Asthma Program Manager

Newly proposed asthma outcome measures will help standardize and improve results from the hundreds of millions of dollars the National Institutes of Health (NIH) spends annually to study asthma, according to the Merck Childhood Asthma Network, Inc. (MCAN), the nation’s only organization focused solely on childhood asthma. Even though years of research have led to groundbreaking improvements in better understanding and managing asthma, MCAN noted that the inability to compare results across many studies has hindered the nation’s efforts to find long-term solutions and reduce childhood asthma disparities.

This set of proposed outcome measures, published as a supplement to the March issue of the Journal of Allergy and Clinical Immunology, will be officially released at the annual meeting of the American Academy of Allergy Asthma & Immunology (AAAAI) in Orlando on March 3. NIH and other agencies will consider these outcomes in future clinical research initiatives later this year, which according to MCAN will permit the comparison of results across many large federally supported studies.

“For years, researchers, clinicians and others have worked to close the wide gap between the treatment that is recommended for children with asthma and the treatment most of them receive. We’ve struggled with an inability to make ‘apples to apples’ comparisons with research outcomes that could lead to improvements in management,” said Dr. Floyd Malveaux, Executive Director of MCAN and former Dean of the College of Medicine at Howard University. “This move towards standardization is a huge step in the right direction. It paves a way to reducing disparities in asthma management and treatment, especially for the most vulnerable children among us.”

In 2010, several federal agencies, non-governmental organizations and industry representatives gathered in Bethesda, Md., to identify how the nation might overcome the lack of outcomes standards in asthma clinical research. The meeting was organized by several NIH institutes, including the National Institute of Allergy and Infectious Diseases; the National Heart, Lung, and Blood Institute; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; and the National Institute of Environmental Health Sciences, as well as the Agency for Healthcare Research and Quality and MCAN. The report of the meeting recommended a standardization of outcome measures that these federal agencies will consider implementing in the coming months.

Dr. Malveaux also noted that there is great potential for increased ability to duplicate successful interventions in some of the country’s neediest communities, identify areas for cost reduction and, through data-sharing, reduce disparities in the communities hardest hit by asthma. Although other endpoints may be proposed by researchers, the NIH has identified seven outcome categories that are important in clinical studies. These categories include:

• Symptoms: Asthma symptoms are used to assess the impact of interventions on health outcomes. Although current tools have shortcomings, the report reviews key instruments and encourages further development of new ones.
• Exacerbations: Future studies will report exacerbations or worsening of asthma requiring the use of systemic corticosteroids.
• Biomarkers: The report identified ten biomarkers relevant to disease progression and response to treatment, with particular emphasis on reporting multi-allergen screening.
• Lung Function: Lung function outcomes are of central importance for future asthma clinical research, and spirometry and bronchial reversibility measures are considered key in diagnosing and determining disease severity.
• Quality of Life: Measures of asthma’s impact on a patient’s life as essential for characterizing patient populations and assessing the benefits or harms of specific asthma interventions; no core measures have been identified to date.
• Asthma Control Questionnaire Results: Several questionnaire instruments, including the Asthma Control Questionnaire (ACQ) and Asthma Control Test (ACT), were identified.
• Healthcare Utilization and Costs: Collecting and reporting information on healthcare utilization, intervention resources and indirect impact of asthma will be encouraged so that costs can be calculated and cost-effectiveness analyses can be conducted across several asthma studies.

The final outcomes standards report entitled “Asthma Outcomes in Clinical Research: Report of the Asthma Outcomes Workshop” is available online at http://www.jacionline.org/issues?issue_key=S0091-6749%2812%29X0003-4. MCAN provided financial support for the 2010 NIH Outcomes Workshop and follow-up activities.

In California, child care facilities must comply with California Child Care Licensing (CCL) regulations for sanitizing and disinfecting in order to maintain infection control. Bleach, a cost-effective multipurpose product, is widely used to meet CCL requirements. However, bleach is known to exacerbate asthma, and according to the State's Work-Related Asthma Program, exposure to bleach has been associated with new asthma cases. Therefore, starting in 2008, the San Francisco Asthma Task Force conducted a grant-funded* pilot project to identify methods for infection control practices that eliminate or reduce child care operator exposure to bleach. 

Based on the findings of the project, the Task Force has established recommendations for bleach-free sanitizers and disinfectants that are safer for asthma; and recommendations regarding safer practices for using bleach. The goal of these recommendations and suggestions--which include specific training needs for management, staff and parents--is to encourage the sustainability of best practices while protecting the health of child care workers and the children served. 

*Funding was provided by San Francisco Foundation, Regional Asthma Management & Prevention, a private donor, and the San Francisco Public Health Foundation.