The NHLBI continues to support research to more precisely tailor interventions based on growing knowledge about the variable symptoms, severity, and underlying mechanisms of asthma. For example, the Precision Interventions for Severe and/or Exacerbation-Prone Asthma (PrecISE) clinical trial network, with 30 locations across the country, is evaluating several novel and approved treatments for asthma by targeting them to defined groups of patients who share similar characteristics, such as genetic factors or biomarkers. The need for more personalized treatments is especially important in light of new findings showing that a variety of patient characteristics — such as ethnicity, overweight/obesity, and sensitivity to household allergens — can influence susceptibility to asthma as well as the severity of the disorder.
In December 2020, the NHLBI announced focused updates of the 2007 national asthma management guidelines, which help providers and patients make treatment decisions. The updated recommendations include guidance on the use of a new inhaled medication, reducing indoor allergens, and immunotherapy (injections of an allergen to desensitize the body, often called allergy shots).
As part of the COPD National Action Plan, several NHLBI research efforts are addressing the high burden of COPD in rural and underserved communities. For example, efforts are also underway to improve the use of pulmonary rehabilitation (PR), especially in rural and remote areas. Although PR has been shown to reduce hospitalizations and improve quality of life among people with COPD, only about 4 percent of eligible patients use it. NHLBI-funded researchers are studying a variety of approaches to increase access and adherence to PR, including through home-based visits, coaching, and telehealth. in 2019, the NHLBI also formed a cooperative agreement with the American Lung Association to conduct the Lung Health Cohort study.
In 2021, the NHLBI is also launching a web-based platform that will allow partners in the COPD National Action Plan to share their activities and collectively track their progress as they implement the plan.
Although organ transplant outcomes have steadily improved in recent years, the mortality rate for lung transplants remains nearly twice as high as for heart, liver, and kidney transplants. To improve outcomes, the NHLBI is establishing a multisite Lung Transplant Consortium that will harmonize clinical studies across lung transplant centers. Read the funding opportunity announcement.
An NHLBI-funded study is also following more than 3,000 patients who have undergone a lung transplant to understand chronic lung allograft dysfunction (CLAD), a condition in which the transplanted lung does not function properly. Other researchers are conducting a trial to determine whether a biologic approved for use in kidney transplants will help reduce CLAD and improve outcomes for lung transplants.
In 2019, reports began to emerge of e-cigarette, or vaping, product use–associated lung injury (EVALI), with more than 2,800 people hospitalized and nearly 70 dead as a result. In November 2019, data from the Centers for Disease Control and Prevention (CDC) had linked many EVALI cases to use of vaping liquids containing tetrahydrocannabinol (THC) — the active ingredient in marijuana — as well as vitamin E acetate, which is an agent used to dilute THC.
NHLBI-funded researchers later confirmed that e-cigarette vapor containing vitamin E acetate causes lung injury in mice similar to that seen in EVALI patients. In response, the U.S. Food and Drug Administration (FDA) advised that vitamin E acetate should not be used in vaping products. EVALI cases declined in late 2019, but the NHLBI continues to support robust research on the long-term health consequences from vaping. The Institute has proposed resources to help speed progress, including the use of patient questionnaires to better characterize vaping behaviors, and collaborative systems to allow researchers to share data and specimens.
Studies funded in part through NIH’s National Center on Sleep Disorders Research (NCSDR) continue to show that sleep deficiency and sleep disorders are important risk factors for diabetes, hypertension, obesity, and other life-threatening conditions. In 2020, a study of nearly 2,000 middle-aged adults showed that compared with people with regular bedtimes and sleep duration, people with the most irregular sleep patterns had more than twice the risk of cardiovascular disease after five years of follow-up. Read more about the study. In addition, a large, prospective study found that sleeping less than six hours a night due to chronic insomnia is associated with a higher risk for cognitive impairment.
As new sleep findings emerge, they are added to the NHLBI’s BioData Catalyst cloud-based data platform to allow researchers to share and analyze the data and speed advances in sleep research.
In November 2020, Marishka K. Brown, Ph.D., was named as the new NCSDR director. Dr. Brown first joined NCSDR in 2016 as a program director for sleep disorders medicine. She also led NCSDR’s coordination of trans-NIH sleep research and chaired the working group responsible for national sleep health objectives as part of the U.S. Department of Health and Human Services’ Healthy People 2030 initiative.