In 2019, the NHLBI’s Division of Lung Diseases celebrated its 50th year of advancing research on chronic obstructive pulmonary disease (COPD), asthma, and other lung conditions. In April, the American Thoracic Society organized a Capitol Hill reception to mark this milestone, featuring remarks and accolades by Congresswoman Rosa DeLauro (D-CT), Congressman Peter King (R-NY), and the co-chairs of the Congressional COPD Caucus, Senator Michael Crapo (R-ID) and Congressman Chris Stewart (R-UT).
Implementing the COPD National Action Plan
Through the COPD National Action Plan, the NHLBI continues to work with its federal and nonfederal partners to intensify research and outreach to address the national burden of COPD, especially in underserved communities. For example, the NHLBI is looking for new ways to increase the use of pulmonary rehabilitation (PR) for COPD patients. PR can be highly effective but is often difficult to access, especially in rural areas. To help address this problem, NHLBI-supported researchers are testing the effectiveness of a home-based PR program, alleviating the need for patients to travel for care.
In 2019, the NHLBI funded the first national adult cohort study that will help address the burden of COPD and other lung diseases—the American Lung Association Lung Health Cohort. The study will follow 4,000 healthy young adults (ages 25–35) over six years to identify early risk factors for lung disease—including the use of nicotine products and e-cigarettes. The study aims to detect lung diseases in their earliest stages, to allow for earlier intervention.
The NHLBI is leading the effort to update the 2007 national asthma guidelines for adults and children. The new guidelines were released for public comment and are expected to be completed by fall 2020.
The Precision Interventions for Severe and/or Exacerbation-Prone Asthma Network (PrecISE) has begun to enroll patients with severe asthma at 30 locations nationwide. PrecISE will evaluate novel and approved treatments for asthma by targeting them to groups of patients who share certain characteristics, such as genetic factors or biomarkers.
Recent NHLBI-funded research illustrates the benefits of tailoring asthma interventions based on patient characteristics.
- One study found that patients with high levels of eosinophils—a type of cell that can contribute to airway inflammation—are more likely to respond to inhaled corticosteroid medications than are patients with fewer eosinophils.
- Another recent study examined how African Americans with poorly controlled asthma respond to more intensive treatment options—either a higher corticosteroid dose or addition of a bronchodilator (a drug to open the airway). The latter option tends to work best for most African Americans older than 12 and for white children. But in this study, the two options were about equally likely to work for African-American children younger than 12.
Researching Sleep and Sleep Disorders
The NHLBI continues to support science on the biology of sleep, circadian rhythms, and sleep disorders, as well as their contributions to heart, lung, and blood health.
Years of NHLBI-supported basic research have established that the brain regulates sleep and wakefulness in part by releasing a hormone called hypocretin. In 2019, a study in mice found that undisturbed sleep maintains the brain’s proper release of hypocretin, which in turn helps quiet inflammation that can contribute to atherosclerosis. Sleep-deprived mice had lower levels of circulating hypocretin and higher rates of atherosclerosis, which could be prevented by giving them infusions of hypocretin. We may be able to leverage this pathway to develop new therapies for atherosclerosis.
We also know that not getting enough sleep can negatively affect heart health. A 2019 study found that people who slept fewer than seven hours per night had lower levels of certain microRNAs (a type of gene-regulating molecule) that help reduce inflammation and support blood vessel health. Another new study found that people who sleep fewer than six hours a night may be at increased risk of abnormal heart rhythm (atrial fibrillation).
Strategic Vision Objectives
Addressing the vaping public health crisis
In 2019, we saw a rising number of cases of severe lung illness as well as deaths associated with e-cigarette use, or vaping. As part of a collaborative response by multiple federal health agencies, the NHLBI is expanding its research on e-cigarettes to better understand their effects on the heart and lungs. A recent NHLBI-funded study suggests that just one vaping session can damage the lungs of young adults. Other data reveal how daily vaping may prime the lungs for chronic disease.
In November 2019, the NHLBI joined several other NIH Institutes to announce a Notice of Special Interest to address the increasing incidence of acute lung injuries related to vaping. The notice invites NIH-funded researchers to apply for additional funding specifically to study vaping-related illness and to better understand the roles of vaping devices, flavorings, aerosols, and behaviors in vaping-related illness and its outcomes.
Leveraging data science to help predict and prevent disease
The NHLBI launched a new cloud-based data science platform in 2019, the BioData Catalyst. In tandem with the NIH Science and Technology Research Infrastructure for Discovery, Experimentation, and Sustainability (STRIDES) Initiative, the BioData Catalyst will help researchers securely find, access, share, cross-link, and analyze large datasets, while also ensuring patient privacy. It includes more than 20,000 chest images from the COPDGene study and more than 150,000 whole genome sequences collected through the TOPMed program, which includes data from more than 80 diverse cohort studies.
In addition, the NHLBI is supporting development of artificial intelligence (AI) tools that can rapidly sift through vast amounts of biomedical data to identify patterns that can help detect disease. For example, the COPDGene study used AI principles to predict acute breathing problems in smokers with COPD, and another study used AI to distinguish between malignant and benign lung nodules (swellings).
This work addresses Strategic Vision Objectives 1, 2, and 7.
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Lung Disease and Sleep Research