II 

111TH CONGRESS 

1ST SESSION S. 1760 

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

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 7, 2009 

Mr. LAUTENBERG (for himself and Mrs. GILLIBRAND) 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 The Congress makes the following findings: 

7 (1) The number of people with asthma more 

8 than doubled between 1980 and 1995. According to 

9 the Centers for Disease Control and Prevention, in 

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1 agnosed with asthma, including an estimated 

2 9,600,000 children. Asthma rates are highest among 

3 Puerto Rican populations. Rates were 140 percent 

4 greater among Puerto Rican children compared to 

5 non-Hispanic White children. Asthma strikes 1 in 13 

6 Americans. 

7 (2) According to the Centers for Disease Con8 trol and Prevention, in 2005 more than 3,800 Amer9 icans died from asthma. The rate of mortality from 

10 asthma is higher among African-Americans and 

11 women. 

12 (3) The Centers for Disease Control and Pre13 vention report that asthma accounted for more than 

14 440,000 hospitalizations and more than 1,600,000 

15 visits to hospital emergency departments in 2006. 

16 The rate for asthma-related emergency room visits is 

17 500 percent greater and hospitalization rates are 

18 300 percent higher for Blacks compared to Whites. 

19 (4) According to the National Heart, Lung, and 

20 Blood Institute of the National Institutes of Health, 

21 the annual cost of asthma to the United States is 

22 approximately $19,700,000,000. 

23 (5) According to the Centers for Disease Con24 trol and Prevention, almost 13,000,000 school days 


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1 and 10,000,000 work days are missed annually as a 

2 result of asthma. 

3 (6) Asthma episodes can be triggered by both 

4 outdoor air pollution and indoor air pollution, in5 cluding pollutants such as cigarette smoke and com6 bustion by-products. Asthma episodes can also be 

7 triggered by indoor allergens such as animal dander 

8 and outdoor allergens such as pollen and molds. 

9 (7) Public health interventions and medical care 

10 in accordance with existing guidelines have been 

11 proven effective in the treatment and management 

12 of asthma. Better asthma management could reduce 

13 the numbers of emergency department visits and 

14 hospitalizations due to asthma. Studies published in 

15 medical journals have shown that better asthma 

16 management results in improved asthma outcomes 

17 at a lower cost. 

18 (8) In 2005, the Centers for Disease Control 

19 and Prevention cited ‘‘the urgent need’’ for en20 hanced public health surveillance data regarding 

21 asthma, noting that the current system has led to a 

22 ‘‘patchwork of health effect measures’’. National 

23 data are needed to allow comparisons at smaller geo24 graphic levels, such as counties, and to better under25 stand the groups at risk. 


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1 (9) The alarming rise in the prevalence of asth2 ma, its adverse effect on school attendance and pro3 ductivity, and its cost 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, asthma’s finan13 cial burden, and the health disparities associated 

14 with asthma. 

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— 

19 (1) by redesignating the second and third sec20 tions 399R (added by Public Laws 110–373 and 

21 110–374, respectively) as sections 399S and 399T; 

22 and 

23 (2) by adding at the end the following: 


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1 ‘‘SEC. 399U. FAMILY ASTHMA CLINICAL AND ENVIRON2 MENTAL HEALTH RESEARCH GRANT PRO3 GRAM. 

4 ‘‘(a) PURPOSE.—The purpose of this section is to au5 thorize the National Institutes of Health to award grants 

6 to carry out pilot projects to prevent and control asthma 

7 symptoms and to reduce asthma attacks and improve pa8 tient self-management for individuals and in families con9 taining individuals with asthma including— 

10 ‘‘(1) utilizing electronic health records, tele11 health, and other novel electronic communications to 

12 prevent acute asthma attacks, and to improve asth13 ma surveillance activities as described under section 

14 317I(c); and 

15 ‘‘(2) expanding the understanding of environ16 mental and other factors that cause and contribute 

17 to the burden of asthma. 

18 ‘‘(b) GRANTS.— 

19 ‘‘(1) IN GENERAL.—The Secretary, acting 

20 through the Director of the National Institutes of 

21 Health, shall award grants to eligible entities to 

22 carry out pilot projects consistent with the activities 

23 described in subsection (a). 

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

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


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1 ‘‘(A) give priority to entities that serve dis2 proportionately impacted populations; and 

3 ‘‘(B) give consideration to an adequate na4 tional understanding of asthma prevalence, so 

5 as to gain better information about asthma at 

6 the national level. 

7 ‘‘(3) COORDINATION OF AGENCIES.—The Na8 tional Heart, Lung, and Blood Institute (which shall 

9 be the lead agency for purposes of activities carried 

10 out under this section), in coordination with the Na11 tional Institute of Environmental Health Sciences, 

12 the National Institute of Allergy and Infectious Dis13 eases, and the National Institute of Child Health 

14 and Human Development, shall administer grants to 

15 be utilized by entities performing research of the 

16 type described in subsection (a). Such institutes 

17 shall coordinate in writing a request for applications, 

18 reviewing applications, and providing administrative 

19 oversight for the program carried out under this sec20 tion. 

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

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

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

24 ‘‘(2) a community health center; 

25 ‘‘(3) a medical school; 


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1 ‘‘(4) a nonprofit institution; or 

2 ‘‘(5) another entity, as designated by the Sec3 retary. 

4 ‘‘(d) APPLICATION.— 

5 ‘‘(1) IN GENERAL.—An eligible entity shall sub6 mit an application to the Director of the National 

7 Institutes of Health for a grant under this section 

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

9 such information as such Director may require. 

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

11 submitted under this subsection shall, as is applica12 ble and practicable to the area and scope of the pilot 

13 project— 

14 ‘‘(A) include information demonstrating 

15 the prevalence of chronic asthma among the 

16 population to be served by the applicant on at 

17 least a State-level basis and where practicable, 

18 in areas and localities within the State; 

19 ‘‘(B) provide assurance that the applicant 

20 will establish consistent communication with pa21 tients, including using the Internet or telephone 

22 for the prompt transmission of patient informa23 tion related to symptoms and conditions, such 

24 as peak flowmeter measurements; 


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1 ‘‘(C) provide assurance that enrollees will 

2 have baseline and ongoing medical data col3 lected, including data related to pulmonary 

4 function and skin or in vitro testing for sen5 sitization to allergies; 

6 ‘‘(D) propose novel approaches to studying 

7 the gene-environment interaction of the patients 

8 and have the capacity to engage in such data 

9 collection, or partner with an institution with 

10 such a capacity; 

11 ‘‘(E) contain assurances that the applicant 

12 will communicate in a manner designed to pre13 serve patient confidentiality, with at least 1 of 

14 the asthma clinical centers of the National In15 stitutes of Health; and 

16 ‘‘(F) provide assurances that the applicant 

17 can effectively coordinate care between physi18 cians, including asthma specialists, nurses, al19 lied health professionals, community health 

20 workers, nonprofit organizations, and the other 

21 entities responsible for implementing the pilot 

22 project involved. 

23 ‘‘(3) COLLABORATION WITH LOCAL INSTITU24 TIONS.—An eligible entity receiving a grant under 

25 this section is encouraged to— 


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

2 Start programs to identify children and families 

3 with asthma within the geographic area of the 

4 applicant; 

5 ‘‘(B) collaborate with local school districts 

6 to recruit children with physician-diagnosed 

7 asthma; and 

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

9 nonprofit organizations to identify children and 

10 families with asthma within the geographic area 

11 of the entity. 

12 ‘‘(e) USE OF FUNDS.— 

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

14 amounts received under a grant under this section to 

15 carry out the purpose described in subsection (a), in16 cluding— 

17 ‘‘(A) conducting an assessment of the pa18 tients served to determine possible contributors 

19 to asthma exacerbations in the indoor and out20 door environments, including exposure to diesel 

21 and other particles, ozone and other gases, gas22 eous pollutants and allergens, mold, chemicals 

23 found in the home or workplace, and other in24 door pollutants; 


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1 ‘‘(B) implementing interventions regarding 

2 indoor and outdoor environments to reduce the 

3 severity and persistence of asthma; 

4 ‘‘(C) developing and maintaining question5 naires completed by the patients, or the parents 

6 or guardians of the patients, regarding their re7 spective occupations and personal exposure his8 tory, in order to increase the understanding of 

9 factors that contribute to asthma prevalence; 

10 and 

11 ‘‘(D) conducting other research as des12 ignated by the Director of the National Insti13 tutes of Health, particularly in areas that will 

14 advance knowledge of the factors that con15 tribute to asthma. 

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

17 An eligible entity receiving a grant under this sec18 tion is encouraged to conduct research under this 

19 section on the interactions between environmental 

20 exposures and genetic susceptibilities that contribute 

21 to the development or exacerbation of asthma. 

22 ‘‘(f) PROTECTION OF INFORMATION.—The Secretary 

23 shall ensure the implementation of protections of indi24 vidual health privacy under this section consistent with the 

25 regulations promulgated under section 264(c) of the 


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1 Health Insurance Portability and Accountability Act of 

2 1996. 

3 ‘‘(g) REPORT.—The Secretary shall submit a report 

4 to the Congress on the success of and the next steps re5 sulting from the pilot projects funded under this section 

6 not later than 5 years after the date of the enactment of 

7 this section. 

8 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

9 are authorized to be appropriated such sums as may be 

10 necessary for each of fiscal years 2010 through 2014 to 

11 carry out this section.’’. 

12 SEC. 4. NATIONAL ASTHMA EDUCATION AND PREVENTION 

13 PROGRAM OF THE NATIONAL HEART, LUNG, 

14 AND BLOOD INSTITUTE. 

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

16 (42 U.S.C. 285 et seq.) is amended by inserting after sec17 tion 424C the following: 

18 ‘‘SEC. 424D. EXPANSION OF THE NATIONAL ASTHMA EDU19 CATION AND PREVENTION PROGRAM. 

20 ‘‘(a) DEVELOPMENT OF A NATIONAL ASTHMA AC21 TION PLAN.— 

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

23 authorization of appropriation available to the Na24 tional Heart, Lung, and Blood Institute for the pur25 pose of carrying out the National Asthma Education 


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1 and Prevention Program (referred to in this section 

2 as the ‘program’), there is authorized to be appro3 priated to such Institute such sums as may be nec4 essary for each of fiscal years 2010 through 2014 to 

5 develop a National Asthma Action Plan. 

6 ‘‘(2) USE OF APPROPRIATIONS.—The amounts 

7 appropriated pursuant to paragraph (1) shall be 

8 used to fund the report by the program described 

9 under subsection (b). 

10 ‘‘(b) REPORT TO CONGRESS.— 

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

12 after the date of the enactment of the Family Asth13 ma Act, the program shall, in consultation with pa14 tient groups, nonprofit organizations, medical soci15 eties, and other relevant governmental and non16 governmental entities that participate in the pro17 gram, submit to the Congress a report that— 

18 ‘‘(A) catalogs, with respect to asthma pre19 vention, management, and surveillance— 

20 ‘‘(i) the activities of the Federal Gov21 ernment, including an assessment of the 

22 progress of the Federal Government and 

23 States, with respect to achieving the goals 

24 of the Healthy People 2020 initiative; and 


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1 ‘‘(ii) the activities of other entities 

2 that participate in the program, including 

3 nonprofit organizations, patient advocacy 

4 groups, and medical societies; and 

5 ‘‘(B) makes recommendations for the fu6 ture direction of asthma activities, in consulta7 tion with researchers from the National Insti8 tutes of Health and other member bodies of the 

9 National Asthma Education and Prevention 

10 Program who are qualified to review and ana11 lyze data and evaluate interventions, includ12 ing— 

13 ‘‘(i) description of how the Federal 

14 Government may improve its response to 

15 asthma including identifying any barriers 

16 that may exist; 

17 ‘‘(ii) description of how the Federal 

18 Government may continue, expand, and 

19 improve its private-public partnerships 

20 with respect to asthma including identi21 fying any barriers that may exist; 

22 ‘‘(iii) identification of steps that may 

23 be taken to reduce the— 

24 ‘‘(I) morbidity, mortality, and 

25 overall prevalence of asthma; 


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1 ‘‘(II) financial burden of asthma 

2 on society; 

3 ‘‘(III) burden of asthma on dis4 proportionately affected areas, par5 ticularly those in medically under6 served populations (as defined in sec7 tion 330(b)(3)); and 

8 ‘‘(IV) burden of asthma as a 

9 chronic disease; 

10 ‘‘(iv) identification of programs and 

11 policies that have achieved the steps de12 scribed under clause (iii), and steps that 

13 may be taken to expand such programs 

14 and policies to benefit larger populations; 

15 and 

16 ‘‘(v) recommendations for future re17 search and interventions. 

18 ‘‘(2) UPDATES TO CONGRESS.— 

19 ‘‘(A) CONGRESSIONAL REQUEST.—During 

20 the 5-year period following the submission of 

21 the report under paragraph (1), the program 

22 shall submit updates and revisions of the report 

23 upon the request of the Congress. 

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

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1 sion of the report under paragraph (1), the pro2 gram shall evaluate its analyses and rec3 ommendations under such report and determine 

4 whether a new report to the Congress is nec5 essary, and make appropriate recommendations 

6 to the Congress.’’. 

7 SEC. 5. ASTHMA–RELATED ACTIVITIES OF THE CENTERS 

8 FOR DISEASE CONTROL AND PREVENTION. 

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

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

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

12 FOR DISEASE CONTROL AND PREVENTION. 

13 ‘‘(a) PROGRAM FOR PROVIDING INFORMATION AND

14 EDUCATION TO THE PUBLIC.—The Secretary, acting 

15 through the Director of the Centers for Disease Control 

16 and Prevention, shall collaborate with State and local 

17 health departments to conduct activities, including the 

18 provision of information and education to the public re19 garding asthma including— 

20 ‘‘(1) deterring the harmful consequences of un21 controlled asthma; and 

22 ‘‘(2) disseminating health education and infor23 mation regarding prevention of asthma episodes and 

24 strategies for managing asthma. 


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1 ‘‘(b) DEVELOPMENT OF STATE ASTHMA PLANS.— 

2 The Secretary, acting through the Director of the Centers 

3 for Disease Control and Prevention, shall collaborate with 

4 State and local health departments to develop State plans 

5 incorporating public health responses to reduce the burden 

6 of asthma, particularly regarding disproportionately af7 fected populations. 

8 ‘‘(c) COMPILATION OF DATA.—The Secretary, acting 

9 through the Director of the Centers for Disease Control 

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

11 public health officials— 

12 ‘‘(1) conduct asthma surveillance activities to 

13 collect data on the prevalence and severity of asth14 ma, the effectiveness of public health asthma inter15 ventions, and the quality of asthma management, in16 cluding— 

17 ‘‘(A) collection of household data on the 

18 local burden of asthma; 

19 ‘‘(B) surveillance of health care facilities; 

20 and 

21 ‘‘(C) collection of data not containing indi22 vidually identifiable information from electronic 

23 health records or other electronic communica24 tions; 


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1 ‘‘(2) compile and annually publish data regard2 ing the prevalence and incidence of childhood asth3 ma, the child mortality rate, and the number of hos4 pital admissions and emergency department visits by 

5 children associated with asthma nationally and in 

6 each State and at the county level by age, sex, race, 

7 and ethnicity, as well as lifetime and current preva8 lence; and 

9 ‘‘(3) compile and annually publish data regard10 ing the prevalence and incidence of adult asthma, 

11 the adult mortality rate, and the number of hospital 

12 admissions and emergency department visits by 

13 adults associated with asthma nationally and in each 

14 State and at the county level by age, sex, race, eth15 nicity, industry, and occupation, as well as lifetime 

16 and current prevalence. 

17 ‘‘(d) COORDINATION OF DATA COLLECTION.—The 

18 Director of the Centers for Disease Control and Preven19 tion, in conjunction with State and local health depart20 ments, shall coordinate data collection activities under 

21 subsection (c)(2) so as to maximize comparability of re22 sults. 

23 ‘‘(e) COLLABORATION.— 

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1 rate with national, State, and local nonprofit organi2 zations to provide information and education about 

3 asthma, and to strengthen such collaborations when 

4 possible. 

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

6 Adolescent and School Health is encouraged to ex7 pand its activities with non-Federal partners, espe8 cially State-level entities. 

9 ‘‘(f) ADDITIONAL FUNDING.—In addition to any 

10 other authorization of appropriations that is available to 

11 the Centers for Disease Control and Prevention for the 

12 purpose of carrying out this section, there is authorized 

13 to be appropriated to such Centers such sums as may be 

14 necessary for each of fiscal years 2010 through 2014 for 

15 the purpose of carrying out this section.’’. 

Æ 


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