Statement of Susan B. Shurin, M.D., acting director, National Heart, Lung, and Blood Institute; Anthony S. Fauci, M.D., director, National Institute of Allergy and Infectious Diseases; and Linda S. Birnbaum, Ph.D., director, National Institute of Environm
May 4, 2010 marks World Asthma Day, when public officials, health organizations, and patient groups around the world take action to increase public awareness of the global burden of asthma and promote better asthma diagnosis and treatment.
For decades, the National Institutes of Health (NIH) has supported groundbreaking research that has led to improvements in outcomes for people with asthma. As the NIH's leading Institutes in this field, we at the National Heart, Lung, and Blood Institute (NHLBI); the National Institute of Allergy and Infectious Diseases (NIAID); and the National Institute of Environmental Health Sciences (NIEHS) renew our dedication to asthma prevention, diagnosis, and management.
Asthma afflicts an estimated 300 million people worldwide and ranks among the most common chronic health conditions in the United States. More than 16 million American adults and 7 million children under 18 years of age have the disease. Asthma disproportionately affects minorities and those with lower incomes. African-Americans, Puerto Ricans, and people living in poverty have higher rates of asthma, and African-Americans have higher rates of hospitalizations and deaths, than whites. There is no cure for asthma, but with appropriate asthma care, most people who have asthma can be active at work, school, and play.
Understanding the causes of asthma, discovering individualized treatments, and promoting better asthma management are central to the NIH's asthma research programs. Together, our diverse research portfolio provides a critical foundation for improving outcomes for asthma patients.
The NHLBI supports a broad asthma research program, spanning basic and clinical research, to genomics, proteomics, epidemiology, clinical trials, and demonstration research that has yielded major advances in the past few decades. Over the years, NHLBI-funded studies have identified wide variation among patient asthma characteristics, or phenotypes, and revealed significant variations in patient responses to asthma treatments. NHLBI studies also have found that even though current therapies can improve day-to-day asthma control, many patients still experience serious complications. Current NHLBI asthma research programs address these problems by investigating approaches to tailor treatments to individual patient characteristics, genotypes, and exposures.
This year, the NHLBI launched two initiatives, the Translational Program Project Grant and Centers for Advanced Diagnostics and Therapeutics, to accelerate the development of new treatments and personalized medicine approaches. In addition, the NHLBI launched AsthmaNet, a research network composed of nine clinical centers and a data coordinating center that are collaborating to address important clinical questions about asthma management and treatment for adult and childhood asthma.
The NHLBI also supports the National Asthma Education and Prevention Program (NAEPP), a partnership among professional, voluntary health, and lay organizations as well as federal agencies to improve the care of patients with asthma. Recently launched under the umbrella of the NAEPP is a multi-component, mobilizing initiative called the National Asthma Control Initiative. A major goal of this initiative is to strengthen collaborative efforts among health care providers, patients and families, and other stakeholders committed to improving asthma management.
NIAID-funded asthma research incorporates the complementary fields of immunology, allergy, microbiology, and genetics to better understand the causes of asthma and to develop new approaches for its prevention and treatment. For more than 40 years, NIAID research --comprising clinical trial centers and basic research laboratories, located in North America and Europe--has made significant contributions to asthma research. These contributions include identifying cockroach and other allergens and air pollution as major factors contributing to asthma severity in inner-city environments; determining the mechanisms of virus-induced asthma exacerbations; and describing the effect of exposure to fungi and bacteria on people with asthma and other allergic diseases. Current studies focus on determining the changes in the immune system that lead to the development and worsening of asthma.
Over the past 20 years, a major thrust of NIAID asthma research has been to understand the unique features of the disease in children living in urban areas. Clinical research is focused on designing and evaluating new therapies tailored to the specific needs of these children, whose asthma is more severe than in children from non-urban areas. Their increased asthma severity may stem from various causes, including poor access to medical care and other socioeconomic factors such as; diet and obesity; and exposure to high levels of certain indoor allergens such as, tobacco smoke, and environmental pollution.
The NIAID's commitment to reduce the disease burden in this population is demonstrated in studies such as the Urban Environment and Childhood Asthma study, in which more than 500 inner-city children are being followed to identify environmental and lifestyle factors that may affect the development of asthma. The contributions of the NIAID's inner-city asthma research programs to improving disease management for inner city children is the focus of the March 2010 issue of the Journal of Allergy and Clinical Immunology.
The NIEHS is pleased to join with the other institutes and agencies working to reduce the burden of asthma worldwide. Asthma is a disease that affects both children and adults, and is a huge public health concern. Research has shown that asthma is caused in part by environmental factors. For example, allergens found in the environment clearly trigger asthmatic attacks and aggravate asthma symptoms. They are found indoors, as well as outdoors. Recent findings have conclusively demonstrated a link between asthma and air pollution, especially ozone. Researchers found that the incidence of new cases of asthma was associated with high exercise levels outdoors in communities with high levels of ozone, whereas exercise in areas of low ozone did not increase asthma risk.
NIEHS researchers are also learning more about genetic susceptibility to asthma. The NIEHS is working closely with other NIH-funded researchers and international collaborators to conduct genome-wide association studies to identify genetic risk factors and their interactions with environmental risk factors to characterize how they may influence susceptibility to the disease. NIEHS research has shown that diet and other environmental influences may directly change the way genes are expressed, thus increasing an individual's susceptibility to asthma. The NIEHS is performing and supporting research on epigenetic factors that may promote the development of asthma.
Additionally, research being conducted in the new Clinical Research Unit opened last summer at the NIEHS campus in North Carolina has led to a greater knowledge about the causes of asthma and how to prevent and treat diseases that are clearly influenced by the environment. This is supplemented by the work being done by the Centers for Children's Environmental Health that the NIEHS supports with the Environmental Protection Agency.
The NIH remains committed to working with scientists, patients, and clinicians to improve the quality of life of people with asthma around the world. Together, our diverse research programs provide the essential foundation for understanding the causes of, improving treatments for, and promoting better control of asthma.
- NIAID Asthma Web page: http://www3.niaid.nih.gov/topics/asthma/
- NIEHS Asthma Web page: http://www.niehs.nih.gov/health/topics/conditions/asthma/index.cfm
- National Asthma Control Initiative: http://www.nhlbi.nih.gov/health-pro/resources/lung/naci/
- Global Initiative for Asthma's World Asthma Day Web page: http://www.ginasthma.org/