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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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
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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 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

To Improve Clinical Practice Recommendations for Asthma

What are the strategies to improve the use of evidence-based clinical practice recommendations and thereby increase the quality of care and improve outcomes for people with asthma? • Lack of provider awareness, knowledge, agreement, and/or self-efficacy in using the guidelines • Inconsistent use of guidelines-based asthma care in clinical practice. • Scarce/limited resources and limited access to target audiences. • ...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 :

• Asthma is a chronic lung disease that affects 26 million people in the U.S., including more than 7 million children, at an estimated cost to the nation of $56 billion. Asthma accounts for 14.2 million missed work days, 10.5 million missed school days, 10.6 million physician office visits, and 1.8 million emergency department visits, and 439,000 hospitalizations each year.

• Despite widespread availability of evidence-based clinical practice guidelines for the diagnosis and management of asthma, only about half of individuals with asthma in the U.S. receive guidelines-based care.

• Identifying strategies to improve use of evidence-based clinical practice recommendations would 1) increase the number of people with asthma who receive evidence-based clinical care, 2) increase the number of health care providers who use (implement) evidence-based clinical practice recommendations, 3) increase the quality of care of people with asthma, and 4) improve outcomes and quality of life for people with asthma.

Feasibility and challenges of addressing this CQ or CC :

• Investigators could evaluate guidelines-based implementation strategies in implementation settings such as community and regional health systems, private medical practices, federally qualified health centers and other safety-net clinics, and hospitals throughout the U.S.

• Documented successful and sustainable implementation strategies could be shared more broadly and applied to future efforts to improve asthma care and control as well as reduce asthma disparities.

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

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6 up votes
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Goal 3: Advance Translational Research

Access to healthcare for treatment/management of asthma and allergies, and funding of research on asthma and allergies

It is essential that people with asthma and allergies have access to affordable, quality healthcare for the treatment and management of asthma and allergies, and that research is funded to address prevention, screening, and lifestyle interventions to reduce the incidence and adverse effects of asthma and allergies. These conditions impose significant costs on the overall health care system and on patients and their families. ...more »

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 :

Currently, more people than ever are struggling to live normal and healthy lives in the face of the daily limits that asthma and allergic diseases create. More than 25 million Americans have asthma, 15 million have food allergies, and 50 million have other allergic conditions. AAFA urges the National Institutes of Health (NIH) to continue to focus and accelerate research on asthma and allergies, which are life threatening chronic conditions for which there are no cures.

 

While asthma affects all populations, the burden of asthma falls disproportionately on the black and Hispanic/Latino—largely Puerto Rican—populations, and especially on minority children. Asthma is the third leading cause of hospitalization among children under the age of 15 and is a leading cause of school absences from chronic disease – accounting for over 10.5 million lost school days in 2008. Asthma costs our healthcare system over $50.1 billion annually and indirect costs from lost productivity add another $5.9 billion. Asthma claimed the lives of more than 3,400 Americans in 2010. According to the American College of Allergy, Asthma & Immunology, allergic diseases, which include asthma, are the fifth most prevalent chronic diseases in all ages, and the third most common in children.

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 2: Reduce Human Disease

Diagnosis and Treatment of the Asthma-COPD Overlap Syndrome

Asthma-COPD overlap syndrome is common and associated with increased morbidity and greater healthcare costs. However, ACOS patients are usually excluded from studies of either disease. There is a compelling need for research in order to define objective diagnostic criteria for ACOS.

Submitted by (@craighersh)

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

Details on the impact of addressing this CQ or CC :

Better diagnostic criteria as well as biomarkers will allow for efficient targeting of specific therapies for ACOS, such as biologic therapies developed for asthma.

Feasibility and challenges of addressing this CQ or CC :

Since ACOS subjects are usually excluded from COPD or asthma trials, this will require identification of study populations that did not exclude ACOS and/or enrollment of ACOS subjects into a new study.

Name of idea submitter and other team members who worked on this idea : C. Hersh

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30 net votes
31 up votes
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Goal 1: Promote Human Health

Environmental Exposures and Atopic Disease

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:

 

What are the molecular and cellular responses in the lung that occur after environmental stimuli (including allergens) that predict homeostatic resilience or transition to atopic diseases?

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 3: Advance Translational Research

Biomarkers of asthma

Need to develop and integrate biomarkers of asthma into phenotype/endotype-driven asthma management algorithms

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 2: Reduce Human Disease

The treatment of asthma in patients with SCD prevents the development of ACS and VOS.

Does the aggressive treatment of asthma prevent the developement of acute chest syndrome (ACS) and vaso-occlusive syndrome (VOS) in patients with sickle cell disease (SCD)?

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 :

Improvement of health for persons with SCD.

Decreased hospitalizations and use of health resources.

Better understanding of the role of bronchospastic/inflammatory airway disease and hypoxemia as causes of acute chest syndrome and VOC.

Feasibility and challenges of addressing this CQ or CC :

Feasible but stumbling block could be enrollment of patients since many patients with SCD are not seen by asthma specialists. Study could be a multicenter study with two hospitals in one major city and in one center, patients with SCD receive usual care and at another center they receive aggressive treatment and monitoring of their lung disease.

Name of idea submitter and other team members who worked on this idea : Scott Schroeder

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13 net votes
27 up votes
14 down votes
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