The burden of asthma in the Chicago community fifteen years after the availability of national asthma guidelines: The design and initial results from the CHIRAH study

Abstract

Since the early 1990s, asthma burden has been recognized as a national public health concern in the United States [1]. The asthma burden has disproportionately affected persons of certain racial/ethnic backgrounds, principally African Americans [2] and those persons living in urban environments [3,4]. Concern about the growing problem of asthma has led to a number of national, state, and local efforts towards improving asthma outcomes and control [5,6,7,8]. No national effort toward asthma control has been more celebrated than the implementation of the National Heart, Lung and Blood Institute's National Asthma Education and Prevention Program (NAEPP). Initiated in 1989, to a large extent in response to the public's concern about the increased asthma prevalence and burden, the NAEPP set its first programmatic effort to the establishment of guidelines to improve asthma care [9]. Since the initial release of these guidelines in 1991, hundreds of thousands of copies have been distributed [10] and there have been countless efforts directed toward moving these guidelines into practice including continuing medical education (CME) programs, disease management programs, clinical performance measures, and research efforts. The NAEPP continues efforts in the establishment of national guidelines through a series of updates to the original guidelines, including the recent release of a major update in November 2007 [11,12]. While there continues to be numerous reports of progress of local implementation and health plan efforts, these reports have focused on changes in asthma processes of care or on outcomes limited primarily to health care utilization among selected, mostly health plan or practice-based samples. To date, there is a rather modest literature on community-wide population-based status of asthma burden and quality of care. The Chicago Initiative to Raise Asthma Health Equity (CHIRAH) is one of the NHLBI Centers of Excellence in Reducing Asthma Disparities. The core activity of the CHIRAH has been to conduct a community-based cohort study designed to characterize those factors that are contributing to racial/ethnic disparities with the purpose of identifying mutable factors that may provide the basis for new intervention strategies to eliminate these disparities. The CHIRAH project therefore provides a unique opportunity to report on a population-based understanding of the burden of asthma in a large urban environment known to have one of the highest asthma mortality rates in the US [13]. The purpose of this report is to examine the overall burden of asthma morbidity and treatment as seen from the perspective of this community-based study.