A trial site network will be established nationwide to support observational studies and clinical trials to better understand asthma and develop treatments and prevention approaches with an emphasis on low-income families residing in urban communities. Incidence of pediatric Asthma in low-income urban communities is higher, and even among minorities, Blacks have higher rates of asthma than do Hispanics or Asians. Poverty, or socioeconomic level or class, represents a correlation to pediatric asthma, and minority children fall into poverty at higher rates in America. Now the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, awarded $10 million in first-year funding to establish the Childhood Asthma in Urban Settings (CAUSE) network to investigate and hopefully find treatments and prevention measures. NAIID reported recently that it intends to provide approximately $70 million over seven years to support the CAUSE network and has established a nationwide leadership center at the University of Wisconsin-Madison led by David Jackson, MD and James Gern, MD.
NIAID recently emphasized that this new initiative is an extension of already active programs targeting the investigation into the high prevalence of asthma in low-income urban communities. The government-based research agency has been at it since 1991 when it first started sponsoring a series of research programs conducted in urban areas where pediatric asthma is more prevalent and severe.
TrialSite provides a brief breakdown of results thus far, delving further into the issue marked by factors such as the social determinants of health, and exploring the opportunity and potential for this vulnerable patient class.
Who is the key contact at NIAID?
Generally, among the entire U.S. population, does the incidence of Asthma impact Blacks more than Whites?
Yes. According to the U.S. Health and Human Services, Office of Minority Health, Blacks face far higher risks associated with incidents of asthma than do whites. This risk is especially pronounced among Black males. In 2013, Kecia Carroll, MD, MPH, at the time Vanderbilt produced a study called “Socioeconomci Status, Race/Ethnicity, and Asthma in Youth” found that while asthma is relatively common, affecting about 9.1% of U.S. children, prevalence and morbidity among Blacks was significant. For example, compared with non-Hispanic white children, non-Hispanic Blacks (including Puerto Rican Blacks) have 1.6 and 2.4 times higher asthma prevalence respectively. This particular study found that Mexican and Asian children had better overall asthma rates than Black children. Carroll found that lower socioeconomic status also correlates with greater asthma morbidity and of course minority children in the U.S., especially in urban areas, are disproportionately affected by socioeconomic status or social class. That is, by 2010, Carroll reminded all that 20% of U.S. children lived in poverty: Black youth faced poverty 38.2% and Hispanic youth 32.3% then.
What is the economic burden of childhood asthma?
In a study titled “The Economic Burden of Pediatric Asthma in the United States: Literature Review of Current Evidence,” researchers from Europe analyzed data, cases, and literature from MEDLINE, EMBASE, Econlit and PsycINFO databases as well as gray literature sources from 2012 to 2018 and found that the total direct cost of pediatric asthma was US$5.92 billion in 2013. The average costs per child ranged from $3,076 to $13,612 while across studies, the primary contributor to total costs included pharmacy ($1,027-$2,120), inpatient ($337-$2,016) and outpatient ($1,049-$8,039). Emergency visits represented a high burden cost: for example, the national annual cost of asthma-related hospitalizations was estimated at $1.59 billion in 2009 and, undoubtedly, that number has gone considerably higher.
What has NIAID accomplished since 1991?
NIAID reports that its funded research has done many things but opted to share first and foremost that it uncovered that exposure to cockroach allergen represents a major risk factor for severe asthma in urban children and that logically, programs that reduce exposure to such elements (e.g. cockroaches and other household allergens) reduces children’s asthma symptoms and health care visits.
NIAID-sponsored investigators established that omalizumab, a drug that reduces immunoglobulin E, can prevent seasonal asthma attacks. Moreover, research scientists identified molecular pathways that evolve in the nasal passages of children with asthma who had colds that led to asthma attacks.
What is a key goal of the CAUSE network?
NIAID reports that CAUSE investigators will work together to improve understanding of the mechanisms that contribute to asthma development and severity and develop new strategies to mitigate the impact of the disease in populations of disadvantaged children and adolescents. In addition to this collaborative work, CAUSE clinical research centers located across the United States will conduct locally relevant clinical and translational studies.
Who are the Principal Investigators and participating trial sites/centers?
The CAUSE network comprises a leadership center at the University of Wisconsin-Madison led by principal investigators Daniel Jackson, M.D., and James Gern, M.D., and the following seven clinical research centers:
- Boston Children’s Hospital. Principal investigators: Wanda Phipatanakul, M.D., and Talal Chatila, M.D.
- Children’s National Research Institute, Washington, D.C. Principal investigator: Stephen Teach, M.D.
- Cincinnati Children’s Hospital Medical Center. Principal investigator: Gurjit Khurana Hershey, M.D., Ph.D.
- Columbia University Health Sciences, New York. Principal investigator: Meyer Kattan, M.D.
- Icahn School of Medicine at Mount Sinai, New York. Principal investigators: Paula Busse, M.D.; Supinda Bunyavanich, M.D.; and Juan Wisnivesky, M.D.
- Lurie Children’s Hospital of Chicago. Principal investigators: Rajesh Kumar, M.D., and Jacqueline Pongracic, M.D.
- University of Colorado Denver. Principal investigator: Andrew Liu, M.D
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