Asthma affects approximately 15 million Americans, nearly 5 million of whom are under the age of 18 - and it has been on the rise. Between 1980 and 1994, the prevalence of asthma in the United States increased approximately 75 percent overall, including among persons between the ages of 5 and 14, according to the National Asthma Education and Prevention Program of the National Institutes of Health. It is estimated that more than 7 percent of children now have asthma.

Research has shown that most asthma-related hospitalizations and virtually all deaths are preventable. Such events occur, however, if the patient is exposed to environmental factors that make asthma worse, is not prescribed or does not routinely take asthma controller medications to prevent symptoms, is not properly educated about the condition, and does not have a written plan for managing symptoms.

A primary research focus in the Department of Health Services Research is the improvement of asthma outcomes through educational interventions for patients of all ages. In 2001, the department's research-based asthma education program, Wee Wheezers, designed for children under the age of 7 and their families, was selected by the U.S. Centers for Disease Control and Prevention for national dissemination in English, Spanish and Southeast Asian (Hmong). Its programs for school-aged children and adults have received similar distribution.

A current study, LET'S Manage Asthma, addresses a critical problem in controlling asthma among children. The study, which will involve 500 3-to-12-year-old children with persistent asthma, is a behavioral intervention designed to reduce a child's exposure to environmental tobacco smoke (ETS) through education of the parents or other caregivers and objective feedback on the child's level of exposure. Researchers hypothesize that this intervention will reduce the children's ETS exposure, resulting in lowered health care utilization related to asthma and improvement in other disease outcomes. (See story on page 14.)

A second study currently underway, Better Outcomes of Asthma Treatment (BOAT), is a multi-site trial of a strategy, called shared decision-making, for managing asthma in adults. The study is designed to improve adherence to asthma controller medications, and thereby improve outcomes. "In general, only about half of patients with asthma or any other chronic disease take their medications at therapeutically effective doses," Department Chair Sandra Wilson, Ph.D., said. "This can lead to continuation of symptoms, high health care utilization and costs, and impaired quality of life."

The BOAT study evaluates a model of shared decision-making between health professionals and patients about the patients' asthma treatment. Shared decision-making, previously only tested in contexts such as the choice of cancer therapy, is based on mutual communication of information and treatment preferences between patient and clinician. More commonly, patient-physician interactions fall somewhere between "paternalism," in which the physician dominates the interaction, and informed decision-making, in which the physician's role is limited to providing information and the patient is given responsibility for the treatment choice.

The BOAT study will determine whether shared decision-making increases patients' commitment to the treatment decision and improves adherence to treatment, thereby leading to better asthma outcomes. "If it does, shared decision-making could prove to be a powerful tool in the management of other chronic diseases as well," Dr. Wilson said.

Both studies are funded by the National Heart, Lung and Blood Institute.
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