Environmental Factor, October 2010, National Institute of Environmental Health Sciences
Foundation commits $2M more to asthma study
The Merck Childhood Asthma Network (MCAN), Inc., will commit $2 million to sustain a successful program for managing childhood asthma in New Orleans that was led by NIEHS from 2006 to 2010. The new MCAN(http://www.mcanonline.org/index.html) grant to Xavier University of Louisiana's Center for Minority Health and Health Disparities Research and Education will support phase two of the Head-off Environmental Asthma in Louisiana (HEAL) Project(http://heal.niehs.nih.gov/home.html).
Mobilizing resources in response to a public health crisis
In the aftermath of Hurricane Katrina, NIEHS started up the first phase of the project along with researchers at Tulane University(http://www.sph.tulane.edu/PRC/pages/HEAL.htm) , Louisiana State University, and the New Orleans Department of Health. The project was funded by NIEHS, MCAN, and the National Center on Minority Health and Health Disparities (NCMHD). HEAL was one of the largest public-private partnerships ever established to address and support an asthma initiative.
The HEAL study partnered 184 asthmatic children, 4 to 12 years old, and their families with a team of health education specialists and community health workers. The specialists provided education and counseling to caregivers on how to manage their child's asthma in a transformed environment and help them improve the environment at home (see text box).
Planning and carrying out a sustainable program
A lead investigator on the HEAL Project was Patricia Chulada, Ph.D., health scientist administrator in the NIEHS Program in Clinical Research, who is currently completing reports on phase one and overseeing data analysis. Chulada attributed the project's success to careful design of the study, meticulous planning of the intervention, and the dedication of the various partners and HEAL scientists. Several of the New Orleans partners in HEAL lost their homes due to Katrina and could identify with HEAL families.
In a draft report on HEAL, Chulada explained, "With HEAL, we combined traditional case-management and environmental interventions from two evidence-based studies - the National Cooperative Inner-City Asthma Study (NCICAS) and the Inner-City Asthma Study (ICAS) - into a 'hybrid' intervention and made modifications to meet the specific needs of post-Katrina families. Our goal was to create a sustainable program for the New Orleans area, as well as a model that could be applied to other natural disaster situations similar to post-Katrina New Orleans."
"Conducting HEAL was very challenging. There was little surviving infrastructure and families were having a difficult time finding adequate housing and just carrying out normal daily activities," Chulada said recently. "HEAL was a great study, and it sets a standard for future projects of its kind. It also created a rich repository of data and samples that researchers will be able to mine for years, as scientists better understand the triggers of asthma and how best to measure them."
Looking ahead to phase two of HEAL
MCAN agreed with Chulada's assessment of the program. As its Aug. 27 press release stated, "The progress for children in the program was positive and cut children's days with symptoms in half, compelling MCAN to pledge nearly $2 million to continue the successful program."
Speaking of the lessons of HEAL's phase one outcomes, MCAN Executive Director Floyd Malveaux, M.D., Ph.D., added, "There is an undeniable connection between the environment and the health of children with asthma. Effective asthma management must go beyond traditional medical care and include additional interventions to manage the problem, as well as to reduce exposure to the specific environmental triggers known to exacerbate a child's asthma."
Creating a model for intervention on the home front
The HEAL home environmental evaluation was one of the most comprehensive ever conducted in a study of this type. Specialists visited caregivers and children in their homes, and helped them remediate asthma risk factors and triggers. This intervention was tailored to the results of a home environmental evaluation and the children's skin sensitivities.
Specialized field technicians periodically inspected the children's homes, focusing moisture, allergens, and other toxic agents. They collected numerous air, dust, and filter samples from multiple rooms to be used in measuring a broad range of suspected allergens with a special focus on mold. Results from the home evaluation were used in conjunction with the children's asthma symptoms and skin sensitivities to both evaluate the effectiveness of the education specialists and help HEAL scientists characterize post-Katrina exposures.
Phase one of HEAL showed the value of a comprehensive home-front intervention. Over a one-year period childhood maximum symptom days, measured over two-week periods, were reduced by nearly 50 percent.