The Role of Epigenetics in Inner City Asthma

Asthma is a complex, heritable disease that affects more than 11.2% of the U.S. population,
which represents approximately 9 million children and 23 million adults. It is thought that
asthma may be caused by the interaction of multiple genetic factors, such as whether a
parent or sibling has asthma, and environmental factors, such as living in an inner city.
Studying DNA from people who have asthma and those who do not have asthma may help us better
understand the importance of those genes and how they are involved in asthma severity and
response to treatment.

Inclusion Criteria:

-Black inner city children with or without asthma.

Control Subjects:

-Black males and females ages 6 to 12 years, inclusive, at Recruitment;

- Who do not have a diagnosis of asthma by a physician;

- Who do not have a diagnosis of atopic dermatitis by a physician;

- Who have an FEV1 ≥ 85% predicted;

- With no positive prick skin-tests to any of a panel of indoor and outdoor allergens;

- With no current asthma as determined by the Respiratory Health Questionnaire (RHQ);

- With no current chronic rhinitis/sinusitis as determined by the RHQ;

- Whose primary place of residence is in one of the pre-selected recruitment census
tracts that contains at least 15% of households below the U.S. government poverty
level;

- Who are able to perform spirometry (according to the Epigenetics Manual of Operations
criteria);

- Whose parent or legal guardian is willing to sign the written Informed Consent prior
to initiation of any study procedure;

- Who are willing to sign the assent form, if age appropriate.

Asthmatic Participants:

- Black males and females ages 6 to 12 years, inclusive, at Recruitment;

- Who have a diagnosis of asthma by a physician;

- Who are currently receiving long-term asthma control therapy and either have symptoms
consistent with persistent asthma (criterion 3a) or have evidence of uncontrolled
disease (criterion 3b); or who are not currently receiving long-term asthma control
therapy and have symptoms consistent with persistent asthma (criterion 3a) and have
evidence of uncontrolled disease (criterion 3b);

- Evidence of persistent asthma as defined by the National Asthma Education and
Prevention Program (NAEPP) Expert Panel Report 3: Guidelines for the Diagnosis and
Management of Asthma (NHLBI 2007), which includes at least one of the following
criteria:

- Asthma symptoms 3 or more days per week during the last two weeks;

- Sleep disturbed due to asthma at least 3 times in the past month;

- Albuterol use (Metered Dose Inhaler or nebulizer) for quick relief at least 8
times in the past two weeks, not including use as a preventive for exercise.

- Evidence of uncontrolled disease as defined by at least one of the following
criteria:

- Two or more asthma-related unscheduled visits to an emergency department (ED),
urgent care (UC), or clinic in the previous 6 months;

- One or more asthma-related overnight hospitalizations in the previous 6 months.

- With physiologic evidence of reversible airflow obstruction or airway
hyperresponsiveness:

- FEV1 < 85% predicted or FEV1/FVC ratio < 0.85 with a bronchodilator response ≥
10% FEV1;

- Positive methacholine challenge (PC20 < 8 mg/ml) for those individuals who have
either:

- Normal airflow (FEV1 ≥ 85% predicted and FEV1/FVC ratio ≥ 0.85);

- Airflow obstruction with a bronchodilator response < 10% FEV1.

- With a positive prick skin-test to at least one of the panel of indoor aeroallergens
(i.e. dust mite, cockroach, mold, cat, dog, rat, mouse);

- Whose primary place of residence is in one of the pre-selected recruitment census
tracts that contains at least 15% of households below the U.S. government poverty
level;

- Who are able to perform spirometry;

- Whose parent or legal guardian is willing to sign the written Informed Consent prior
to initiation of any study procedure;

- Who are willing to sign the assent form, if age appropriate.

Exclusion Criteria:

- Who have a sibling already enrolled in the study (i.e. one individual from each
family is permitted to participate [case or control], though samples will be
collected from parents and siblings);

- Who have received systemic prednisone (or equivalent) during the 30 days prior to the
screening visit;

- Who have received systemic prednisone (or equivalent) for > 15 days out of the past
60 days prior to the screening visit;

- Who are pregnant or lactating;

- With acute sinusitis, chest infection, or ear infection that required treatment with
antibiotics within 30 days of the screening visit;

- Who are currently participating in another asthma-related pharmaceutical study or
intervention study or who have participated in another asthma-related pharmaceutical
study or intervention study in the month prior to the screening visit;

- Who are currently receiving or have received hyposensitization therapy to any
allergen in the past year prior to the screening visit;

- Who have the presence of the following chronic medical conditions: cardiac condition
requiring daily medication, seizure disorder requiring daily medication, obvious
severe mental retardation that prohibits the subject from answering questions or
following instructions, cystic fibrosis, immune deficiency, diabetes, allergic
bronchopulmonary aspergillosis, or any other chronic medical condition at the
discretion of the study physician. (Exceptions: Attention deficit disorder with or
without hyperactivity; iron deficiency anemia; gastroesophageal reflux disease;
otitis media (ear infections); sinusitis; allergic rhinitis);

- Who do not speak and understand English;

- Whose caretaker does not speak and understand English.