II 

109TH CONGRESS 

1ST SESSION S. 1489 

To amend the Public Health Service Act with regard to research on asthma, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 26, 2005 

Mrs. CLINTON (for herself and Mr. DEWINE) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL

To amend the Public Health Service Act with regard to 

research on asthma, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Family Asthma Act’’. 

5 SEC. 2. FINDINGS. 

6 Congress makes the following findings: 

7 (1) The number of people with asthma has 

8 more than doubled from 1985 to 2005. According to 

9 the Centers for Disease Control and Prevention, in 

10 2002, more than 20,000,000 Americans had been di-
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1 agnosed with asthma, and an estimated 6,000,000 

2 children were suffering from asthma. By 2020, asth3 ma is expected to strike 1 in 14 Americans and 1 

4 in 5 families. 

5 (2) According to the Centers for Disease Con6 trol and Prevention, in 2002, more than 4,000 

7 Americans died from asthma. The Asthma and Al8 lergy Foundation of America reports that in the 

9 United States, 14 individuals die of asthma every 

10 day. According to the Centers for Disease Control 

11 and Prevention’s National Center for Health Statis12 tics, mortality from asthma is higher among Afri13 can-Americans and women. 

14 (3) According to the Centers for Disease Con15 trol and Prevention, asthma accounts for nearly 

16 500,000 hospitalizations each year. More than 

17 1,900,000 people are treated for asthma attacks in 

18 hospital emergency departments each year. 

19 (4) The Morbidity and Mortality Weekly Report 

20 notes that from 1980 to 1999, the number of physi21 cian office visits increased from 5,900,000 to 

22 10,800,000. There were higher rates of physician of23 fice visits for African-Americans, females, and chil24 dren. 
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1 (5) According to the National Heart Lung and 

2 Blood Institute at the National Institutes of Health, 

3 the annual cost of asthma to the United States is 

4 approximately $16,100,000,000. 

5 (6) The Department of Education states that 

6 asthma is the most commonly cited reason for school 

7 absences. According to the Centers for Disease Con8 trol and Prevention, in 2002, more than 14,000,000 

9 school days and 11,800,00 work days were missed as 

10 a result of asthma. 

11 (7) Asthma episodes can be triggered by both 

12 outdoor air pollution and indoor air pollution, in13 cluding pollutants such as cigarette smoke and com14 bustion by-productions. Asthma episodes can also be 

15 triggered by indoor allergens such as animal dander 

16 and outdoor allergens such as pollen and molds. 

17 (8) Public health interventions and medical care 

18 in accordance with existing guidelines have been 

19 proven effective in the treatment and management 

20 of asthma. Better asthma management could reduce 

21 the numbers of emergency department visits and 

22 hospitalizations due to asthma. Studies published in 

23 medical journals have shown that asthma care from 

24 specialists results in improved asthma outcomes at a 

25 lower cost. 
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1 (9) The alarming rise in the prevalence of asth2 ma, its adverse effects on school attendance and pro3 ductivity, its costs for hospitalizations and emer4 gency room visits, argue for a more vigorous Federal 

5 leadership role, including increasing awareness of 

6 asthma as a chronic illness, its symptoms, the role 

7 of both indoor and outdoor environmental factors 

8 that exacerbate the disease, and other factors that 

9 affect its exacerbations and severity. The goals of 

10 the government and its partners in the nonprofit 

11 and private sectors should include reducing the num12 ber and severity of asthma attacks, its financial bur13 den, and the health disparities associated with asth14 ma. 

15 SEC. 3. FAMILY ASTHMA CLINICAL AND ENVIRONMENTAL 

16 HEALTH RESEARCH GRANTS. 

17 Part P of title III of the Public Health Service Act 

18 (42 U.S.C. 280g et seq.) is amended by adding at the end 

19 the following: 

20 ‘‘SEC. 399O. FAMILY ASTHMA CLINICAL AND ENVIRON21 MENTAL HEALTH RESEARCH GRANT PRO22 GRAM. 

23 ‘‘(a) PURPOSES.—The purposes of this section are to 

24 provide authority to award grants to eligible entities serv25 ing a medically underserved population (as defined in sec-
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1 tion 330(b)(3)) for the conduct of pilot projects to prevent 

2 and control asthma symptoms and to reduce asthma at3 tacks in families containing individuals with asthma 

4 through activities which may include— 

5 ‘‘(1) researching and developing novel interven6 tions to reduce the burden of asthma, improve dis7 ease control, assist with the management of asthma 

8 exacerbations by patients and their families, and 

9 prevent asthma exacerbations; 

10 ‘‘(2) utilizing the electronic medical record, tele11 health, and other novel electronic communications to 

12 prevent acute asthma attacks; 

13 ‘‘(3) facilitating communication of intervention 

14 and prevention information to individuals with asth15 ma and their families and caregivers; 

16 ‘‘(4) expanding the understanding of environ17 mental and other factors that cause and contribute 

18 to the burden of asthma; 

19 ‘‘(5) collecting and analyzing data in order to 

20 determine the incidence, prevalence, and severity of 

21 asthma and associated risk factors; and 

22 ‘‘(6) expanding data collection of research into 

23 the genetic susceptibility to asthma. 

24 ‘‘(b) AUTHORITY TO MAKE GRANTS.— 
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1 ‘‘(1) IN GENERAL.—The Secretary, acting 

2 through the Director of the National Institutes of 

3 Health, shall award grants to eligible entities to 

4 carry out pilot projects consistent with the activities 

5 described in subsection (a). 

6 ‘‘(2) AWARDING OF GRANTS.—In awarding the 

7 grants under paragraph (1), the Secretary shall— 

8 ‘‘(A) give priority to entities that serve a 

9 medically underserved population; and 

10 ‘‘(B) give consideration to an adequate 

11 rural-urban distribution, so as to gain better in12 formation about asthma at the national level. 

13 ‘‘(3) COORDINATION OF AGENCIES.—The Na14 tional Institute of Environmental Health Sciences 

15 (which shall be the lead agency for purposes of ac16 tivities carried out under this section), in coordina17 tion with the National Heart, Lung, and Blood In18 stitute, the National Institute of Allergy and Infec19 tious Diseases, and the National Institute of Child 

20 Health and Human Development, shall administer 

21 grants to be utilized by entities performing research 

22 of the type described in subsection (a). Such Insti23 tutes shall coordinate in writing a Request for Appli24 cations, reviewing applications, and providing admin-
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1 istrative oversight for the program carried out under 

2 this section. 

3 ‘‘(c) ELIGIBILITY.—To be eligible to receive a grant 

4 under subsection (b), an entity shall be— 

5 ‘‘(1) a hospital, including children’s hospitals; 

6 ‘‘(2) a community health center; 

7 ‘‘(3) a medical school; 

8 ‘‘(4) a nonprofit institution; or 

9 ‘‘(5) another entity, as designated by the Sec10 retary. 

11 ‘‘(d) APPLICATION.— 

12 ‘‘(1) IN GENERAL.—An eligible entity shall sub13 mit an application to the Director of the National 

14 Institutes of Health for a grant under this section 

15 at such time, in such manner, and accompanied by 

16 such information as such Director may require. 

17 ‘‘(2) REQUIRED INFORMATION.—An application 

18 submitted under this subsection shall, to the extent 

19 practicable— 

20 ‘‘(A) include information demonstrating 

21 the prevalence of chronic asthma among the 

22 population to be served by the applicant on at 

23 least a State level basis and where practicable, 

24 in areas and localities within the State; 
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1 ‘‘(B) provide assurance that the applicant 

2 will establish consistent communication with pa3 tients using the Internet or telephone for the 

4 prompt transmission of patient information re5 lated to symptoms and conditions, such as peak 

6 flow meter measurements; 

7 ‘‘(C) provide assurance that enrollees will 

8 have baseline and ongoing medical data col9 lected, including data related to pulmonary 

10 function and skin or in vitro testing for sen11 sitization to allergies; 

12 ‘‘(D) propose novel approaches to studying 

13 the gene-environment interaction of the patients 

14 and have the capacity to engage in such data 

15 collection, or partner with an institution with 

16 such a capacity; 

17 ‘‘(E) contain assurances that the applicant 

18 will communicate in a manner designed to pre19 serve patient confidentiality, with at least 1 of 

20 the Asthma Clinical Centers of the National In21 stitutes of Health; and 

22 ‘‘(F) provide assurances that the entity 

23 can effectively coordinate care between physi24 cians, including asthma specialists, nurses, al25 lied health professionals, community health 
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1 workers, nonprofit organizations, and the other 

2 entities responsible for implementing the pilot 

3 project involved. 

4 ‘‘(3) COLLABORATION WITH LOCAL INSTITU5 TIONS.—An eligible entity under this section is en6 couraged to— 

7 ‘‘(A) collaborate with 1 or more Head 

8 Start programs to identify children and families 

9 with asthma within the geographic area of the 

10 applicant; 

11 ‘‘(B) collaborate with local school districts 

12 to recruit children with physician-diagnosed 

13 asthma; and 

14 ‘‘(C) partner with local, community-based 

15 nonprofit organizations to identify children and 

16 families with asthma within the geographic area 

17 of the applicant. 

18 ‘‘(e) USE OF FUNDS.— 

19 ‘‘(1) IN GENERAL.—An eligible entity shall use 

20 amounts received under a grant under this section to 

21 carry out the purposes described in subsection (a), 

22 including— 

23 ‘‘(A) conducting an assessment of the pa24 tients served to determine possible contributors 

25 to asthma exacerbations in the indoor and out-
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1 door environments, including exposure to diesel 

2 and other particles, ozone and other gases, gas3 eous pollutants and allergens, mold, and other 

4 indoor pollutants; 

5 ‘‘(B) implementing interventions regarding 

6 indoor and outdoor environments to reduce the 

7 severity and persistence of asthma; 

8 ‘‘(C) developing and maintaining question9 naires completed by the patients, or the parents 

10 or guardians of the patients, regarding their re11 spective occupations and personal exposure his12 tory, in order to increase the understanding of 

13 factors that contribute to asthma prevalence; 

14 and 

15 ‘‘(D) conducting other research as des16 ignated by the Director of the National Insti17 tutes of Health, particularly in areas that will 

18 advance knowledge of the factors that con19 tribute to asthma. 

20 ‘‘(2) RESEARCH OF SIGNIFICANT INTEREST.—

21 An eligible entity is encouraged to conduct research 

22 under this section on the interactions between envi23 ronmental exposures and genetic susceptibilities that 

24 contribute to the development or exacerbation of 

25 asthma. 
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1 ‘‘(f) PROTECTION OF INFORMATION.—The Secretary 

2 shall ensure the protections of individual health privacy 

3 under this section consistent with the regulations promul4 gated under section 264(c) of the Health Insurance Port5 ability and Accountability Act of 1996. 

6 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

7 are authorized to be appropriated $10,000,000 for each 

8 of fiscal years 2006 through 2010 to carry out this sec9 tion.’’. 

10 SEC. 4. NATIONAL ASTHMA EDUCATION AND PREVENTION 

11 PROGRAM OF THE NATIONAL HEART, LUNG, 

12 AND BLOOD INSTITUTE. 

13 Part C of title IV of the Public Health Service Act 

14 (42 U.S.C. 285 et seq.) is amended by inserting after sec15 tion 424B the following: 

16 ‘‘SEC. 424C. EXPANSION OF THE NATIONAL ASTHMA EDU17 CATION AND PREVENTION PROGRAM. 

18 ‘‘(a) DEVELOPMENT OF A NATIONAL ASTHMA AC19 TION PLAN.— 

20 ‘‘(1) IN GENERAL.—In addition to any other 

21 authorization of appropriation available to the Na22 tional Heart, Lung, and Blood Institute for the pur23 pose of carrying out the National Asthma Education 

24 and Prevention Program (referred to in this section 

25 as the ‘Program’), there is authorized to be appro-
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1 priated to such Institute $1,000,000 for each of fis2 cal years 2006 through 2010 to develop a National 

3 Asthma Action Plan. 

4 ‘‘(2) USE OF APPROPRIATIONS.—The amount 

5 appropriated under paragraph (1) shall be used to 

6 fund the report by the Program described under 

7 subsection (b). 

8 ‘‘(b) REPORT TO CONGRESS.— 

9 ‘‘(1) IN GENERAL.—Not later than 2 years 

10 after the date of enactment of the Family Asthma 

11 Act, the Program shall, in consultation with patient 

12 groups, nonprofit organizations, medical societies, 

13 and other relevant governmental and nongovern14 mental entities that participate in the Program, sub15 mit to Congress a report that— 

16 ‘‘(A) catalogs, with respect to asthma pre17 vention, management, and surveillance— 

18 ‘‘(i) the activities of the Federal Gov19 ernment, including an assessment of the 

20 progress of the Federal Government and 

21 States, with respect to achieving the goals 

22 of the Healthy People 2010 initiative; and 

23 ‘‘(ii) the activities of other entities 

24 that participate in the Program, including 
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1 nonprofit organizations, patient advocacy 

2 groups, and medical societies; and 

3 ‘‘(B) makes recommendations for the fu4 ture direction of asthma activities, in consulta5 tion with researchers from the National Insti6 tutes of Health and other member bodies of the 

7 National Asthma Education and Prevention 

8 Program who are qualified to review and ana9 lyze data and evaluate interventions, includ10 ing— 

11 ‘‘(i) how the Federal Government may 

12 improve its response to asthma; 

13 ‘‘(ii) how the Federal Government 

14 may continue, expand, and improve its pri15 vate-public partnerships with respect to 

16 asthma; 

17 ‘‘(iii) steps that may be taken to re18 duce the— 

19 ‘‘(I) morbidity, mortality, and 

20 overall prevalence of asthma; 

21 ‘‘(II) financial burden of asthma 

22 on society; 

23 ‘‘(III) burden of asthma on dis24 proportionately affected areas, par25 ticularly those in medically under-
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1 served populations (as defined in sec2 tion 330(b)(3)); and 

3 ‘‘(IV) burden of asthma as a 

4 chronic disease; 

5 ‘‘(iv) identify programs that have 

6 achieved the steps described under clause 

7 (iii), and steps that may be taken to ex8 pand such programs to benefit larger pop9 ulations; and 

10 ‘‘(v) recommendations for future re11 search and interventions. 

12 ‘‘(2) UPDATES TO CONGRESS.— 

13 ‘‘(A) CONGRESSIONAL REQUEST.—During 

14 the 5-year period following the submission of 

15 the report under paragraph (1), the Program 

16 shall submit updates and revisions of the report 

17 upon the request of Congress. 

18 ‘‘(B) FIVE-YEAR REEVALUATION.—At the 

19 end of the 5-year period following the submis20 sion of the report under paragraph (1), the 

21 Program shall evaluate its analyses and rec22 ommendations under such report and determine 

23 whether a new report to Congress is necessary, 

24 and make appropriate recommendations to Con25 gress.’’. 
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1 SEC. 5. ASTHMA–RELATED ACTIVITIES OF THE CENTERS 

2 FOR DISEASE CONTROL AND PREVENTION. 

3 Section 317I of the Public Health Service Act (42 

4 U.S.C. 247b–10) is amended to read as follows: 

5 ‘‘SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 

6 FOR DISEASE CONTROL AND PREVENTION. 

7 ‘‘(a) PROGRAM FOR PROVIDING INFORMATION AND

8 EDUCATION TO THE PUBLIC.—The Secretary, acting 

9 through the Director of the Centers for Disease Control 

10 and Prevention, shall collaborate with State and local 

11 health departments to conduct activities, including the 

12 provision of information and education to the public re13 garding asthma including— 

14 ‘‘(1) deterring the harmful consequences of un15 controlled asthma; and 

16 ‘‘(2) disseminating health education and infor17 mation regarding prevention of asthma episodes and 

18 strategies for managing asthma. 

19 ‘‘(b) COMPILATION OF DATA.—The Secretary, acting 

20 through the Director of the Centers for Disease Control 

21 and Prevention, shall, in cooperation with State and local 

22 public health officials— 

23 ‘‘(1) conduct asthma surveillance activities to 

24 collect data on the prevalence and severity of asth25 ma, the effectiveness of public health asthma inter-
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1 ventions, and the quality of asthma management, in2 cluding— 

3 ‘‘(A) collection of sample household data 

4 on the local burden of asthma; and 

5 ‘‘(B) surveillance of sample health care fa6 cilities; and 

7 ‘‘(2) compile and annually publish data regard8 ing— 

9 ‘‘(A) the prevalence and incidence of chil10 dren suffering with asthma in each State and, 

11 to the extent practicable, at the county level; 

12 ‘‘(B) the childhood mortality rate associ13 ated with asthma nationally and in each State 

14 and, to the extent practicable, at the county 

15 level; 

16 ‘‘(C) the number of hospital admissions 

17 and emergency department visits by children 

18 associated with asthma nationally and in each 

19 State and, to the extent practicable, at the 

20 county level; and 

21 ‘‘(D) the prevalence and incidence of adult 

22 asthma, the adult mortality rate, and the num23 ber of hospital admissions and emergency de24 partment visits by adults associated with asth-
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1 ma nationally and in each State and, to the ex2 tent practicable, at the county level. 

3 ‘‘(c) COORDINATION OF DATA COLLECTION.—The 

4 Director of the Centers for Disease Control and Preven5 tion, in conjunction with State and local health depart6 ments, shall coordinate data collection activities under 

7 subsection (b)(2) so as to maximize comparability of re8 sults. 

9 ‘‘(d) COLLABORATION.— 

10 ‘‘(1) IN GENERAL.—The Centers for Disease 

11 Control and Prevention are encouraged to collabo12 rate with national, State, and local nonprofit organi13 zations to provide information and education about 

14 asthma, and to strengthen such collaborations when 

15 possible. 

16 ‘‘(2) SPECIFIC ACTIVITIES.—The Division of 

17 Adolescent and School Health is encouraged to ex18 pand its activities with non-Federal partners, espe19 cially State-level entities. 

20 ‘‘(e) ADDITIONAL FUNDING.—In addition to any 

21 other authorization of appropriations that is available to 

22 the Centers for Disease Control and Prevention for the 

23 purpose of carrying out this section, there is authorized 

24 to be appropriated to such Centers $5,000,000 for each 
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1 of fiscal years 2006 through 2010 for the purpose of car2 rying out this section.’’. 

3 SEC. 6. FELLOWSHIP TRAINING TO IMPROVE ASTHMA 

4 CARE. 

5 Part C of title IV of the Public Health Service Act 

6 (42 U.S.C. 285 et seq.) is amended by inserting after sec7 tion 463B the following: 

8 ‘‘SEC. 463C. FELLOWSHIP TRAINING TO IMPROVE ASTHMA 

9 CARE. 

10 ‘‘(a) FELLOWSHIP TRAINING PROGRAM.— 

11 ‘‘(1) IN GENERAL.—The Director of the Insti12 tute shall establish individual and institutional train13 ing grants for education and training of healthcare 

14 providers, including asthma specialists, researchers, 

15 and educators on the role of environmental factors 

16 in the development and prevention of asthma and re17 current asthma attacks, as well as methods to re18 duce such factors, including knowledge of treatment 

19 as recommended by the National Asthma Education 

20 and Prevention Program guidelines. 

21 ‘‘(2) NAME OF TRAINING GRANTS.—The train22 ing grants awarded under paragraph (1) shall be 

23 named in honor of Dr. Irving J. Selikoff for his 

24 leadership in inaugurating the environmental medi25 cine movement. 
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1 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated $2,000,000 for each of 

3 fiscal years 2005 through 2010 to carry out this section.’’.

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