Statement of Linda S. Birnbaum, Ph.D., director, National Institute of Environmental Health Sciences and National Toxicology Program; Susan B. Shurin, M.D., acting director, National Heart, Lung, and Blood Institute; and Anthony S. Fauci, M.D., director,
Today, the National Institutes of Health joins with public health officials, health organizations, and patient groups around the world to recognize World Asthma Day.
As NIH's leading supporters of asthma research, we at the National Institute of Environmental Health Sciences (NIEHS), the National Heart, Lung, and Blood Institute (NHLBI), and the National Institute of Allergy and Infectious Diseases (NIAID) renew our commitment to advancing studies that will help improve asthma prevention, diagnosis, and management. Our diverse programs provide a critical foundation for improving outcomes for patients with asthma. Each of our institutes focuses on a fundamentally different aspect of asthma, and we work closely together to coordinate our research programs. Our goal is to make this year's theme, You Can Control Your Asthma, not just a slogan but a reality.
Asthma is a chronic inflammatory disorder of the airways, affecting more than 17 million American adults and 7 million children under 18 years of age. Asthma disproportionately affects minorities, people with lower incomes, females, and children. The disorder is characterized by mild to life-threatening episodes of airway narrowing and obstruction, causing wheezing, coughing, chest tightness and shortness of breath. Asthma has no cure, but daily preventive treatment can enable individuals to manage their symptoms and lead active lives.
As the lead NIH institute focusing on how environmental factors impact human health, NIEHS is working to understand how exposures to environmental agents trigger diseases such as asthma, and how we can prevent, diagnose and treat these diseases.
In addition to identifying environmental factors contributing to asthma, NIEHS is developing and testing new technologies to help determine environmental triggers and reduce asthma symptoms. PIPER, or the Pre-toddler Inhalable Particulate Environmental Robotic sampler, is a robot developed by NIEHS grantees capable of mimicking children's floor activities while collecting better estimates of young children's exposure to indoor air pollutants, such as particulate matter, pesticides, allergens, endotoxins and airborne fungi. PIPER is being used as part of a study that will compare measurements of particulates obtained by PIPER with those from standard adult height monitoring stations and examine their association with asthma symptoms.
NIEHS is also supporting research to find improved asthma interventions. Through collaborative programs such as the Head-off Environmental Asthma in Louisiana (HEAL) Project, implemented in New Orleans soon after Hurricane Katrina, we are learning about the important role that comprehensive home-front interventions can have on children with asthma.
NIEHS researchers continue to learn more about genetic susceptibility to asthma, by working closely with other NIH-funded researchers and international collaborators to conduct genome-wide association studies. The studies are aimed at identifying genetic risk factors and their interactions with environmental risk factors, in order to characterize how they may influence susceptibility to the disease.
Also, work being done by the Centers for Children's Environmental Health, supported by NIEHS and the U.S. Environmental Protection Agency, is helping us better understand and treat asthma. For example, research from one of the centers has shown that children living close to major roadways in Southern California have a higher risk of asthma. Additionally, research conducted at the NIEHS Clinical Research Unit in Research Triangle Park, N.C., is leading to a greater knowledge about the causes of asthma, and how to prevent and treat diseases that are clearly influenced by the environment.
The NHLBI supports a broad asthma research program that spans basic research, genomics, proteomics, epidemiology, clinical trials and demonstration projects. This support has advanced our understanding of the mechanisms of asthma and improved patient care. For example, the NHLBI-funded Asthma Clinical Research Network recently demonstrated that tiotropium bromide, an anticholinergic drug that helps reduce airway contraction, was an effective add-on therapy to inhaled corticosteroids for adults with poorly controlled asthma.
Several current NHLBI research programs are addressing the problem of recurrent asthma flare-ups in people with otherwise good day-to-day asthma control. These programs include studying new treatment approaches for flare-ups in infants and school-age children, as well as genome-wide association studies investigating the genetic factors that make some patients prone to worsening of asthma symptoms. The NHLBI will soon launch a network of six clinical centers that will integrate molecular, cellular and clinical studies of severe asthma to better predict when serious complications of asthma will occur and identify new targets for therapy.
Because asthma was the most common underlying health condition among those hospitalized in the United States with 2009 H1N1 influenza infection during the 2009-2010 influenza season, NHLBI and NIAID conducted a collaborative study to establish safe and effective strategies to vaccinate children and adults with mild to severe asthma against the 2009 pandemic H1N1 influenza virus. The results of this study showed that the 2009 pandemic H1N1 influenza virus vaccine is safe and can produce appropriate antibody levels in people with asthma.
The NHLBI is exploring ways to prevent asthma from developing, including an ongoing study examining whether vitamin D supplements given to pregnant women could prevent their children from developing 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 clinical guidelines-based care. The NAEPP's National Asthma Control Initiative aims to strengthen collaboration among health care providers, patients and families, and other stakeholders committed to improving asthma management.
NIAID's program in asthma research focuses on understanding how allergens, pollutants, infections and genetics interact with the immune system to cause and aggravate asthma. It also centers on developing strategies to treat and prevent the disease. NIAID funds three multi-site asthma clinical research programs and many individual grants in support of these efforts.
NIAID-funded researchers have greatly increased our understanding of asthma by studying inner-city children, who are at a disproportionately high risk for the disease. Initial studies identified a strong association between environmental allergic sensitization and asthma and showed that removing household allergens reduced asthma symptoms and health care visits. Environmental pollution also can aggravate asthma and increase susceptibility to allergic diseases, and NIAID-supported researchers are investigating the mechanisms behind this association. Similarly, major efforts are under way to understand how viral infections can worsen asthma, and how obesity may affect the disease.
In the area of treatment, a recent NIAID-sponsored clinical trial found that augmenting NIH asthma guidelines-based therapy with a drug that targets immunoglobulin E, an antibody that plays a key role in allergy, nearly eliminated seasonal increases in asthma attacks and significantly decreased asthma symptoms among inner-city youth.
Finally, NIAID, NHLBI, and several other NIH institutes, together with the Agency for Healthcare Research and Quality and the Merck Childhood Asthma Network, co-sponsored a workshop to develop standardized definitions and data collection methods for asthma clinical studies. These standards will enable investigators to better compare results across studies and better inform the direction of future research. The March 2010 workshop participants reached consensus on seven key outcome measures that will be required in future NIH-sponsored asthma clinical trials and observational studies: symptoms, exacerbations, biomarkers, lung function, quality of life, asthma control questionnaire results and health care utilization and cost. The workshop report will be published in the Journal of Allergy and Clinical Immunology in fall 2011.
- NIEHS Asthma Web page: http://www.niehs.nih.gov/health/topics/conditions/asthma/index.cfm
- NIAID Asthma Web pageL http://www.niaid.nih.gov/topics/asthma/
- Global Initiative for Asthma's World Asthma Day Web page: http://www.ginasthma.com