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High local incidence of serious asthma target of study

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By Allison M. Heinrichs
Sunday, Jan. 4, 2009

Dr. Fernando Holguin has fewer than five years to figure out why children in Western Pennsylvania are nearly 400 percent more likely than the national average to need emergency care for asthma -- and then solve the problem.

He isn't daunted. And he intends to catapult what he learns into a decades-long program tracking Pittsburgh's asthmatic children into adulthood.

"It's a very ambitious project," he said. "But if we can follow these kids long-term, we'll find how different environmental stressors effect their health."

Children's Hospital of Pittsburgh recruited Holguin to lead its new Pediatric Environmental Medicine Center. Such centers are an emerging trend in health care, especially with the implementation of The National Children's Health Study in 2007, a federal program that plans to follow 100,000 children into adulthood to learn how environment impacts health.

Prior to the appointment, Holguin was a Centers for Disease Control and Prevention pulmonologist studying the health of people living along the Mexico/U.S. border and director of Emory University's Asthma Translational Research Program. He spent time studying the effects of air pollution on people in his native Mexico City.

The center at Children's is paid for with a $5 million grant from The Heinz Endowments that will be distributed over five years. The Endowments set a goal of incorporating environmental medicine -- which addresses links between pollution and disease -- into routine health care.

Holguin and his seven-member team of physicians, scientists, epidemiologists and community liaisons are selecting at least two Monongahela Valley school districts to begin the center's efforts. The Mon Valley consistently has high air pollution levels. An air monitor there last spring earned Pittsburgh the top spot on the American Lung Association's annual ranking of sootiest cities.

According to Children's, use of emergency services by children with asthma in Western Pennsylvania is 300 to 400 percent above the national average and asthma hospitalization rates are two to three times the national average.

Shari Campbell was in Children's emergency department Friday with her daughter, Casey, 6, who was diagnosed with asthma at age 2.

"Anytime she has a cold, it triggers an asthma attack and we're up in the ER," said Campbell, of Liberty. "But it's also environmental. People smoking will cause Casey to start wheezing."

Campbell said she hopes the center will help teach people in the Mon Valley to stop smoking around children.

Before research starts, the Children's team plans to gain the communities' trust.

"When you are doing community work, the community has to feel you are a part of them," said Michele Tedder, the center's community health coordinator, "that you are not just coming to deliver your goods and tell them what they need, but that you have an appreciation, a sensitivity and a passion for what they perceive as their true needs."

Tedder, a resident of White Oak who grew up in North Braddock, attends meetings of established community groups in the Mon Valley, such as the Pittsburgh Association for the Education of Young Children and a local branch of the State Health Improvement Plan. Soon the center will organize workshops about asthma prevention, screening and care, and teach community leaders about asthma control.

Eventually, the researchers plan to fit some children's backpacks with air pollution monitors to learn the quality of air they breathe. Genetic testing could show whether children have a predisposition to a certain type of asthma. A mobile van outfitted as a doctor's office will help collect clinical data, such as a child's height, weight and lung capacity.

But collecting data isn't the biggest goal.

"Our main focus is to improve the health of these children by educating them, their parents and others in their community," Holguin said. "And, in so doing, we hope to learn more about what makes asthmatic kids healthier."

George Leikauf, a professor of environmental and occupational health at the University of Pittsburgh Graduate School of Public Health, said Children's Pediatric Environmental Medicine Center will complement asthma research at Pitt.

"What we're looking for from Dr. Holguin's program is information from the community," he said. "We've been doing a lot of work at the bedside but we'd like to move out into the community, so I think it's fantastic that the center will be doing that. It will be a real great addition to the programs we've got going now."



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