MICAS (Miami Inner City Asthma) Project

Abstract: The purpose of MICAS will be two-fold: 1) to examine the relevant airborne exposures to environmental pollutants and allergens in the warm climate of Miami; the exposure to ETS in the homes; the genetic component; and behavioral factors including life events, stress and violence with regard to asthma morbidity and severity in 300 children, age 5-11 with asthma living in inner city area of Miami, FL and 2) to search for new ways to reduce asthma morbidity and severity by reducing exposure to these agents using an Environmental Intervention (EI) and a Physician Feedback Intervention (PFI). This will be a community based intervention that will utilize existing community health workers, the parents/guardians, and the primary care physicians.

MICAS hypotheses are the following:

1) An education-based environmental intervention will reduce asthma morbidity, as assessed by symptoms frequency, quality of life, lung function, and utilization of acute health care services, among urban children with moderate to severe asthma.
2) An education-based environmental intervention will reduce the levels of important indoor allergens and the biomarkers of ETS in the homes of urban children with asthma.
3) Among sensitized children with asthma, reductions in measured levels of indoor allergens over time and an identification of both genetic and environmental factors that will lead to a much better understanding of susceptibility to asthma and development of a pharmacogenomic approach to treatment will be correlated with improvements in asthma, as measured by the above indices.
4) An intervention that provides the primary care physician with bimonthly information on the child’s asthma symptoms and medication use, accompanied by severity-specific NIH guidelines on asthma management, will reduce asthma morbidity, as measured by the above indices.
5) An intervention that provides the primary care physician with bimonthly information on the child’s asthma symptoms and medication use, accompanied by severity-specific NIH guidelines on asthma management, will improve the physician’s quality of asthma care.

These hypotheses will be performed by pursuing a two-fold specific aim:
To evaluate the effectiveness of two types of interventions (environmental intervention and physician feedback intervention) to reduce asthma morbidity and severity among minority and / or inner-city children, ages 5 -11 living in Miami, Florida. To achieve this aim, the home-based environmental intervention will include education and remediation for the following six allergens/irritants: cockroach, mold, dust mite, furry pets, rodents, and environmental tobacco smoke exposure along with the study of the genetic component and behavioral factors including life events, stress and violence with regard to asthma morbidity and severity. The Physician Feedback Intervention will entail development and implementation of a novel communication / physician education system that will provide physicians with up-to-date information on patient clinical status, medication use, and health care utilization.