BALTIMORE-- By 2020, the number of people afflicted with asthma--and the number of related deaths--are projected to double, according to Attack Asthma, a study released by the Pew Environmental Health Commission at the Johns Hopkins School of Public Health.[1] Within the next two decades, this disease will affect an estimated 29 million Americans.

The Department of Health and Human Services (HHS) has recognized the need to develop an asthma strategy and has outlined its plan in two reports, Healthy People 2010 and Action Against Asthma. However, the Pew Environmental Health Commission believes that federal funding for prevention should be expanded.

Right now, 72% of funds are allocated for treatment. In contrast, less than 9% is geared toward prevention and 17% toward research into the etiology of asthma. Instead, the Commission is urging the federal government to rethink its proposed plan of action for the fight against asthma; in fact, it is calling on HHS to mount a "War on Asthma."

Physician involvement is crucial if federal priorities are to be changed. "Physicians are part of the front lines in the fight against asthma," said Paul Locke, DrPH, in an interview with Respiratory Reviews. "We need the support of physicians for preventive research." Dr. Locke, a co-investigator of the report and a faculty member at the Johns Hopkins School of Public Health, noted that Healthy People 2010 outlines eight goals directed toward improving asthma treatment, but no strategy for reducing the number of asthma cases.

COURSE OF ACTION

The Pew Environmental Health Commission advocates a 50% reduction in the incidence of asthma by 2020. Attack Asthma recommends five courses of action to accomplish this goal, which together constitute a timeline for HHS to develop an infrastructure for improving America's respiratory health:

• Within one year, create a "911 Force" at the Centers for Disease Control and Prevention that consists of clinicians, epidemiologists, and health and environmental professionals to track every asthma death in this country.
• Within two years, implement a public awareness campaign to educate Americans on known causal factors, such as allergens, infections, and poor air quality.
• Within five years, establish and commit funding for a national asthma tracking system that will analyze the incidence and prevalence of asthma, as well as environmental risk factors that contribute to the disease.
• Initiate research programs to help improve knowledge on the environmental risk factors for asthma as well as other chronic diseases; these programs should include primary intervention trials to help prevent asthma in children. Additional investigations should be conducted to develop a better understanding of why asthma rates are higher among low-income and minority communities.
• Give the US Surgeon General the responsibility of coordinating all federal efforts in order to keep the War on Asthma organized and effective.

Key in this war will be mapping trends in the prevalence and incidence of asthma. "Our main focus is on tracking the disease and the exposures that cause and exacerbate it. Presently, physicians don't have access to accurate, good quality regional data on the occurrence of asthma in their neighborhoods," said Dr. Locke. "The government is interested in mechanistic scientific research; we think additional resources must be dedicated to studying asthma prevention. Focusing on eliminating environmental hazards will help make an impact now," he concluded.

--Martha L. Heckel

Reference
1. The Pew Environmental Health Commission. Attack Asthma. Baltimore, Md. The Johns Hopkins School of Public Health; 2000.