The goals of this Center are to determine the mechanisms underlying the disparities in asthma, and to improve asthma care in a targeted group at high risk for asthma-specific, maternal and perinatal complications, pregnant women with asthma. The proposed Meharry-Vanderbilt Center for Reducing Asthma Disparities entitled Asthma Disparities in Cohorts at Risk for Morbidity@ is a joint collaborative effort produced in the context of a formal alliance between the institutions, the Meharry-Vanderbilt Alliance. This Alliance commits the two institutions to learn from each other for the benefit of student education, patient care, and research progress. The Alliance has already established NIH funding, organized community outreach, and formalized institutional cross training. The proposed Center would be a natural extension of Alliance goals and methods. The training projects were developed jointly to optimize the unique values of the minority serving institution, Meharry Medical College, and the research intensive institution, Vanderbilt University. Funds are dedicated for summer research experiences for medical students and for pilot investigations relevant to asthma disparities. This proposal targets minority groups at risk of significant asthma-related morbidity: pregnant women, children requiring intensive care unit (ICU) admission and asthmatics requiring emergency care. A controlled randomized trial of the relative efficacy of two culturally sensitive asthma education and smoking cessation programs will target pregnant women with asthma of black or Hispanic race/ethnicity. Simultaneously, the same investigators will examine asthma-related morbidity in a large cohort of pregnant women utilizing administrative data and vital records. Perceptions of asthma severity and ways to describe it appear to differ in Blacks compared to whites. Therefore we will convene focus groups of patients and families attending the emergency room to validate a culturally sensitive instrument to allow improved descriptors of asthma severity for Blacks. Estimates by the patients of asthma severity will be matched to objective measures, and compared with those of whites. This methodology will then be used to extend the hypothesis to children admitted with severe asthma to the region=s only pediatric ICU. In the pediatric ICU, the admission rates and outcomes will be associated with the potentially important genetic variations in the beta 2 adrenergic receptor (BADR2). Using parents and non-affected siblings as case controls, a novel computational method will test for gene-gene interactions that explain a genetic basis for asthma disparities in severe asthma. These interrelated projects jointly conducted by investigators from each institution will illuminate the mechanisms responsible for asthma disparities and provide novel interventions in targeted minority groups at risk for morbidity from asthma.
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