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Forward toward the Future
New NIH-Funded Multi-Center Asthma Research Collaboration
CHORI is pleased to announce the creation of AsthmaNet, a collaborative venture between Children’s Hospital & Research Center Oakland’s outstanding pediatric asthma center and the University of California, San Francisco’s asthma center. A National Institutes of Health (NIH) Asthma Center, AsthmaNet is one of only 8 asthma centers in the country to receive NIH funding. We anticipate research to be conducted in the both emergency room (ER) setting with Claudia Morris, MD, as the principle invstigator, and the primary care setting with Kelley Meade, MD, and Mindy Benson, NP, as the co-principle investigators.
“What makes AsthmaNet so exciting is that we get to work with centers all over the United States. This makes the research we do more powerful, because there are that many more subjects, making the research that much more meaningful.”

Asthma – a chronic condition in which inflammation and bronchocontriction compromise the airways– is a huge problem in the United States, and the local community of Oakland in particular is considered an epicenter, with asthma numbers triple to quadruple those found nationally.

“The causes are multi-factorial, but they involve poor housing, mold because of moist conditions here in the bay area, and poverty,” explains Ms. Benson, who has been treating patients at the hospital and researching asthma for more than a decade.

“If we plot ER visits and hospitalizations related to asthma by zipcode, we find that many of them are coming from areas along the 880 highway corridor.”

Not only is the pollution from highways a particular problem in Oakland, but the exponential growth of the port of Oakland has also been implicated, with large trucks driving through neighborhoods, and idling while waiting for barges to come in, for as long as 10 or 12 hours. As a result, the ER sees about 5 thousand patients a year with a diagnosis of asthma. While many patients recover from asthma episodes, 40 percent of the patients seen in the ER are hospitalized overnight for more intensive treatment.
“About 25 percent of the patients seen in the ER have had a previous ER visit in the last 12 months. A second ER visit is almost always preventable, which means we’re not doing a good job educating and empowering families to manage this acute condition.”
While asthma is primarily a disease of inflammation, if unchecked it may cause scarring over time and permanent damage to the breathing tubes that results in shorter life spans, greater complications with aging, and everything from chronic lung problems to decreased lung capacity and early death. That’s where AsthmaNet comes in.

“We don’t really have great management strategies for asthma. We are just not that able to reduce inflammation, which is really the root cause of airway constriction,” explains Ms. Benson.

“Inhaled corticosteroids are the gold standard for asthma management and they can help reduce airway inflammation, but for some the effect is limited and there are not many other treatment choices. The larger question is why are we having so much inflammation and what can we do to prevent it from the outset?”

AsthmaNet will hopefully provide the keys to answering that question. The studies AsthmaNet conducts through the NIH multi-center collaboration will target a variety of different treatment approaches to asthma, from assessing the benefit of antibiotic treatments to determining whether or not increasing vitamin D intake could help with asthma symptoms. Vitamin D has been implicated in inflammation, and low levels of vitamin D are frequently found in patient populations more affected by asthma.

“Right now we take out the big cannon – steroids – to treat almost everybody. Steroids are powerful drugs that will reduce inflammation but there are indications that we may be able to reduce inflammation with more focused treatments,” Ms. Benson points out. “I think what we really need to be looking at are other ways of decreasing inflammation on a more individualized basis.”

Each person has a different make up of inflammation. In some patients, an anti-histamine can reduce asthma symptoms, while others require a blend of different treatments. The future of asthma treatment may in fact lie in personalized medicine – being able to run a blood panel on an individual to identify different markers of different sources of inflammation, so that the treatment can be tailored exactly to the individual cause of inflammation.

“While we are probably a long way off from being able to provide individualized treatments, you have to start somewhere,” says Ms. Benson.

AsthmaNet provides a strong foundation, allowing Children’s Hospital & Research Center Oakland to participate in both high-powered data collection that will provide a better understanding of best practices and treatment response, as well as interventions geared toward establishing new and better treatment and prevention protocols for the future.

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Tuesday, May 17, 2011 8:19 AM

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