The effects of the DASH dietary pattern on clinical outcomes and quality of life in adults with uncontrolled asthma: Design and methods of the ALOHA Trial.

BACKGROUND: Poor diet quality is an important risk factor for increased asthma prevalence and poor asthma control. To address the question of whether adults with asthma can benefit from following a healthy diet, this trial will test the efficacy and mechanisms of action of a behavioral intervention promoting the Dietary Approaches to Stop Hypertension (DASH) dietary pattern with sodium reduction among patients with uncontrolled asthma. METHODS: In this 2-arm randomized clinical trial, 320 racially/ethnically and socioeconomically diverse adults with uncontrolled asthma on standard controller therapy will be randomized to either a control or an intervention group and assessed at baseline, 3, 6 and 12 months. Control and intervention participants will receive education on lung health, asthma, and other general health topics; additionally, the intervention group will receive DASH behavioral counseling over 12 months. The primary hypothesis is that the DASH behavioral intervention, compared with the education-only control, will lead to significantly more participants with minimum clinically important improvement (responders) in asthma-specific quality of life at 12 months. Secondary hypotheses will test the intervention effects on other asthma (e.g., asthma control, lung function) and non-asthma outcomes (e.g., quality of life). Additionally, therapeutic (e.g., short chain fatty acids, cytokines) and nutritional biomarkers (e.g., dietary inflammatory index, carotenoids) will be assessed to understand the mechanisms of the intervention effect. CONCLUSION: This trial can substantially advance asthma care by providing rigorous evidence on the benefits of a behavioral dietary intervention and mechanistic insights into the role of diet quality in asthma. CLINICALTRIALS: gov #: NCT05251402.

Identifying Barriers to Physical Activity Among African American Women with Asthma.

OBJECTIVE: African American Women (AAW) are disproportionately impacted by both physical inactivity and asthma. The aims of this study were to: 1) understand barriers to physical activity among AAW with asthma; 2) obtain feedback from AAW on an evidence-based walking intervention; and 3) modify the intervention using input from AAW with asthma. METHODS: Focus groups and interviews were conducted with sedentary AAW with uncontrolled asthma to identify barriers to walking. Women also suggestions for tailoring an existing walking intervention. Qualitative data were coded using domains from the Behavior Change Wheel and guided modifications of the existing walking intervention to tailor the content for sedentary AAW with asthma. RESULTS: Six focus groups (2-4 /group) and five interviews were completed. Women (n=20) represented an obese (37 kg/m2 ± 11), middle-aged (46 years ± 15) and low-income population. Barriers to physical activity were mapped to 8 theoretical domains: 1) Limited physical capability; 2) Lack of knowledge; 3) Lack of self-monitoring skills; 4) Complex decision making processes; 5) Lack of areas to walk; 6) Lack of social support; 7) Beliefs about consequences; 8) Beliefs about capability. To target these barriers, the existing walking intervention was modified to include an asthma education session, text messages, monthly group meetings, a walking session and informational materials. CONCLUSION: AAW with asthma reported unique barriers to engaging in physical activity. An assessment of the feasibility, acceptability and efficacy of a modified intervention that addresses these barriers is warranted to address physical inactivity and poor asthma outcomes among AAW with asthma.