Med J
Culture and clinical care: folk illness beliefs and behaviors and their implications for health care delivery
JAMA
Cited by (83)
The importance of atopy on exhaled nitric oxide levels in African American children
2015, Annals of Allergy, Asthma and ImmunologyRisk Factors Associated With Hospital Readmission in Pediatric Asthma
2015, Journal of Pediatric NursingCitation Excerpt :The high degree of overlap of racial and socioeconomic status makes it difficult to determine if it is bi-factors or a factor that produces disparities in health status and health outcomes (LaVeist, 2005). In addition, the mechanisms contributing to the disparities in pediatric readmission linked with race/ethnicity and public insurance are also complicated, and have been attributed to the complex interactions among biological, psychological, and environmental risk factors (Strunk, Ford, & Taggart, 2002). Chen, Bloomberg, et al. (2003) suggest that less caretaker confidence in providing home asthma care may be associated with feeling more overwhelmed and thus with a higher likelihood of child hospitalizations.
Challenges in Providing Preventive Care To Inner-City Children with Asthma
2013, Nursing Clinics of North AmericaCommentary: Charity begins at home
2013, Surgery (United States)Pregnancy related treatment disparities of acute asthma exacerbations in the emergency department
2011, Respiratory MedicineRegional and racial disparities in asthma hospitalizations in Mississippi
2010, Journal of Allergy and Clinical Immunology
- ☆
Supported by the National Heart, Lung, and Blood Institute, Division of Lung Diseases.
- ☆☆
*Workshop participants are listed in the appendix.
- ★
Reprint requests: Robert C. Strunk, MD, Department of Pediatrics, Washington University School of Medicine, Division of Allergy and Pulmonary Medicine, St Louis Children's Hospital, 1 Children's Place, St Louis, MO 63108.