Goal 3: Advance Translational Research

Disease-modifying treatments for asthma

Develop disease modifying treatments for asthma and asthma disease prevention.

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

This is an opportunity for additional research

Name of idea submitter and other team members who worked on this idea : Asthma and Allergy Foundation of America (AAFA)

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Goal 3: Advance Translational Research

Including subjects with both COPD and asthma in clinical trials

Subjects with both COPD and asthma are typically excluded from clinical trials, but they represent an important segment of the chronic airflow obstruction population. Defining this combination diagnosis is difficult, but requiring a significant smoking history (e.g. 10 pack years), chronic airflow obstruction (GOLD stage 2 or greater after bronchodilator), age > 45, and childhood onset of asthma could identify the relevant ...more »

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea : American Thoracic Society member

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Goal 1: Promote Human Health

THE RELEVANCE OF PREVENTION TRIALS

Prevention trials, implemented to reduce or delay progression to overt disease in a population at risk to the disease, are an important approach to health promotion. Therapies shown to reduce disease severity in patients with a specific disease are obvious, but not the only, candidates for a prevention trial in populations at high risk for prevalent diseases (such as heart failure, diabetes, COPD, asthma in children). ...more »

Submitted by (@media0)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

The impact of implementing such trials is considerable. They will clearly address an important component of NHLBI’s mission with respect to effectiveness of therapies and behavioral interventions, and it has minimal and clearly definable overlap with commercial trials of specific therapeutic products. It will also provide an important public health focus – preventing disease or reducing the impact of disease processes, thus potentially reducing chronic care costs and increasing years of useful life.

Feasibility and challenges of addressing this CQ or CC :

The biggest challenge in designing and implementing prevention trials is identifying the target, “at risk” population most likely to develop the clinical disease from known biomarkers or early signs/symptoms. Increasing availability of large, population-based registries or databases maintained for other purposes provides a very cost-efficient mechanism to electronically screen and identify “at risk” individuals. The same mechanism may also facilitate implementation of pragmatic, electronically managed, cost efficient trials.

Name of idea submitter and other team members who worked on this idea : Sonja McKinlay other Team Members: Susan Assmann and Paul Stark

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7 net votes
10 up votes
3 down votes
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Goal 2: Reduce Human Disease

Behavioral Science in Asthma Clinical Research

As the current chair of the Research and Training Division, I would like to convey that the AAAAI membership would like the NHLBI to consider the following in the development of its strategic plan:

 

Will integration of behavior science in clinical research improve effectiveness of interventions for asthma associated with behavioral risk factors? 

Submitted by (@wheeze)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : Mitchell Grayson on behalf of the American Academy of Allergy, Asthma, and Immunology

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8 up votes
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Goal 2: Reduce Human Disease

Linking Clinics and schools to improve asthma control and reduce health disparities

How can we improve communication between schools and clinicians in order to develop support systems for children with severe asthma with health disparities?

 

How can we eliminate inefficiency in medical communication to better serve children with severe asthma?

Submitted by (@stanley.szefler)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Children with asthma, especially severe asthma, are compromised by school absence and sleep disturbance. School scan play a significant role in identifying these children, assisting in monitoring their adherence to therapy and supporting the clinician's management plan. However, steps must be taken to improve communication systems that link clinics to schools and allow schools to communicate effectively with clinicians. While systems are in place for some schools that have active asthma management programs, there are many schools that do not have these resources or infrastructure. Model systems can be developed to assist these schools and improve the overall care of asthma in the United States.

Feasibility and challenges of addressing this CQ or CC :

Challenges that must be overcome is standardization of communication forms and harmonization of approach to asthma care, as well resolving barriers that exist due to confidentiality barriers in sharing medical information.

Name of idea submitter and other team members who worked on this idea : Stanley Szefler, MD

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Goal 2: Reduce Human Disease

Oral Magnesium Supplementation in Asthmatic Populations

Do asthmatics and/or those at risk for developing asthma benefit from oral Magnesium supplementation?

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Possible reduction of asthma symptoms, bronchial reactivity, bronchodilator use, and increased quality of life in asthmatic population particularly those with higher asthma burden. Oral Mg supplementation could be effective adjunct therapy.

Feasibility and challenges of addressing this CQ or CC :

Oral Mg supplementation is inexpensive and appears to be safe in Asthma populations studied so far. Careful consideration of asthma endpoint(s) to be measured, Mg status measure, and mechanisms of action may be possible at this time considering previous studies in this area. Equipoise appears to exist based on the literature, for finding definitive answer about effectiveness/efficacy (and safety) of oral Mg supplementation.

 

Thoughtful consideration of asthma endpoint(s) and Mg status measure, and the population to be studied so that the trial provides definitive answers. Feasibility for enrolling the population with the chosen characteristics, in sufficient numbers without interfering with institute-initiated Asthma studies, may need to be demonstrated.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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3 up votes
24 down votes
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Goal 3: Advance Translational Research

Asthma Treatment Recommendations for Blacks

Considering the fact that Blacks bear a disproportionate degree of asthma morbidity and mortality, should treatment recommendations be different for Blacks vs. Caucasians?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea : American Thoracic Society

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1 net vote
1 up votes
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Goal 2: Reduce Human Disease

Biomarkers and phenotypic characteristics of asthma patients

Are there biomarkers or phenotypic characteristics that will allow us to identify the patients with asthma who will experience a more rapid decline in lung function?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea : American Thoracic Society

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Goal 3: Advance Translational Research

Clinical Tools for Pediatric CVD Risk Reduction and Asthma Treat

What are effective strategies and clinical decision support tools that can maximize pediatric care providers’ adoption of evidence-based recommendations for assessment and treatment of cardiovascular risk factors and/or asthma? • Clinical recommendations and associated implementation tools are often incorporated into electronic medical records (EMRs). Currently there is no standard EMR format and therefore it is difficult ...more »

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

• Cardiovascular disease (CVD) remains the leading cause of death and disability in North America. There is extensive evidence documenting the initiation of the atherosclerotic process, the pathologic basis for clinical heart disease, in childhood. Additionally, asthma a chronic condition that affects more than 7 million children in the U.S. and leading to numerous emergency visits.

• Among the major factors that are associated with increased clinical recommendation use are ease of access and feasibility. A common obstacle that providers face is the availability of proper information at the point of care.

• The Community Preventive Services Task Force recommends clinical decision-support systems for prevention of cardiovascular disease based on sufficient evidence of effectiveness in improving screening for CVD risk factors and practices for CVD-related preventive care services, clinical tests, and treatments. Mobile solutions may help to further facilitate this process.

• Successful implementation of clinical recommendations for prevention and treatment of CVD pediatric risk factors and asthma could greatly reduce the number of youth moving into adulthood at increased risk for CVD and could improve health outcomes for children with asthma.

Feasibility and challenges of addressing this CQ or CC :

• Most care providers have mobile devices or computers for use in the clinical setting. There is good evidence that clinical decision support tools (and other implementation tools) can help facilitate adoption of clinical recommendation.

• It is important to test strategies in a large scale intervention that will measure clinical CVD outcomes.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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Goal 3: Advance Translational Research

Developing Research to Address the Critical Problem of Nonadherence to Effective Treatments

A large gap in healthcare is nonadherence to proven effective treatments. One important area for reducing morbidity, mortality and cost for patients with chronic diseases that require frequent home, non-healthcare assisted, administration of treatment is the promotion of adherence to treatment recommendations.

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

The lack of research in this field highlights the need for more research in not only asthma but all chronic diseases. One entrant in this NHLBI online forum is entitled: “Improve patient compliance through community health workers.” That is just one of a multitude of ideas that might be considered by an Expert NHLBI Panel in the Adherence Research field. The Institute is gathering ideas for the most compelling scientific priorities to address over the next decade and addressing adherence research to enable the maximal effect of proven medical therapies to reduce unnecessary morbidity and improve the quality of life deserves critical attention.

Feasibility and challenges of addressing this CQ or CC :

Nonadherence is recognized as a gap in care but not a priority of the National Heart Lung and Blood Advisory Council (NHLBAC) Asthma Expert Working Group’s assessment of the need for a potential update to the 2007 National Asthma Education and Prevention Program’s (NAEPP) Expert Panel Report. The report provides a description of the needs assessment methods used by the Working Group, their recommendations for selected study topics, and their views on the potential respective roles of NHLBI and NAEPP in the process of updating the 2007 guidelines. Adherence was not considered as a priority since there was not significant publications/research to add to the update.

Name of idea submitter and other team members who worked on this idea : Asthma and Allergy Foundation of America (AAFA)

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Goal 3: Advance Translational Research

Apps for asthma and allergy management

Integrate real time data acquired from or through mobile health care applications (apps) and devices into asthma and allergy management.

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea : Asthma and Allergy Foundation of America (AAFA)

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Goal 3: Advance Translational Research

Unconventional beliefs and negative attitudes to 'smart' asthma therapy

Systematically examine the contribution of unconventional beliefs and negative attitudes to inadequate clinical outcomes for asthma.

 

Budesonide/fomoterol controller/reliever therapy ('smart' therapy) in large US studies - adults

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea : American Thoracic Society member

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