Lessons Learned for the Study of Childhood Asthma from the Centers for Children's Environmental Health and Disease Prevention Research Peyton A. Eggleston,1 Greg Diette,1 Michael Lipsett,2 Toby Lewis,3 Ira Tager,4 Rob McConnell,5 Elizabeth Chrischilles,6 Bruce Lanphear,7 Rachel Miller,8 and Jerry Krishnan1 1Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; 2University of California at San Francisco School of Medicine, San Francisco, California, USA; 3University of Michigan School of Medicine, Ann Arbor, Michigan, USA; 4University of California at Berkeley School of Public Health, Berkeley, California, USA; 5University of Southern California School of Medicine, Los Angeles, California, USA; 6University of Iowa College of Public Health, Ames, Iowa, USA; 7University of Cincinnati School of Medicine, Cincinnati, Ohio, USA; 8Columbia University College of Physicians and Surgeons, New York, New York, USA Abstract The National Children's Study will address, among other illnesses, the environmental causes of both incident asthma and exacerbations of asthma in children. Seven of the Centers for Children's Environmental Health and Disease Prevention Research (Children's Centers) , funded by the National Institute of Environmental Health Sciences and the U.S. Environmental Protection Agency, conducted studies relating to asthma. The design of these studies was diverse and included cohorts, longitudinal studies of older children, and intervention trials involving asthmatic children. In addition to the general lessons provided regarding the conduct of clinical studies in both urban and rural populations, these studies provide important lessons regarding the successful conduct of community research addressing asthma. They demonstrate that it is necessary and feasible to conduct repeated evaluation of environmental exposures in the home to address environmental exposures relevant to asthma. The time and staff required were usually underestimated by the investigators, but through resourceful efforts, the studies were completed with a remarkably high completion rate. The definition of asthma and assessment of disease severity proved to be complex and required a combination of questionnaires, pulmonary function tests, and biologic samples for markers of immune response and disease activity. The definition of asthma was particularly problematic in younger children, who may exhibit typical asthma symptoms sporadically with respiratory infections without developing chronic asthma. Medications confounded the definition of asthma disease activity, and must be repeatedly and systematically estimated. Despite these many challenges, the Children's Centers successfully conducted long-term studies of asthma. Key words: asthma, children, Children's Centers, environmental health, National Children's Study, pregnancy. Environ Health Perspect 113: 1430-1436 (2005) . doi:10.1289/ehp.7671 available via http://dx.doi.org/ [Online 24 June 2005] This article is part of the mini-monograph "Lessons Learned from the National Institute of Environmental Health Sciences/U.S. Environmental Protection Agency Centers for Children's Environmental Health and Disease Prevention Research for the National Children's Study." Address correspondence to P.A. Eggleston, Department of Pediatrics, CMSC 1102, Johns Hopkins Hospital, 600 North Wolfe St., Baltimore, MD 21287 USA. Telephone: (410) 955-5883. Fax: (410) 955-0229. E-mail: pegglest@jhmi.edu We acknowledge the support of the National Children's Study in the development of the articles in this mini-monograph. We also gratefully acknowledge the outstanding, dedicated staff and co-investigators at each of the Children's Centers, the community members who helped shape the studies, and the many families and children who participated. This work was supported in part by the National Institute of Environmental Health Sciences (ES009606, ES09589, ES009605, ES009581, ES09607, ES011261, ES009600) and the U.S. Environmental Protection Agency (R826724, R826710, R826709, R826708, R826711, R829389, R827027) . The authors declare they have no competing financial interests. Received 12 October 2004 ; accepted 23 June 2005. The full version of this article is available for free in HTML or PDF formats. |