Showing 42 ideas for tag "asthma"

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.

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

Voting

30 net votes
31 up votes
1 down votes
Active

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)?

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

Voting

13 net votes
27 up votes
14 down votes
Active

Goal 3: Advance Translational Research

Chronobiology in Chronic Lung Diseases

In the new era of once a day inhalers for Asthma and COPD, there is critical need to determine whether delivery of drugs to the lung at night or day have different therapeutic effects and/or side effect profile.

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

Details on the impact of addressing this CQ or CC

Understanding whether a delivery of a LAMA, LABA and/or ICS at different times of the day has a potential critical impact in symptom control and preservation of lung function

Feasibility and challenges of addressing this CQ or CC

This question can ben addressed via the use of Pragmatic Clinical Trials.

Name of idea submitter and other team members who worked on this idea Alejandro Comellas

Voting

11 net votes
22 up votes
11 down votes
Active

Goal 2: Reduce Human Disease

Precision medicine in non-malignant lung diseases

NIH has a major initiative in Precision Medicine, including whole genome sequencing. In contrast to cancer, mutations with large clinical effects are expected to be uncommon in most non-malignant chronic diseases, such as asthma and COPD. Other data types such as gene expression, biomarkers, and micro RNAs must be combined with clinical and imaging phenotyping to advance Precision medicine in non-malignant lung diseases.... more »

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 goal is to combine clinical and molecular data to identify subtypes of patients within the major chronic respiratory diseases. Understanding molecular pathways will first lead to more appropriate drug repositioning and eventually novel drug development.

Feasibility and challenges of addressing this CQ or CC

NHLBI has many cohorts of subjects with chronic lung diseases with longitudinal clinical characterization, many with banked biospecimens. It is quite feasible to perform genomic, epigenetic and biomarker assays on these specimens. Based on these results, hypothesis-based targeted profiling can be done in prospective studies.

Voting

12 net votes
15 up votes
3 down votes
Active

Goal 2: Reduce Human Disease

Biomarkers and Response Predictors in Asthma

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: Given the development of specific biologic therapy for asthma, what are the biomarkers and predictors of response that will allow clinicians to choose the best therapeutic combination of medications (biologic and otherwise)... more »

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

Voting

7 net votes
18 up votes
11 down votes
Active

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?

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

Voting

6 net votes
12 up votes
6 down votes
Active

Goal 2: Reduce Human Disease

Asthma Disparities in Low income children

What are the most effective methods to reduce asthma disparities in low income children?

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

Details on the impact of addressing this CQ or CC

Despite advances in care, asthma inequities are persistent among low income children. What are the most effective measures to close the gap?

Feasibility and challenges of addressing this CQ or CC

There are multiple strategies but what are the most effective treatment options in low income children who have higher morbidity and mortality?

Voting

4 net votes
9 up votes
5 down votes
Active

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 »

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

Voting

7 net votes
10 up votes
3 down votes
Active

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 »

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

Voting

3 net votes
3 up votes
0 down votes
Active

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 »

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

Voting

0 net votes
10 up votes
10 down votes
Active

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 »

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

Voting

1 net vote
6 up votes
5 down votes
Active

Goal 2: Reduce Human Disease

Pulmonary Complications of Sickle Cell Disease

What is the effectiveness and safety of treatment of the co-morbid condition of asthma with medications known to improve asthma outcomes in individuals without SCD?

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

Details on the impact of addressing this CQ or CC

We and others have demonstrated that a doctor diagnosis of asthma is associated with increased morbidity and mortality in those with SCD. While doctor diagnosis of asthma is the issue for children, wheezing symptoms even without a diagnosis is the risk factor for adults.

This suggests either that asthma is under diagnosed in adults or that the disease patterns shifts from childhood to adulthood.

Making a diagnosis of asthma in individuals with SCD is difficult, as SCD by itself causes respiratory symptoms that can be similar to asthma in general populations, but diagnostic criteria are being proposed. There is concern about the value of treatment of the co-morbid of asthma in prevention of symptoms and even more so in reducing morbidity of pain and ACS episodes. There is also concern with regard to the potential side effects of inhaled corticosteroids by themselves increasing pain episodes and also having adverse effects on bone density, which can be affected by SCD itself.

Name of idea submitter and other team members who worked on this idea ATS Member

Voting

2 net votes
2 up votes
0 down votes
Active

Goal 2: Reduce Human Disease

Preventing hospitalization of asthma patients through agressive acute asthma management

Develop simplified agressive acute asthma treatment protocol and promote the implementation for primary care, ED, Urgent care, Internists, Pediatricians, Allergists, Pulmonologists, and Families. Goal is to prevent hospitalization of children and adults with asthma.
For example: 3 cycles of Duoneb and Albuterol, monitoring pulsoximetry, with oral / IM Dexamethasone dosage. Also initiation of controller medication at... more »

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 D M Meier MD

Voting

0 net votes
7 up votes
7 down votes
Active