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Spring 2008 Respiratory Therapist in Alabama Asthma Clinic Helps Serve Unmet Needs of His Community Food Triggers for Asthma and Allergies Debunking Cultural Myths on the Management of Asthma
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 Researchers Link Gene Variants to Asthma New research sponsored by the National Heart, Lung, and Blood Institute (NHLBI) suggests asthma risk is related to variations in a gene called CHI3L1; and measuring blood levels of a protein known as YKL-40, which is regulated by the gene and known to be elevated in people with asthma, could be a good way to assess for susceptibility to the condition. In the study, people with one type of genetic variation had higher levels of YKL-40, while those with another variation had lower levels and a lower risk of developing asthma. The University of Chicago study was built on previous research that identified the gene variants in 700 members of an isolated and closely related religious community in South Dakota known as the Hutterites. In the new study, investigators confirmed the connection between the gene and the YKL-40 protein in three additional and more genetically diverse white groups in Chicago, Wisconsin, and Freiburg, Germany. “YKL-40 appears to serve as a marker for genetic susceptibility to asthma and decline in lung function,” James P. Kiley, PhD, director of the NHLBI division of lung diseases, was quoted as saying. “These findings will help pave the way for more research on pre-empting the development of disease.” The study appeared in the April 17 edition of the New England Journal of Medicine.
Dust Mites Almost Impossible To Eradicate, Says Study People who have asthma may want to consider the latest analysis that indicates interventions aimed at ridding a home of dust mites are ineffective. The researchers analyzed data from 54 studies involving 3,000 asthma patients, finding nothing can stop the microscopic allergens from invading a home environment and causing problems for asthmatics. “We can conclude with confidence that there is no need to buy expensive vacuum cleaners or mattress covers or to use chemical methods against house dust mites, because these treatments do not work,” lead author Peter Gotzsche, MD, director of The Nordic Cochrane Centre in Copenhagen, Denmark, was quoted as saying. The products don’t work, he says, because “the level of allergens is so high in most homes that what remains after the treatment is still high enough to cause asthma attacks.” Dr. Gotzsche notes some of the trials included in the review resulted in a reduction in dust mites of 50% or more, but even a reduction of 90% is ineffective in stopping the impact of the allergen on people with asthma. In commenting on the study, Noreen Clark, PhD, professor of public health at the University of Michigan and national program director for the Robert Wood Johnson Foundation Allies Against Asthma program, described the study as an important review, noting that, “Patient treatment and counseling should focus on a few things that evidence shows will be significant in getting the disease under control. This study suggests that trying to reduce exposure to dust mites by covering mattresses, using ionizers, washing bedding at high temperatures, and so on, will not help and should not be on the list.” The study appeared in the April 16 online edition of the Cochrane Database of Systematic Reviews. More studies need to be conducted to confirm the validity of this study.
Complex relationships exist between culture and asthma A study from the University of Florida illustrates the complex relationships that exist between race/ethnicity, mental health, and asthma. Investigators examined 2004 data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System to see whether racial and ethnic disparities in asthma prevalence are impacted by poor mental health and socioeconomic status. Results showed a three-way interaction between race/ethnicity, income, and chronic asthma on the number of days of poor mental health among the group. However, subgroup analysis revealed surprising discrepancies. For example, Hispanics with incomes of less than $15,000 per year had significantly more days of poor mental health than non-Hispanic whites with similar incomes. However, among Hispanics in just a slightly higher income bracket, poor mental health days were actually lower than for non-Hispanic whites with similar incomes. The study was published in the January issue of Psychosomatic Medicine.
Cultural problems with educational materials Educational materials can go a long way toward helping asthmatic children and their families cope with the condition. But what’s key for health care professionals is targeting these materials to the different cultures involved. Researchers who looked at asthma education materials in Wisconsin found plenty of room for improvement. Their review identified only 17 educational materials targeted specifically to minorities, with 16 geared to Hispanics and one geared to Native Americans. There were no materials targeting African-Americans or Asian-Americans. An evaluation of the materials based on language, normative cultural values, folk illnesses, parent/patient beliefs, provider practices, visuals, and an overall assessment found average scores for language and visuals and significantly lower scores for all other measures. The overall assessment scores were in the poor to fair range. “The few asthma educational materials targeting minorities that exist in Wisconsin are not culturally competent,” conclude the investigators. The study appeared in the Autumn 2008 issue of Ethnicity & Disease.
Disparities common in pediatric care Researchers have used pediatric quality monitors established by the federal Agency for Healthcare Research and Quality to detect disparities in health care delivery for children hospitalized with five potentially avoidable diagnoses (asthma, short-term complications of diabetes, gastroenteritis, urinary tract infection, and perforated appendix) and find health disparities do exist. Black children were significantly more likely to be discharged with a diagnosis of asthma, and publicly insured children were significantly more likely to be discharged with all five diagnoses. “The results show that black children and children insured by public programs have significantly different discharge rates for pediatric potentially avoidable hospitalizations than do white children or commercially insured children,” write the authors. “This could be the result of less access to high-quality ambulatory care.” The report appeared in the Sept. 14, 2007, Epub edition of Clinical Pediatrics. In another study, this one focusing on asthma, New Jersey investigators found persistent racial and ethnic disparities in emergency department (ED) use among children with asthma. Their study involved 37,216 children ages one to 19 who accounted for 47,548 ED visits and hospitalizations in New Jersey in 2004 and 2005. While significant racial/ethnicity disparities were seen among the group, admission rates from the ED were similar among children of different racial and ethnic groups. The authors of this study believe this finding suggests pediatric asthma patients receive similar management once they are seen in the ED. They recommend integrating existing ED and hospitalization records to enhance asthma surveillance and target interventions to reduce racial and ethnic disparities. The study was published in the December 2008 issue of the Journal of Asthma.
Culture counts Cultural beliefs may be playing a big role in how parents care for their children with asthma, report British investigators publishing in the December 2007 issue of the Archives of Disease in Childhood. They surveyed the parents of 150 children ages three to nine who were seen in asthma clinics or accident and emergency departments for asthma. The group included a high percentage of South Asian families, along with white families and families of “other” ethnicity. The researchers found South Asian parents were less likely than white parents to give their children preventive medications for their asthma, more likely to believe most drugs were addictive, and more likely to state that medicines could do their children more harm than good. Both South Asian parents and those listed as “other” ethnicity were less likely to tell other people about their children’s asthma. The authors conclude, “Cultural perspectives related to ethnicity are key factors in the understanding of asthma management. Health staff should give high priority to eliciting parents’ beliefs regarding management of their children’s asthma.”
Home-based asthma program helps those with low income A home-based asthma intervention program aimed at low income Puerto Rican families with asthmatic children proved successful in reducing ED visits and hospitalizations for asthma. The program, which is called CALMA (the Spanish acronym for “Take Control, Empower Yourself and Achieve Management of Asthma”), was tested among children with persistent asthma who were selected from a national health plan’s insurance claims database. Families were randomly assigned to receive the intervention or usual care. While no difference in symptom-free days was seen between the two groups, children in the CALMA group had more symptom-free nights, were more likely to have their asthma under control, and were less likely to visit the ED or be hospitalized. Caregivers were less likely to be frustrated by their child’s asthma or feel helpless or upset, and more likely to express confidence in managing their child’s condition. The study appeared in the Nov. 30, 2008, Epub edition of the Journal of Allergy and Clinical Immunology.
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