2012 health disparity asthma course
DESCRIPTION
AsthmaTRANSCRIPT
1. Gain a general knowledge of the significance of asthma
2. Gain an appreciation of the immunologic asis for asthma
!. Gain an appreciation of asic and translational asthma research
SOURCE: Behavioral Risk Factor Surveillance System, 2009
continues to gro$
• 1 in 12 people "aout 2# million, or $% of the population& had asthma in 2''(,
compared with 1 in 1) "aout 2' million, or *%& in 2''1
• 1 in 1' children "1'%& had asthma and 1 in 12 adults "$%& had asthma in 2''(.
+omen were more likel than men and os more likel than girls to ha-e asthma
• 1 in ( "11%& nonHispanic lacks of all ages and aout 1 in / "1*%& of nonHispanic
lack children had asthma in 2''(, the highest rate among racial0ethnic groups
• he greatest rise in asthma rates was among lack children "almost a #'% increase&
from 2''1 through 2''(
• (umber of visits )to ph%sician offices, hospital outpatient
and emergenc% departments* $ith asthma as primar%
diagnosis: 1+0 million
diagnosis: .+/,000
SOURCE: Behavioral Risk Factor Surveillance System, 2009
Asthma has a high economic impact
• sthma cost the 3S aout 4!,!'' per person with asthma each ear from 2''2 to 2''* in
medical e5penses
• 6edical e5penses associated with asthma increased from 4)$./ illion in 2''2 to 4#'.1 illion
in 2''*. • 2 in # ")'%& uninsured people with asthma could not afford their prescription medicines
• 1 in ( "11%& insured people with asthma could not afford
their prescription medicines
• 6ore than half "#(%& of children and onethird "!!%& of adults who had an asthma attack
missed school or work ecause of asthma in 2''$. 7n a-erage, in 2''$ children missed )
das of school and adults missed # das of work ecause of asthma
SOURCE: Behavioral Risk Factor Surveillance System, 2009
3espiration
:espiration is a comple5 process of o5gen and caron dio5ide e5change
in humans, it includes;
!. Gas transport through circulation to organs.
). Peripheral gas e5change from tissue capillaries into cells and
mitochondria.
2 =orced >5pirator <olume in 1 sec "=><1&
2 Peak >5pirator =low "P>=&
#he biochemistr% of asthma 6enjamin 7aston,
Universit% of 8irginia chool of 5edicine, ediatric 3espirator% 5edicine, O 6o9 "01! ;harlottesville, 8A !!/0"-0"<, UA http:==d9doiorg=10101<=jbbagen!0110<00", 'o$ to ;ite or Lin> Using DOI
stimulating the response of the ner-es in the air
passage.
unknown
asthma
Allergen
s%stem
67.+0, 67.+
e'ranulation, 67.8
B cells
/ast Cells
67.+0, 67.+2 an 67.2)
/ast Cells
4c 3eceptor 4unction
4I7U3? . ;lassicall% described activities of L#6. and 7D! that are relevant to asthma #-cell traffic>ing in asthma: lipid mediators grease the $a%
>o1 o 1e e@ectively aress health %roAlems (&sthma*
phsical and pschosocial en-ironmental
ha9ards and the molecular and genetic
determinants of risk
integrates di-erse disciplinespecific theories,
models, measures, and analtical methods
into ongoing asthma research
!
2 :apid rise in atop and asthma is greatest in
de-eloped countries and uran areas
2 8annot e e5plained change in genetic ackground
ut is thought to e the result of comple5 interactions
etween genes and the en-ironment
?tiological 4actors @?nvironmental
2 Da care0silings
Asthma %mptoms
4he Genetics o5 &sthma an &ller'ic isorers, /ichael E! /arch uAlishe on "anuary +, 20++
7enetic ris> factors of asthma
/ichel S, 7ian' 7, e%ner /, Dlo%% 3, et al! (20+0* Uni5yin' Caniate Gene an G&S &%%roaches in &sthma! 7oS O3E -(++*: e+)<9! oi:+0!+)+Hournal!%one!00+)<9 htt%:HH111!%losone!or'HarticleHin5o:oiH+0!+)+Hournal!%one!00+)<9
7enetic basis for
immunologic influences on
aged 0-1. :1"1C or 110,"<+ $ith asthma
Denton
Hoo"
#ohnson
)ise County home to +,2<) chilren a'e 0.+ 50678 or 59:9 1ith asthma
Parker County home to 20,--0 chilren a'e 0.+
59608 or 7:7: 1ith asthma
Hood County home to <,<20 chilren a'e 0. + 596;8 or 5<== 1ith asthma
+enton County home to +)<,+-) chilren a'e 0.+ 596:8 or 0<599 1ith asthma
(arrant County home to 0+,)22chilren a'e 0.+ 5>6?8 or 9:?<? 1ith asthma
@ohnson County home to )2,2+ chilren a'e 0. +
5=6;8 or ?505 1ith asthma CC>&S n I ,)9
'ealth Disparities and Asthma:
Among ;hildren In #arrant ;ount%, #e9as
• Populationased epidemiological component and a patientased indi-idual component
• he epidemiological component of the stud will e5amine characteristics of patients en-ironments including data
from the >n-ironmental Protection genc, arrant 8ount Pulic Health Department, and the 3.S. 8ensus
Bureau
• he indi-idual component of the stud will e5amine patient characteristics otained from sur-e Cuestionnaires,
lood samples, dust samples from patients homes.
• Gloal hpothesis; hat there is an association etween patient race and asthma "pre-alence,
• he specific aims of this stud are to;
• ?n-estigate the independent effects and then the snergistic effects of en-ironmental, indi-idual and
genetic risk factors on the occurrence of asthma
• B e5amining the three tpes of risk factors together, enale in-estigators to Cuantif the relati-e
importance of one tpe of e5posure "en-ironmental, indi-idual or genetic& with another
• aken in total, pro-ide etter e5planation of the disproportionate pre-alence of asthma among
minorit populations in arrant 8ount, e5as
ho$ stress influences immune defense
mechanisms $ith the intension of fostering the
development of comprehensive therapeutics to
combat diseaseE
%stems lin> stress as a co-factor of disease
susceptibilit%
controllabilit% and asthma pathogenesis
2. ?ncorporate an animal model of stress
!. ?dentif potential iological targets representing stress and immune dsfunction.
). Proe for links etween stress, immune function and asthma pathogenesis
#. Begin translation in-estigations
responses
E$%erimental &nti'en (OvalAumin* is introuce to suAectKs res%iratory air1ays!
Evaluate Aehavioral, enocrine, an immune %arameters
Ste% +
tress e9posure increases lung inflammation
l%mphoid infiltrate
cellular adaptive immune responses
optimal acCuired immunit.
presentation of antigen.
3on.&sthmatic &sthmatic
1. Gain a general knowledge of the significance of asthma
2. Gain an appreciation of the immunologic asis for asthma
!. Gain an appreciation of asic and translational asthma research
SOURCE: Behavioral Risk Factor Surveillance System, 2009
Ac>no$ledgements
3or4e$ Grou%: r! RoAerto Cararelli, r! Dim Fula, r! &nna Es%ino?a, /ayo1a 6a'Aemi, Ste%hen Bair an stuent an sta@ su%%ort!
Cook ChilrenKs &Mliate, r! "ames /arshall an sta@
CollaAorators: r! Bruce Ben?, r! 3uha 7ackan
7aA memAers an associates: Byun'."in Dim, Day DayemAe, aniel 4allent, Navier Gon?ales, &niket eshmuk, Dhaisha "ohnson, &shley Benton, "ackie Rori;e?
artners: Simecka, /ark ulse, r! Ber', r! Ca@rey, r! /achu, r! ish1anatha an r! eiss
2. Gain an appreciation of the immunologic asis for asthma
!. Gain an appreciation of asic and translational asthma research
SOURCE: Behavioral Risk Factor Surveillance System, 2009
continues to gro$
• 1 in 12 people "aout 2# million, or $% of the population& had asthma in 2''(,
compared with 1 in 1) "aout 2' million, or *%& in 2''1
• 1 in 1' children "1'%& had asthma and 1 in 12 adults "$%& had asthma in 2''(.
+omen were more likel than men and os more likel than girls to ha-e asthma
• 1 in ( "11%& nonHispanic lacks of all ages and aout 1 in / "1*%& of nonHispanic
lack children had asthma in 2''(, the highest rate among racial0ethnic groups
• he greatest rise in asthma rates was among lack children "almost a #'% increase&
from 2''1 through 2''(
• (umber of visits )to ph%sician offices, hospital outpatient
and emergenc% departments* $ith asthma as primar%
diagnosis: 1+0 million
diagnosis: .+/,000
SOURCE: Behavioral Risk Factor Surveillance System, 2009
Asthma has a high economic impact
• sthma cost the 3S aout 4!,!'' per person with asthma each ear from 2''2 to 2''* in
medical e5penses
• 6edical e5penses associated with asthma increased from 4)$./ illion in 2''2 to 4#'.1 illion
in 2''*. • 2 in # ")'%& uninsured people with asthma could not afford their prescription medicines
• 1 in ( "11%& insured people with asthma could not afford
their prescription medicines
• 6ore than half "#(%& of children and onethird "!!%& of adults who had an asthma attack
missed school or work ecause of asthma in 2''$. 7n a-erage, in 2''$ children missed )
das of school and adults missed # das of work ecause of asthma
SOURCE: Behavioral Risk Factor Surveillance System, 2009
3espiration
:espiration is a comple5 process of o5gen and caron dio5ide e5change
in humans, it includes;
!. Gas transport through circulation to organs.
). Peripheral gas e5change from tissue capillaries into cells and
mitochondria.
2 =orced >5pirator <olume in 1 sec "=><1&
2 Peak >5pirator =low "P>=&
#he biochemistr% of asthma 6enjamin 7aston,
Universit% of 8irginia chool of 5edicine, ediatric 3espirator% 5edicine, O 6o9 "01! ;harlottesville, 8A !!/0"-0"<, UA http:==d9doiorg=10101<=jbbagen!0110<00", 'o$ to ;ite or Lin> Using DOI
stimulating the response of the ner-es in the air
passage.
unknown
asthma
Allergen
s%stem
67.+0, 67.+
e'ranulation, 67.8
B cells
/ast Cells
67.+0, 67.+2 an 67.2)
/ast Cells
4c 3eceptor 4unction
4I7U3? . ;lassicall% described activities of L#6. and 7D! that are relevant to asthma #-cell traffic>ing in asthma: lipid mediators grease the $a%
>o1 o 1e e@ectively aress health %roAlems (&sthma*
phsical and pschosocial en-ironmental
ha9ards and the molecular and genetic
determinants of risk
integrates di-erse disciplinespecific theories,
models, measures, and analtical methods
into ongoing asthma research
!
2 :apid rise in atop and asthma is greatest in
de-eloped countries and uran areas
2 8annot e e5plained change in genetic ackground
ut is thought to e the result of comple5 interactions
etween genes and the en-ironment
?tiological 4actors @?nvironmental
2 Da care0silings
Asthma %mptoms
4he Genetics o5 &sthma an &ller'ic isorers, /ichael E! /arch uAlishe on "anuary +, 20++
7enetic ris> factors of asthma
/ichel S, 7ian' 7, e%ner /, Dlo%% 3, et al! (20+0* Uni5yin' Caniate Gene an G&S &%%roaches in &sthma! 7oS O3E -(++*: e+)<9! oi:+0!+)+Hournal!%one!00+)<9 htt%:HH111!%losone!or'HarticleHin5o:oiH+0!+)+Hournal!%one!00+)<9
7enetic basis for
immunologic influences on
aged 0-1. :1"1C or 110,"<+ $ith asthma
Denton
Hoo"
#ohnson
)ise County home to +,2<) chilren a'e 0.+ 50678 or 59:9 1ith asthma
Parker County home to 20,--0 chilren a'e 0.+
59608 or 7:7: 1ith asthma
Hood County home to <,<20 chilren a'e 0. + 596;8 or 5<== 1ith asthma
+enton County home to +)<,+-) chilren a'e 0.+ 596:8 or 0<599 1ith asthma
(arrant County home to 0+,)22chilren a'e 0.+ 5>6?8 or 9:?<? 1ith asthma
@ohnson County home to )2,2+ chilren a'e 0. +
5=6;8 or ?505 1ith asthma CC>&S n I ,)9
'ealth Disparities and Asthma:
Among ;hildren In #arrant ;ount%, #e9as
• Populationased epidemiological component and a patientased indi-idual component
• he epidemiological component of the stud will e5amine characteristics of patients en-ironments including data
from the >n-ironmental Protection genc, arrant 8ount Pulic Health Department, and the 3.S. 8ensus
Bureau
• he indi-idual component of the stud will e5amine patient characteristics otained from sur-e Cuestionnaires,
lood samples, dust samples from patients homes.
• Gloal hpothesis; hat there is an association etween patient race and asthma "pre-alence,
• he specific aims of this stud are to;
• ?n-estigate the independent effects and then the snergistic effects of en-ironmental, indi-idual and
genetic risk factors on the occurrence of asthma
• B e5amining the three tpes of risk factors together, enale in-estigators to Cuantif the relati-e
importance of one tpe of e5posure "en-ironmental, indi-idual or genetic& with another
• aken in total, pro-ide etter e5planation of the disproportionate pre-alence of asthma among
minorit populations in arrant 8ount, e5as
ho$ stress influences immune defense
mechanisms $ith the intension of fostering the
development of comprehensive therapeutics to
combat diseaseE
%stems lin> stress as a co-factor of disease
susceptibilit%
controllabilit% and asthma pathogenesis
2. ?ncorporate an animal model of stress
!. ?dentif potential iological targets representing stress and immune dsfunction.
). Proe for links etween stress, immune function and asthma pathogenesis
#. Begin translation in-estigations
responses
E$%erimental &nti'en (OvalAumin* is introuce to suAectKs res%iratory air1ays!
Evaluate Aehavioral, enocrine, an immune %arameters
Ste% +
tress e9posure increases lung inflammation
l%mphoid infiltrate
cellular adaptive immune responses
optimal acCuired immunit.
presentation of antigen.
3on.&sthmatic &sthmatic
1. Gain a general knowledge of the significance of asthma
2. Gain an appreciation of the immunologic asis for asthma
!. Gain an appreciation of asic and translational asthma research
SOURCE: Behavioral Risk Factor Surveillance System, 2009
Ac>no$ledgements
3or4e$ Grou%: r! RoAerto Cararelli, r! Dim Fula, r! &nna Es%ino?a, /ayo1a 6a'Aemi, Ste%hen Bair an stuent an sta@ su%%ort!
Cook ChilrenKs &Mliate, r! "ames /arshall an sta@
CollaAorators: r! Bruce Ben?, r! 3uha 7ackan
7aA memAers an associates: Byun'."in Dim, Day DayemAe, aniel 4allent, Navier Gon?ales, &niket eshmuk, Dhaisha "ohnson, &shley Benton, "ackie Rori;e?
artners: Simecka, /ark ulse, r! Ber', r! Ca@rey, r! /achu, r! ish1anatha an r! eiss