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Research and the Community

National Cooperative Inner-City Asthma Study

The NIAID-supported National Cooperative Inner-City Asthma Study (NCICAS) is composed of eight units in seven cities that are studying the unusually high morbidity rates of asthma in inner-city children.

The objective of NCICAS phase I is to identify modifiable factors determining asthma severity and morbidity among inner-city children. A number of interesting findings have emerged from pilot studies. For example, allergen surveys of more than 80 inner-city homes revealed that cockroaches may be a more important trigger of asthma in this population than are house dust mites.

NCICAS is also evaluating the use of peak flow meters, plastic devices that can be used by patients at home to monitor their breathing. (Because of airflow obstruction in the lungs, asthmatics have trouble breathing air out.) From the patient's monitoring records, the doctor can tell when a person is doing well and when to take action, such as increasing medication to forestall trouble. The peak flow meter pilot studies showed that a two-week monitoring of the variability of peak air flow can be successfully and accurately carried out.

In addition, an innovative technique has been developed to measure the quality of asthma care delivered in inner-city emergency rooms.

Demonstration and Education Projects

To reduce asthma morbidity, Demonstration and Education (D & E) projects develop innovative ways to apply existing knowledge and programs. The main objectives of the projects are to teach better self-management skills to those with asthma and to increase asthma knowledge among health care providers.

Two school-based D & E projects involve new self-management skills. One project, carried out by investigators at Scripps Clinic in San Diego, California, is concerned with developing asthma intervention protocols in fourth through sixth graders in a predominantly Hispanic school district. The other, based at The Johns Hopkins University in Baltimore, Maryland, is studying new evaluation tools for asthma in 13- to 18-year-olds in a predominantly African-American school district.

In addition, a clinic-based project, a computer-driven asthma education aid for children, is in the final stages of development at Children's Hospital in Boston, Massachusetts. This program will teach asthma management skills to African-American asthma patients under age 15.

Asthma, Allergy and Immunologic Diseases Cooperative Research Centers (AAIDCRCs)

NIAID established the Asthma, Allergy, and Immunologic Diseases Cooperative Research Centers (AAIDCRCs) to promote interaction among basic and clinical researchers and to enhance outreach and demonstration activities. These centers encourage close coordination between scientists studying fundamental concepts of immunology, genetics, biochemistry, and pharmacology and clinical investigators who treat allergic individuals. This approach will lead to both a better understanding of the complex mechanisms underlying asthma and allergies and to the clinical application of this knowledge. Various allergic problems are under investigation at the AAIDCRCs: asthma; skin diseases, such as atopic dermatitis; urticaria; angioedema; and allergic reactions caused by insect stings, foods, drugs, and airborne allergens.

Studies also focus on the basic mechanisms involved in immune system function and reactions, including research on antibodies, particularly IgE, and on the inflammation-inducing chemicals released during an allergic attack.

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