Childhood asthma is a chronic inflammatory disease, with symptoms likely affected by physical, environmental and social factors. With regard to social factors, previous research has linked asthma management and beliefs to morbidity outcomes in children with asthma. In two studies, it was tested whether beliefs about and management of one's illness would predict biological outcomes cross-sectionally (in Study 1), and longitudinally over 18 months (in Study 2) in a sample of children with asthma. Associations of asthma management-related beliefs and behaviors with immune markers and clinical outcomes were examined in a sample of 66 children with asthma (ages 9-18) in Study 1, and longitudinal associations of asthma management-related beliefs and behaviors with changes in asthma-relevant biological markers in a subsample of 40 children with asthma in Study 2. Children and parents were interviewed about asthma management beliefs and behaviors. In Study 1, immune measures included stimulated production of cytokines implicated in asthmatic airway inflammation, eosinophil counts, and IgE levels. Clinical outcomes included pulmonary function, symptoms, beta agonist use, and physician contacts. In Study 2, asthma outcomes included lung function (FEV 1%), eosinophil counts, and daily cortisol measured at two time points, 18 months apart. In Study 1, children's reports of greater conceptual understanding of asthma, parents' reports of quicker responses to asthma symptoms, and children's and parents' reports of more balanced integration of asthma into daily life were all associated with reduced inflammatory profiles. Inflammatory profiles were found to be a statistically significant pathway linking asthma beliefs and behaviors to clinical outcomes. In Study 2, children with a less sophisticated disease belief (the "no symptoms, no asthma" belief) displayed eosinophil counts that increased over time, controlling for baseline levels. Poorer family asthma management was associated.

One-liner: A set of policy recommendations to promote the development and maintenance of communities in which children with asthma can be swiftly diagnosed, effectively treated, and protected from exposure to harmful environmental factors. An estimated 5 million U.S. children have asthma. Too many of these children are unnecessarily impaired. Much of the money spent on asthma is for high-cost health care services to treat acute periods of illness. Many asthma attacks could be avoided--and much suffering prevented and many medical costs saved--if more children received good-quality, ongoing asthma care and if the 11 policy recommendations presented in this report were implemented in a oordinated fashion. A national call to action, the policy recommendations span public and private interests and compel integration of public health activities across local, state, and federal levels. This report summarizes the findings of an effort funded by the Robert Wood Johnson Foundation as part of the Pediatric Asthma Initiative, whose purpose is to address current gaps in national childhood asthma care. It is the first national initiative that simultaneously addresses treatment, policy, and financing issues for children with asthma at the patient, provider, and institutional levels. The purpose of RAND's effort was to:--identify a range of policy actions in both the public and private sectors that could improve childhood asthma outcomes nationwide--select a subset of policies to create a blueprint for national policy in this area--outline alternatives to implement these policies that build on prior efforts.The effort developed a comprehensive policy framework that maps the identified strategies to one overall policy objective: to promote the development and maintenance of asthma-friendly communities--communities in which children with asthma are swiftly diagnosed, receive appropriate and ongoing treatment, and are not exposed to environmental factors that exacerbate their condition. This report is intended as a working guide for coordinating the activities of both public and private organizations at the federal, state, and local community levels.

While numerous studies have linked family routines to pediatric asthma outcomes, it remains unclear how family routines come to be associated with these outcomes on a biological level. The current study investigated whether longitudinal trajectories of inflammatory markers of asthma could be predicted by levels of family routines in youth with asthma. Family routines were assessed at baseline through parent questionnaires and peripheral blood samples obtained from youth every 6 months (total number of assessments = 4) over the course of an 18 month study period. Youth with more family routines in their home environment showed decreases in mitogen-stimulated production of a cytokine implicated in asthma, IL-13, over the course of the study period. In turn, within-person analyses indicated that at times when stimulated production of IL-13 was high, asthma symptoms were also high, pointing to the clinical relevance of changes in IL-13 over time. A variety of potential explanations for this effect were probed. Parental depression, stress, and general family functioning could not explain these effects, suggesting that family routines are not just a proxy for parent psychological traits or family relationship quality. However, medication use eliminated the relationship between family routines and stimulated production of IL-13. This suggests that family routines do impact asthma outcomes at the biological level, possibly through influencing medication adherence. Considering daily family behaviors when treating asthma may help improve both biological and clinical profiles in youth with asthma.

Severe asthma is a form of asthma that responds poorly to currently available medication, and its patients represent those with greatest unmet needs. In the last 10 years, substantial progress has been made in terms of understanding some of the mechanisms that drive severe asthma; there have also been concomitant advances in the recognition of specific molecular phenotypes. This ERS Monograph covers all aspects of severe asthma – epidemiology, diagnosis, mechanisms, treatment and management – but has a particular focus on recent understanding of mechanistic heterogeneity based on an analytic approach using various ‘omics platforms applied to clinically well-defined asthma cohorts. How these advances have led to improved management targets is also emphasised. This book brings together the clinical and scientific expertise of those from around the world who are collaborating to solve the problem of severe asthma.

Childhood asthma still imposes an enormous burden on children and their families. To the best of our knowledge, no study reviewed the literature on the effect of family asthma education on major asthma outcomes. This study aimed to explore the effect of family education programs on major asthma outcomes in children. Quasi-experimental studies and randomized controlled trials were conducted among children with asthma aged 6,Äì18 years and their parents were included. Pub Med, Science Direct, and Trip databases were used to extract data published in English from 2010 to 2021. Twenty-two studies were reported in this review. It was demonstrated that family empowerment interventions were effective in improving the quality of life of children and their parents, asthma symptom control, and pulmonary function. Family education that was specific to medication improved medication adherence, inhalation technique, and asthma control. Family asthma education enhanced asthma management and family functioning. This approach should be a cornerstone of pediatric asthma therapy. It helps health care professionals to build a strong connection and trustful relationship with children with asthma and their families.

In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

Abstract: African-American children demonstrate poorer asthma outcomes than children of any other racial group, and poor asthma management has been identified as a contributing factor. Researchers suggest cultural beliefs about health and illness may influence families' approach to asthma management, and encourage health care providers to examine these beliefs during the clinical encounter. Beliefs, however, do not directly translate into asthma management behaviors. From an ecocultural perspective, asthma management is a compromise between what is desirable according to cultural beliefs and practical within a family's ecological context. Ecological barriers, or social and environmental constraints, to asthma management have been identified, yet little is known about the factors underlying these barriers or how African-American parents navigate these barriers to manage their children's asthma. Furthermore, it remains unclear what African-American parents believe health care providers can do to support parents as they manage asthma within their ecological context. According to family-centered care, parents are experts of their families and asthma management experiences. Therefore, through semi-structured interviews this dissertation examines the perspective of 19 African-American parents of children with asthma living in the inner-city. Data analysis identifies four adaptive routines parents use to manage asthma within their ecological context: (1) give young children with asthma responsibility for medication use, (2) monitor the availability of the school nurse, (3) manage air quality, and (4) frequently clean the home, as well as three roles parents believe health care providers have in supporting asthma management: (1) prescribing environmental control resources, (2) assisting parents in accessing resources for daily family life, and (3) providing ongoing education for parents and school personnel. Findings indicate that parents desire health care providers who understand their ecological context. Examining family routines is presented as a practical approach that health care providers can use to understand the daily and socio-historical context of African-Americans living in the inner city. Collaboration among families, health care providers, policy makers, researchers, and public health advocates to minimize the existing childhood asthma disparity, and improve the health of African-American children with asthma is indicated.