On World Asthma Day 2015, the National Institutes of Health stands with the international community to renew our commitment to advance our understanding of asthma and develop effective strategies to manage and prevent the disease. Within a broad asthma research portfolio, NIH-supported scientists are making progress in understanding how certain exposures—such as to microbes, allergy-triggering substances (allergens) and pollution—may contribute to the development or worsening of asthma, and are working on new approaches to address these factors.
An estimated 300 million people worldwide are living with asthma, a chronic disease that inflames and narrows the airways of the lungs, causing wheezing, breathlessness, chest tightness and coughing. Globally, an estimated 15 million years of life are lost each year due to asthma-related disability or early death. Asthma is a leading cause of hospitalization and missed school and work days in the United States, and managing the condition can be costly for families and health care systems.
The National Institute of Allergy and Infectious Diseases (NIAID); the National Heart, Lung, and Blood Institute (NHLBI); and the National Institute of Environmental Health Sciences (NIEHS) are the lead NIH institutes that support and conduct asthma research. Among many other asthma-related projects, scientists supported by these institutes are working to advance knowledge of how exposures affect asthma development and severity. These studies underpin NIH efforts to reduce the worldwide burden of asthma and improve the quality of life for people with this chronic disease.
NIAID conducts and supports basic, preclinical and clinical research to better understand, treat and ultimately prevent immunologic and infectious diseases. In the area of asthma, one current focus is exploring the influence of microbial exposures and their interaction with allergens in the development of asthma and its symptoms. For example, NIAID-funded scientists have found that combined viral and bacterial infections are associated with an increase in asthma symptoms that many children experience during the fall. Earlier this year, these investigators identified a cellular receptor for rhinovirus C, a cold-causing virus associated with severe asthma attacks, pointing to a novel target for the development of strategies to prevent and treat rhinovirus C-induced colds and asthma attacks. Other recent research, conducted through the NIAID-supported Inner-City Asthma Consortium, has suggested that exposure to specific combinations of bacteria and allergens within the first year of life may protect children from early wheezing, which is a risk factor for developing asthma.
NHLBI supports a wide range of research efforts targeting asthma, including studies to evaluate the impact of the microbiome and the general environment on those living with asthma. The NHLBI-supported AsthmaNet is conducting a multicenter trial to compare the lung and gut microbiome among three groups: healthy adults who do not have asthma or allergies, adults with allergies but no asthma and adults with asthma and allergies. A better understanding of the microorganisms living in the guts and lungs could lead to future asthma treatment targets. NHLBI also supports the Childhood Origins of Asthma (COAST) program, which tracks children at high risk for asthma starting at birth to learn about potential exposure factors that may contribute to asthma development. The study focuses on how environmental factors, such as exposure to pets, daycare facilities, food and respiratory viruses, interact with the immune system. COAST has already shown that rhinovirus infection is the strongest predictor of wheezing at age 3 and development of asthma by age 6.
NIEHS research focuses on how the environment contributes to diseases, such as asthma. Research has shown that environmental exposures, such as parental smoking, can play an important role in the initiation and severity of asthma, particularly in children. Recent work at NIEHS suggests that maternal smoking during pregnancy may have trans-generational effects on asthma development. Studying indoor and outdoor exposures, as well as genetics, helps researchers develop cost effective interventions and novel treatments for asthma. In 2015, the NIEHS Clinical Research Unit began recruiting patients for the Natural History of Asthma with Longitudinal Environmental Sampling study (NHALES). NHALES will help scientists understand how the environment affects asthma symptoms. In particular, NIEHS scientists will examine how bacteria living in and on humans and in their homes, known collectively as the microbiome, may be associated with asthma activity. This five-year study will provide free treatment, medications and compensation so participants can get their asthma under control.