Adult Asthma: The Use of Novel Public Health Methods to Investigate the Prevalence of Environmental Risk Factors

Although the incidence of new cases of asthma has decreased in recent years, the prevalence of asthma morbidity continues to be a significant clinical and public health issue. The measures of morbidity include the need for urgent medical care and high-dose asthma medications due to uncontrolled asthma symptoms. However, the risk factors for uncontrolled asthma symptoms are poorly defined, especially for the adult asthmatic. Much interest in the host-environment interaction has evolved in response to the greater morbidity observed in adult asthmatics. Thus, the need to identify risk factors is greater than ever. An underlying problem is that surveillance for asthma does not exist at the local or state level. Here we address the concept of environmental health surveillance by demonstrating the utility of local asthma hospitalization data to estimate the burden of asthma morbidity in hopes of identifying environmental risk factors. We examine this burden within 2 geographic settings: 1. a selected urban-rural setting in Pennsylvania and 2. within the 89 zip codes in Allegheny County, Pennsylvania. We also demonstrate that such hospitalization records are a rich source for data needed to generate hypotheses with respect to the prevalence of environmental risk factors and chronic disease morbidity. Lastly, we demonstrate the use of a non-invasive biomarker (i.e. antibodies specific for atypical respiratory pathogens) to assess the risk of exposure to a biological environmental agent to adult asthma morbidity. Given the poor understanding of risk factors for adult asthma prevalence and morbidity, this research is both relevant and important in addressing environmental public health disparities