Between 20 and 30 percent of children living near Comer Children’s Hospital on the South Side have asthma, which is double or triple the state average of 10 percent.
“Exposure to allergens—such as cockroaches, rat droppings, mold in low-income housing, and urban outdoor pollution—can exacerbate asthma and increase morbidity in children,” said Dr. Sharmilee Nyenhuis, associate professor of pediatrics and medicine. Allergy and Immunology. “Low birth weight can also lead to underdeveloped lungs, which increases the risk of asthma.”
Although treatment of asthma has primarily focused on medications, Nyenhuis believes there may be a better option to prevent the progression of the disease — regular physical activity. “There is good data to suggest that exercise can improve asthma control and lung function and reduce asthma exacerbations, sometimes as much as certain medications,” Nyenhuis said.
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In an ongoing trial, Nyenhuis is investigating whether exercise can improve asthma in black women, who have the lowest rates of regular physical activity. Less than 15% met the recommended amount of physical activity. Compared with white women, they have higher rates of asthma exacerbations and health care use, worse lung function, worse asthma-related quality of life, and higher crude asthma mortality rates.
Previous research on how physical activity can help control asthma has overlooked black women, something Nyenhuis aimed to correct with the current trial. She hopes to expand the study to include black girls with asthma and their mothers. Nyenhuis has applied for funding to conduct a randomized companion trial of an exercise intervention among black mothers with asthma and their daughters aged 8 to 12 years.
“Mothers of school-age girls can have a positive impact on their daughters’ physical activity levels,” said Nyenhuis, who is also associate director for diversity, equity and inclusion in the Department of Pediatrics. “We included mothers in this new study so they could establish exercise habits and support their daughters.”
Black girls have higher rates of uncontrolled asthma, asthma mortality, asthma-related emergency room visits, and hospitalizations than white girls. Black boys also have higher rates of asthma than other groups, but tend to be more active than black girls and therefore less likely to benefit from exercise interventions, Nyenhuis said.
“If we can help girls develop lifelong exercise habits, they may have better control of their asthma as adults and recognize other benefits of exercise, such as reducing obesity and metabolic diseases such as diabetes and cardiovascular disease,” Nyenhuis said.
She plans to conduct focus groups to explore the types of sports that appeal to both girls and their mothers. “Our primary goal is to improve asthma outcomes and reduce health disparities for Black girls and their mothers,” she said.
Promising results for asthma treatment in black women
Nyenhuis and colleagues at the University of Illinois at Chicago are conducting this randomized trial centered on a walking intervention. The study, funded by the National Institute on Minority Health and Health Disparities, will randomly assign 224 women to participate in an intervention called Physical Activity in Minority Women with Asthma (ACTION) or receive only Asthma Education Group.
During the 24-week study, members of the intervention group received asthma education sessions led by black coaches. Each woman has a Fitbit to measure her steps, goes on monthly group walks, and receives customized text messages to provide support and step goals.
“We are using behavioral technology to help participants increase step count and exercise intensity,” Nyenhuis said. The control group received asthma education sessions, asthma advice, and additional asthma education via text message.
Results from a pilot study of 53 women randomized to receive the ACTION intervention or augmented usual care showed that women who received the intervention had asthma control and clinically significant improvements in quality of life at 24 weeks compared with the control group .
In addition to assessing changes in lung function and asthma control among study participants, Nyenhuis and her colleagues are studying how the women overcome environmental and social barriers that prevent them from achieving their walking goals.
“Women and girls living on Chicago’s South Side face significant challenges to exercise, such as poor outdoor air quality due to heavy industry and construction, as well as violence or other dangers on neighborhood streets,” Nyenhuis said. The study directly addresses these challenges. Social determinants of health disadvantage.
For example, to mitigate the effects of air pollution, researchers will send alerts to participants on days when air quality is particularly poor or when outdoor temperatures are too hot or cold to safely walk. On those days, women receive guidance on where to achieve their step goals indoors, such as walking in hallways or climbing stairs.
Some participants said they were afraid to walk in their neighborhoods because of gang violence and other threats. In group sessions, participants discuss ways to make them feel safer, such as walking at specific times of day, avoiding certain areas, or walking with a partner. “We rely on the collective intelligence of this group of women to develop strategies that allow them to continue exercising despite the challenges they face,” Nyenhuis said.
Overcoming adverse social determinants of health in asthma management is a theme of Nyenhuis’ research. “Despite the complexity of clinical practice, it is critical to address the unmet social needs of people with asthma,” she said. “We need to screen children for risks such as food and housing insecurity, exposure to violence and stress, which can greatly impact the development and progression of asthma.” For example, caregivers of children who come to Comer’s outpatient clinics receive a A questionnaire asked about gaps in patients’ social needs. If food insecurity is found, the family will be referred to resources such as the Comer Food Pantry.
Young asthmatics treated at Comer Children’s Hospital may see allergy and pulmonary pediatric specialists as well as child life specialists and social workers. Clinicians may also refer patients to the Southside Pediatric Asthma Center (SSPAC), a multi-institutional initiative led by Comer Children’s Hospital and other medical institutions. Community health workers trained in asthma work with families of at-risk children and increase access to care.
“Community health workers will conduct home visits to identify which environmental factors may be contributing to uncontrolled asthma symptoms and provide resources to reduce exposure to allergens, such as cockroaches and mold,” said Nyenhuis, SSPAC clinical director. “They also provide asthma education, and connect patients to community resources related to asthma management.”
According to SSPAC family reports, days missed from school decreased by 73% and emergency room visits decreased by 52%. “We know that clinical community partnerships and resource referrals can alleviate existing inequities in low-income and minority children with asthma,” Nyenhuis said. “We want to do everything we can to give them a fighting chance to manage their asthma and live without their symptoms. ”