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Frederica Freyberg:
The UW School of Medicine and Public Health is the recipient of its largest grant ever. The National Institutes of Health has awarded $70 million for continuing work on the Inner City Asthma Consortium. Since 2002, the NIH has awarded more than $190 million to the Consortium’s project. The goal? To reduce the severity and work toward prevention of asthma in urban children. William Busse is professor of medicine at UW and the Inner City Asthma Consortium’s principal investigator. Thanks very much for being here.
William Busse:
Thank you for having me.
Frederica Freyberg:
So what will the latest grant money allow the project to do?
William Busse:
Well, we’ve got a number of aspects to the grant. First of all, we have clinical trials that we do. We’re going to be looking at two major areas. One of them is allergies is a major factor for children in the inner city, as it is for all children with asthma. In the inner city the difference though is the antigen that both causes their asthma and makes it worse, and that's cockroach. There are ways in which you can modify the immune response to cockroaches. And one of them is giving injections, beginning with very small amounts and people develop tolerance. So that’s going to be one aspect. The other aspect of it is a major problem for anybody with asthma is asthma attacks or asthma exacerbations. That’s what takes them to the emergency room or to the hospital. We’ve got ways in which we can modify the frequency of that. So that’s one aspect. Again, these are ten centers across the states that will be doing this. The other aspect is we have a birth cohort. It's called — or the Urban Environmental Interaction Group. We’ve got 500 children who are now turning seven years of age and we have followed them since birth. And we’re getting ideas as to when and how and what consequences lead to the development of asthma. And this will give us some clues to both treat and prevent the disease. And then the last aspect, we have three mechanistic sites, one in Seattle, one in La Jolla and the other one in San Francisco. They're looking at aspects of this. One looking at bacteria in the environment that could modify asthma. We’re also looking at the immune response to cockroach, some unique aspects. And another area called systems immunology, trying to bring all these data together and find out genetic pathways that are involved in it. So $70 million is a lot, we’re delighted to have it. But it goes very quickly.
Frederica Freyberg:
And in total to date it’s been $190 million toward this project. Why this level of support toward helping to treat and prevent this condition?
William Busse:
Well, for a lot of reasons. First of all, it’s a common disease. 8% of the people in the United States have asthma, and for many of them it’s a lifetime disease. If you look at the inner cities, though, or areas of poverty, the rates are up around 12% and the severity is an awful lot higher. So first of all, there's a need, and again also studying individuals at highest risk can give you clues not only to control their disease, but also to get a better insight to all of asthma.
Frederica Freyberg:
Now, why is it inner city children and minority children in particular? I mean, does it have everything to do with their living conditions, the environment?
William Busse:
This is a very good question and I wish I could give you the answer.
Frederica Freyberg:
You're studying that.
William Busse:
We’re studying that. I think there’s a lot of aspects to it. I think, first of all, there’s something called the hygiene hypothesis. About 30 years ago it was found that people living in the westernized world had a higher frequency of asthma. We felt it was related to the fact that things have been cleaned up too much. We know that children living on farms or in rural area have less asthma. And when we move to the urban areas, things have changed and people really felt that if you’re living in the inner cities, it might be dirtier. But I think there’s a number of factors that make it different in the inner city. First of all, it’s no doubt their environment. And again, in our inner cities in the East Coast, it’s cockroach antigen which is very, very prevalent, and it's a highly potent antigen. The other thing that has materialized is that the bacteria in one’s environment may determine whether or not you have asthma or are protected from it. We know from studies out of Germany, where children are living above the barn and sort of exposed to cows below, their frequency of asthma is about half of the general population. So there may be very good bacteria to have in our environment. And these things may be having an influence. I think another aspect in inner city is stress. This is a very difficult lifestyle. And put all these things together, and it seems that this is a very major risk factor. The other aspect is the social economic aspect of living in the inner city. If you’ve got the disease, it’s just harder to get care than it is in the suburbs. So, again, I think all of these things together put this group at a very, very high risk. And, again, by studying them, trying new forms of treatment or getting treatments we can familiar with into their health care, we can improve outcomes.
Frederica Freyberg:
Is there progress in treatment?
William Busse:
There is progress in treatment. I think a number of aspects of things. I think we can divide asthma up into two groups. One is those that have mild to moderate disease. We’ve got great treatments. The biggest thing is for people to take them. Then you have the severe disease and here is a group of individuals, and children are in this group, also, whatever they take, it doesn’t control the disease. It’s different. It’s different. And we did a study early on in which we looked at whether using what we’ve called guideline care, which is very prescribed, evidence-based treatment. If it’s given to the youngster in the inner city, will it make a difference? And we monitored them very closely. They did very well. They did very well. So it’s a matter of getting the medications, monitoring things very well. So if you get a segment of them, if you get the right drugs to them, the right medications they’ll do very well. It’s the other aspect and the high frequency which make it a very unique situation.
Frederica Freyberg:
Now, this is a nationwide project and these funds go toward that, but UW is kind of at the center of that. You’re the lead investigators, is that right?
William Busse:
That’s correct, that’s correct. We’re in charge of both the administration and also the initiation of many of these efforts. We also do some basic work here. Dr. James Gern in our group does a lot of the virology aspects and some of the immunology aspects. But our job is supervision, planning of the protocols, supervising things. And the other thing is to get us all to work together.
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