On this World Asthma Day, we at the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID), parts of the National Institutes of Health (NIH), stand side-by-side with scientists, policymakers, patient advocates, health care providers, and patients across the country to renew our dedication to understanding the causes of asthma, finding better treatments and promoting better asthma control.
Asthma imposes a staggering burden, affecting approximately 300 million people worldwide. In the United States more than 16 million adults and nearly 7 million children have asthma, leading to nearly 1.8 million emergency department visits and half million hospitalizations each year. More than 10 million work days and 13 million school days are lost each year; the direct and indirect costs of asthma to the U.S. economy exceed $19.7 billion annually.
Asthma disproportionately strikes the poor, who are at least 30 percent more likely to have asthma than those living above the poverty line. Ethnic and racial disparities in asthma burden persist, with significant impact on African American and Puerto Rican communities, that have not only a higher prevalence of asthma, but more severe disease and a higher rate of death from the disease.
Understanding the causes, finding better treatments and prevention strategies, and promoting better asthma control are central to the NHLBI and NIAID efforts for asthma. Together, our diverse research programs provide the essential foundation for improving treatments for asthma. The NHLBI supports a broad asthma research program, spanning basic and clinical research, to genomics, proteomics, epidemiology, clinical trials and demonstration research which has yielded major advances in the past few decades. For example, basic research revealed the central role of inflammation in asthma that led to an emphasis on treatment approaches to reduce inflammation. Currently, basic research examines how altered immune function early in life may result in the development of asthma. Findings from NHLBI clinical research networks identify best practices for treating different levels of asthma severity. Genetics research examines the link between genes and environmental exposures that cause asthma, which may one day lead to new therapies. Employing genetic information to predict and personalize therapy to individual patients is the next frontier of asthma research. Education and demonstration research has led to many advances in teaching various patient populations to learn the self-management skills necessary to control their asthma, such as computer games and peer counseling programs for urban teens, telephone consultation programs for women, telemonitoring programs, and programs designed for the school setting. Four Centers for Reducing Asthma Disparities conduct research to identify the causes of disparities and develop innovative programs to reduce them.
Translating research discoveries into clinical care is another part of NHLBI's mission. Last fall, NHLBI's National Asthma Education and Prevention Program (NAEPP) released the Expert Panel Report-3 Guidelines for the Diagnosis and Management of Asthma, emphasizing that asthma control is possible for almost everyone who has asthma. Through NAEPP, NHLBI works with more than 40 partners, including those at other federal agencies, professional societies, and voluntary organizations in the private sector to promote adoption of the guidelines in clinical practice, and to develop programs for patients and their families that help them improve asthma control.
Since 1971, NIAID has been at the forefront of conducting research into the mechanisms underlying asthma and developing treatments for the disease. NIAID is investigating the alterations of the immune system that lead to asthma and allergy and the impact of environmental factors such as allergens, viral infections, and pollution on the development and exacerbation of asthma. In addition, NIAID supports clinical trials that test the use of innovative methods to block certain immune responses to prevent the development or stop the progression of allergies and asthma.
NIAID's fifteen Asthma and Allergic Diseases Cooperative Research Centers conduct state-of-the-art basic and clinical research to understand the immunologic basis and the pathobiology of asthma and allergic diseases and to develop new treatments. Current studies focus on the mechanisms of virus-induced asthma exacerbations, the genetics of allergy and asthma, the mechanisms of airway inflammation in asthma, and the effects of allergens, pollutants and microbial and fungal products on asthma and allergy.
Through NIAID's Inner City Asthma Consortium, which includes 10 clinical centers located in U.S. inner cities, researchers are studying the causes of the high asthma severity in inner-city children and conducting clinical trials using immunomodulatory treatments to prevent and reduce the severity of the disease. For example, a birth cohort of more than 500 inner-city children is being studied to provide fundamental information on why and how asthma develops. NIAID's Inner City Asthma program recently demonstrated that both indoor and outdoor environments within the inner city contribute to asthma severity. Indoor reductions in the levels of allergens and tobacco smoke were shown to substantially improve asthma outcomes. In contrast, levels of outdoor pollutants were associated with increased asthma symptoms and reduced pulmonary function, even when pollution levels were within current air quality standards.
NHLBI and NIAID will continue to work together with patients, families, and health care providers to address this important public health concern.