Asthma study, straight out of Dot, raises researcher eyebrows

Sometimes even Ph.Ds can use a little help from the neighborhood. Just ask Dr. Doug Brugge of Tufts University.

Next to his and his colleagues' names on a breakthrough article in the November issue of the Journal of Asthma are those of the Boston Urban Asthma Coalition's Acheson Bennett and Neal-Dra Osgood. Bennett is a parent leader who graduated from a training program Osgood runs at BUAC. Both Bennett and Osgood - and several others from BUAC - helped gather findings that have pointed in a new direction for asthma research.

"The community initiated the study and was involved in every aspect," said Brugge in a phone interview. "I think it emerges from my values, wanting to work in the community and address their problems."

Originally, Osgood's aim, as part of the coalition's Strengthening Voices Project, was simply to gather data on the neighborhood to help set priorities for BUAC and other groups that focus on the disease, which is diagnosed in over 14 percent of adults and children in Massachusetts. Dorchester has one of the highest hospitalization rates for the disease among children 5 to 14 years of age.

"We just wanted to know about asthma prevalence in Dorchester and what barriers there were for people to getting care for themselves and their children," said Osgood. "We called Doug and he was more than willing to help us."

But as Brugge and team combed through the numbers, they noticed a significant disparity between U.S. and foreign-born African-Americans that had never been recorded in a study before. Asthma prevalence was 30.2 percent in U.S. born African-American adults surveyed in the study, versus 11.1 percent for foreign-born African immigrants.

"I think that it suggests directions for more research that in my opinion are more important to pursue," said Brugge. "We have an idea why U.S. born folks have more asthma but we haven't proven what that is."

Other studies, including one led by Brugge in Chinatown, have shown disparities in asthma prevalence between foreign and U.S. born populations of Asians and Latinos, but this may be the first for African-Americans.

The prevailing hypothesis - at least in Brugge's opinion - is that exposure to a higher burden of infectious diseases in developing countries could alter an individual's immune system, thus creating a resistance to asthma.

But there are many competing theories, and Brugge's favorite rules none of them out. Other researchers have variously proposed that a higher exposure to sunlight, drinking raw milk, breathing in less pollution in rural areas, or ingesting certain intestinal parasites may contribute to a lesser prevalence of asthma in other countries.

And after an article on the study appeared in Tuesday's Boston Globe Brugge received a number of complaints from people who prefer to blame chemicals for the higher prevalence here in Dorchester, a claim he said his research does not rule out.

"I don't feel like you have to choose one or the other; asthma is a multi-factorial disease," said Brugge. "It includes generally a history of infectious disease but it also includes exposure to tobacco smoke, pollution, indoor pollution like molds and dust mites, just a whole range of things, even psycho-social stress. I don't think we can claim it's all one or another.

"The more practical outcome [of the study] I think is if you are trying to establish asthma prevalence in a population you really need to know how many are native and U.S. born. Not doing that is really going to obscure this hidden disparity."

To see the results of BUAC's survey, including some interesting recommendations for improving care locally that the group drew out of a related set of focus groups with parents of children with asthma, see their To Breath or Not to Breath report at buac.org/buac_docs.html.

For information about the Boston Public Health Commission's efforts to reduce asthma disparities in the city, including their nationally recognized Breathe Easy at Home program, go to bphc.org and choose "asthma."

2008