HYGIENE  ENDOTOXIN  EARLY INTERVENTION  CHILDHOOD ASTHMA  INNER CITY ASTHMA  RHINOSINUSITIS  NATURAL HISTORY Andrew H. Liu, M.D. Staff Contact in association with:

click to enlarge Asthmatic children living in our inner cities tend to develop severe asthma and experience poor outcomes. This is evident in a disproportionate burden of life disruption, missed school days, severe exacerbations, emergency room visits, hospitalizations, and deaths due to asthma. What key factors underlie this disparity? Inner city environment, especially their home lives Biological vulnerability Inadequate asthma management We are involved in 3 research initiatives to better understand and manage this problem: Childhood Asthma Prevention Study (CAPS): This is a longitudinal study of inner city infants in metro Denver at high risk for persistent asthma. Under the direction of Principal Investigator Dr. Mary D. Klinnert, this study is the first of its kind, with detailed home environmental, psychosocial, lung physiological, and immune biological information for characterizing these children. From this study, we can better understand the factors leading to severe, persistent asthma. CAPS publications Klinnert Am J Pub H 2002: asthma risk patterns in inner-city infants Klinnert Pediatrics 2003: morbidity patterns in inner-city wheezing infants Inner City Asthma Consortium (ICAC): This is the 3rd in a series of NIH multi-center study groups sponsored by the National Institute of Allergic and Infectious Diseases (NIAID), for the study of inner-city asthmatic children. We are part of a 12-center study group (Administrative Center: University of Wisconsin — Madison; Principal Investigators: Dr. William Busse, Dr. Stanley J. Szefler). ICAC studies: Exhaled Breath Condensates Cockroach Allergen Standardization Asthma Control Evaluation Asthma Control Evaluation — Mechanistic Urban Environment and Childhood Asthma Childhood Asthma Management: Denver Health & Hospitals We have worked with the main safety-net provider of medical care for children in the City and County of Denver, to better manage their asthmatic children. In collaboration with the Director of Pediatric Clinics for Denver, Health, Dr. Mark Anderson, we have recently found that a School-based intervention on the National Jewish campus (Kunsberg School) significantly reduced hospitalizations, emergency room visits, physician visits, and Denver Health's costs over the 3-year study period. LiuLab publications Reviews: Federico/Liu PCNA 2003: Recent review of inner-city childhood asthma Article: Anderson/Liu J Asthma 2004: Successful school-based intervention for children with asthma Related Hygiene Hypothesis — Nature's Immunotherapy for allergies & asthma? Endotoxin, a prototypical microbial exposure in health and disease Natural history of allergies & asthma in childhood Early Intervention for asthma Coming Paper on childhood asthma types in inner-city children