Infectious Asthma: Understanding the Complex Interplay between Infections and Asthma

Greetings to Members and Subscribers of the World Asthma Foundation

As a chronic respiratory disease, asthma affects millions of individuals worldwide, causing inflammation and narrowing of the airways, leading to breathing difficulties, coughing, and wheezing. Asthma can have a significant impact on individuals and their families, as well as the broader society, due to the high cost of treatment and the potential for reduced quality of life. Recent research has explored the relationship between infections and asthma, with a focus on the role of infections in exacerbating asthma symptoms. The World Asthma Foundation aims to provide a comprehensive review of the latest research related to infections and asthma, and to explore potential strategies for managing and preventing infection-related asthma.

Introduction

While the exact causes of asthma are not fully understood, researchers have identified several factors that can contribute to the development and exacerbation of the disease, including infections. Infections can be caused by a range of pathogens, including respiratory viruses, bacterial infections, and fungi, among others. Although the relationship between infections and asthma has been widely studied, a fundamental question that remains to be addressed is whether infections may be responsible for creating the asthmatic predisposition in the first place. Understanding the relationship between infections and asthma is critical for the management and prevention of asthma.

Infectious Agents and Asthma

Recent studies have shown that various infectious agents may contribute to the development and exacerbation of asthma. Respiratory viral infections, particularly those caused by rhinovirus and respiratory syncytial virus, have been linked to the development of childhood asthma. In addition, certain bacterial infections, such as those caused by Streptococcus pneumoniae and Haemophilus influenzae, may also contribute to the development of asthma.

More recent research has also implicated Chlamydia pneumoniae, Staphylococcus aureus, and Candida albicans as potential infectious agents linked to the development and exacerbation of asthma.

Chlamydia pneumoniae has been associated with a specific type of asthma, known as Chlamydia pneumoniae-mediated asthma. Staphylococcus aureus has been linked to the development of severe asthma, particularly in patients with atopic dermatitis. Candida albicans has been linked to the development and exacerbation of asthma, particularly in patients with severe asthma or fungal sensitization.

Antibiotics and Asthma

In addition to preventive strategies, such as avoidance and good hygiene practices, antibiotics may also have a role in the management of severe asthma. Azithromycin, an antibiotic, has been shown to be effective in reducing asthma exacerbations. However, the exact mechanism of action is not established, so it is unknown whether azithromycin works vis its antibiotic effects or because of some non-infectious anti-inflamatory activity. While most asthma specialists believe that azithromycin works because it is an anti-inflammatory, recent research suggests that it may be due to its antimicrobial effects against chronic atypical respiratory infections such as Chlamydia pneumoniae and Mycoplasma pneumoniae. It is important to note that a growing amount of research reflects that antibiotic use can contribute to dysbiosis and the development of asthma, and appropriate antibiotic use is necessary to prevent this potential negative impact on the microbiome.

Antifungal Therapy and Asthma

Fungi, particularly Candida albicans and Aspergillus fumigatus, have been implicated in the development and exacerbation of asthma. Fungal sensitization has been associated with more severe asthma and poorer asthma control. Some studies have shown that antifungal therapy may be effective in reducing asthma symptoms and improving lung function in individuals with fungal sensitization. However, the evidence for antifungal therapy in asthma is limited and further research is needed to fully understand the potential benefits and risks of this treatment. Moreover, antifungal therapy raises issues about efficacy and resistance, as improper use of antifungal medications can contribute to the development of drug-resistant fungi. Therefore, accurate diagnosis and appropriate use of antifungal therapy are necessary to prevent the development of drug-resistant fungi and ensure the safe and effective management of asthma.

Microbiome and Asthma

Recent research has also explored the role of dysbiosis, or an imbalance in the microbiome, in the development and exacerbation of asthma. The microbiome may influence asthma through several potential mechanisms, including modulation of the immune system and production of metabolites. While microbiome-targeted therapies, such as probiotics and fecal microbiota transplantation, may have potential as treatments for asthma, it is important to note that overuse of antibiotics can contribute to dysbiosis and the development of asthma. Therefore, appropriate antibiotic use is essential to prevent antibiotic overuse and the potential negative impact on the microbiome. Furthermore, the exact mechanisms by which dysbiosis influences asthma are not fully understood and require further research.

Challenges and Barriers

While significant progress has been made in understanding the relationship between infections and asthma, challenges and barriers remain. The lack of well-established classification and terminology for different types of infectious asthma is one such challenge. Further research is needed to develop a more comprehensive understanding of the complex interplay between infections and asthma, including the identification of specific types of infections that are most likely to trigger asthma exacerbations and the potential role of infections in creating the asthmatic predisposition.

Key Takeaway

  • Infections, particularly respiratory infections, have been linked to the development and exacerbation of asthma. Future research is needed to fully understand the complex interplay between infections and asthma.
  • Dysbiosis, or an imbalance in the microbiome, may contribute to the development and exacerbation of asthma.
  • Overuse of antibiotics can contribute to dysbiosis and the development of asthma. Therefore, appropriate antibiotic use is essential to prevent antibiotic overuse and the potential negative impact on the microbiome.
  • Fungi, particularly Candida albicans and Aspergillus fumigatus, have also been implicated in the development and exacerbation of asthma.
  • Antifungal therapy may be effective in reducing asthma symptoms and improving lung function in individuals with fungal sensitization, but further research is needed to fully understand the potential benefits and risks of this treatment.
  • Improper use of antifungal medications can contribute to the development of drug-resistant fungi, so accurate diagnosis and appropriate use of antifungal therapy are necessary to prevent the development of drug-resistant fungi and ensure the safe and effective management of asthma.
  • The exact mechanisms by which infections, dysbiosis, and fungi influence asthma are not fully understood and require further research.
  • It is essential to accurately diagnose and manage asthma to reduce the risk of exacerbations and improve quality of life.
  • This includes identifying and managing potential triggers, such as infections and dysbiosis.
  • Collaboration between researchers, healthcare providers, and patients is necessary to advance our understanding of the complex interplay between infections, dysbiosis, fungi, and asthma and develop effective strategies for managing this challenging disease.

Call to Action: Improving Diagnostic Tools and Methodology for Asthma

While significant progress has been made in understanding the relationship between infections and asthma, there are still challenges and barriers to identifying and managing the infectious agents that contribute to asthma development and exacerbation. One of the biggest challenges is the lack of well-established diagnostic tools and methodology for identifying the specific types of infections that are most likely to trigger asthma exacerbations.

Therefore, the World Asthma Foundation must call for increased research into developing and validating new diagnostic tools and methodology for infectious asthma. This research should focus on identifying new biomarkers that can be used to distinguish between different types of infectious asthma, and on developing new diagnostic tests that are highly sensitive and specific for detecting these biomarkers.

In addition, the World Asthma Foundation should advocate for increased funding for research into infectious asthma, including research into the mechanisms by which infectious agents contribute to asthma development and exacerbation, and the potential role of dysbiosis and the microbiome in infectious asthma.

Improved diagnostic tools and methodology for infectious asthma will be critical for developing more effective strategies for managing and preventing this challenging disease. By supporting research in this area, the World Asthma Foundation can make a significant impact on improving the lives of individuals living with asthma.

Future reports will delve further into the challenges and opportunities related to developing improved diagnostic tools and methodology for infectious asthma, highlighting new research and potential strategies for addressing this critical need.

Let’s work together to improve our understanding of infectious asthma and develop better ways to manage and prevent it.

Conclusion

Asthma is a complex respiratory disease with various factors that can contribute to its development and exacerbation, including infections.

A comprehensive understanding of the complex interplay between infections and asthma is critical for the management and prevention of asthma.

Further research is needed to develop more effective strategies for managing and preventing infection-related asthma.

As the World Asthma Foundation, it is essential to continue supporting and encouraging research into the relationship between infections and asthma, to improve the lives of those living with asthma.

References

Darveaux JI, Lemanske RF Jr. Infection-mediated asthma: etiology, mechanisms and treatment options, with focus on
Chlamydia pneumoniae and macrolides. Respir Res. 2002;3:14. doi:10.1186/rr172

Infection-mediated asthma: etiology, mechanisms and treatment options, with focus on Chlamydia pneumoniae and macrolideviruses
Wilmore C. Webley & David L. Hahn https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-017-0584-z

Jackson DJ, Johnston SL. The role of viruses in acute exacerbations of asthma. J Allergy Clin Immunol. 2010;125(6):1178-1187. doi:10.1016/j.jaci.2010.04.021

Huang YJ, Marsland BJ, Bunyavanich S, et al. The microbiome in allergic disease: Current understanding and future opportunities-2017 PRACTALL document of the American Academy of Allergy, Asthma & Immunology and the European Academy of Allergy and Clinical Immunology. J Allergy Clin Immunol. 2017;139(4):1099-1110. doi:10.1016/j.jaci.2017.02.007

Johnston SL. Azithromycin for acute asthma: the AMASE randomized clinical trial. JAMA. 2016;316(17):1711-1713. doi:10.1001/jama.2016.16302

Asthma Research Participants Wanted

Dear World Asthma Foundation friends, the following message is from a research company interested in connecting.

Hello,

My name is Maggie, and I am with LaGrippe Research, a market research firm specializing in healthcare. We are currently inviting Parents of children aged 6-17 diagnosed with Asthma as well as teens aged 12-17 diagnosed to participate in our upcoming discussion on the topic of asthma and wanted to see if you would be interested in participating. This project’s purpose is to learn more about the adolescent patient journey with Asthma from the parent/caregiver perspective and the child. Participants must live in the USA.

There are a few ways in which you and/or your child can participate:

Parent only web assisted telephone discussion – 75-minute one-on-one call + 20-minute pre-task = $175

Paired webcam interview to include both you and your child – 90 minutes + 20-minute pre-task each = $300

For children ages 12-17 – 90-minute webcam mini focus group + 20-minute pre-task $150

If this sounds like something you might be interested in, please fill out our preliminary questions online here: https://www.surveymonkey.com/r/9DY7TRR

Once this is done, we will call you to go over a few additional items, as well as discuss which format you and/or your child which to participate in.

If you have any questions, please contact Maggie at 847-373-4104 or email maggie@lagripperesearch.com

Maggie Barber
Director
847-373-4104
www.lagripperesearch.com

Understanding and Managing Severe Asthma: Types, Symptoms, and Treatment

Severe asthma is a type of asthma that is difficult to control and can have a significant impact on a person’s daily life. Symptoms of severe asthma can include frequent exacerbations (attacks), high levels of asthma symptoms, and a need for high doses of medication to manage symptoms. Causes of severe asthma can include allergies, exposure to environmental triggers, and genetics. Treatment for severe asthma typically includes a combination of long-term control medications, such as inhaled corticosteroids and bronchodilators, as well as quick-relief medications to be taken during exacerbations. In some cases, additional treatments such as biologic medications or immunomodulators may be needed to manage symptoms.

Types of severe Asthma

There are several subtypes of severe asthma that can be characterized based on specific symptoms and causes. These include:

It’s important to note that some people may have characteristics of more than one subtype of severe asthma. It’s important to work with a healthcare professional to identify your specific subtype of asthma and develop a treatment plan that works for you.

Allergic Asthma

Allergic asthma is a subtype of severe asthma that is caused by an allergic reaction to a specific trigger, such as dust mites, mold, animal dander, pollen, or certain foods. The allergens cause the immune system to overreact and release chemicals, such as histamine, which can lead to inflammation and narrowing of the airways.

  1. Allergic asthma: characterized by an allergic reaction to a specific trigger, such as dust mites, mold, or pet dander.
  2. Non-allergic asthma: characterized by symptoms that are not caused by an allergic reaction, but rather by triggers such as viral infections, cold air, or exercise.
  3. Aspirin-exacerbated respiratory disease (AERD): characterized by severe asthma symptoms that are triggered by the use of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs)
  4. Obesity-related asthma: characterized by asthma symptoms that are made worse by being overweight or obese.
  5. Occupational asthma: characterized by symptoms caused by exposure to specific triggers in the workplace, such as chemicals or dusts.
  6. Bronchial thermoplasty: characterized by symptoms caused by structural changes in the airways, such as thickening of the muscle layers that can make it harder to breathe.
  7. Eosinophilic asthma: characterized by a high number of white blood cells called eosinophils in the airways.

Symptoms of allergic asthma can include:

  • Shortness of breath
  • Wheezing
  • Chest tightness
  • Coughing, especially at night or early in the morning
  • Difficulty breathing, especially during physical activity
  • Rapid breathing

Allergic asthma is diagnosed through a combination of medical history, physical examination, and laboratory tests such as skin prick test or blood test (specific IgE) to determine the specific allergens to which an individual is sensitive.

Treatment for allergic asthma typically includes:

  • Avoiding exposure to allergens as much as possible
  • Long-term control medications, such as inhaled corticosteroids and bronchodilators
  • Quick-relief medications to be taken during exacerbations, such as short-acting bronchodilators
  • Allergen-specific immunotherapy (allergy shots) to help reduce sensitivity to specific allergens over time.

It’s important to note that many people with allergic asthma also have other allergic conditions, such as hay fever, eczema, or hives. They may have benefit from a comprehensive allergy management plan, including allergy testing and immunotherapy.

Non allergic asthma

Non-allergic asthma is a subtype of severe asthma that is not caused by an allergic reaction, but rather by other triggers such as viral infections, cold air, exercise, stress, or exposure to certain chemicals or pollutants. The exact cause of non-allergic asthma is not known, but it is thought to be related to changes in the airways that make them more sensitive to certain triggers.

Symptoms of non-allergic asthma can include:

  • Shortness of breath
  • Wheezing
  • Chest tightness
  • Coughing, especially at night or early in the morning
  • Difficulty breathing, especially during physical activity
  • Rapid breathing

Non-allergic asthma is diagnosed through a combination of medical history, physical examination, and laboratory tests such as pulmonary function test, to rule out other causes of asthma like infections or structural changes.

Treatment for non-allergic asthma typically includes:

  • Identifying and avoiding triggers as much as possible
  • Long-term control medications, such as inhaled corticosteroids and bronchodilators
  • Quick-relief medications to be taken during exacerbations, such as short-acting bronchodilators
  • Monitoring of symptoms and lung function regularly

It’s important to note that non-allergic asthma and allergic asthma can have similar symptoms and the distinction between the two subtypes can be difficult. A healthcare professional will work with you to identify the specific triggers of your asthma and create an individualized treatment plan.

Mucus Plugs and Asthma

Mucus plugs, also known as bronchial plugs, can be a complication of asthma. Mucus plugs are clumps of thick, sticky mucus that can block the airways and make it harder to breathe. They can form in the airways of people with asthma as a result of inflammation and increased mucus production in the lungs.

Symptoms of mucus plugs in asthma can include:

  • Shortness of breath
  • Wheezing
  • Chest tightness
  • Coughing, especially at night or early in the morning
  • Difficulty breathing, especially during physical activity
  • Rapid breathing
  • Wet or gurgling sounds when breathing
  • Increased mucus production and difficulty clearing mucus from the lungs

Mucus plugs can be caused by a number of factors, including exposure to triggers such as allergens, viral infections, or pollutants, as well as by changes in the airways that make them more sensitive to certain triggers.

Treatment for mucus plugs in asthma typically includes:

If you have asthma and are experiencing symptoms of mucus plugs, it’s important to speak with your healthcare professional to develop an individualized treatment plan. In some cases, additional treatments such as biologic medications or immunomodulators may be needed to manage symptoms.

Wheezing and Severe Asthma

Wheezing is a common symptom of severe asthma, as well as other types of asthma. It is a whistling or whistling sound that can be heard when breathing, especially during exhalation. Wheezing is caused by narrowed or obstructed airways, which can make it harder to breathe.

In severe asthma, wheezing can be a sign of increased inflammation and narrowing of the airways, which can lead to difficulty breathing and increased risk of exacerbations. The increased airflow resistance leads to increased air movement velocity, generating the wheezing sound.

Symptoms of severe asthma can include:

  • Frequent exacerbations (attacks)
  • High levels of asthma symptoms, such as shortness of breath, chest tightness, and coughing
  • A need for high doses of medication to manage symptoms
  • Increased risk of hospitalization
  • Difficulty with daily activities and impairment of quality of life

Treatment for severe asthma typically includes a combination of long-term control medications, such as inhaled corticosteroids and bronchodilators, as well as quick-relief medications to be taken during exacerbations. In some cases, additional treatments such as biologic medications or immunomodulators may be needed to manage symptoms.

It’s important to work closely with a healthcare professional to develop an individualized treatment plan for severe asthma. This may include regular monitoring of symptoms and lung function, as well as a plan to manage exacerbations and prevent future attacks.

  • Identifying and avoiding triggers as much as possible
  • Long-term control medications, such as inhaled corticosteroids and bronchodilators
  • Quick-relief medications to be taken during exacerbations, such as short-acting bronchodilators
  • Chest physical therapy, such as chest clapping and vibration, to help remove mucus from the lungs
  • Monitoring of symptoms and lung function regularly

Food Dye and Inflamation

Common food dye can trigger inflammatory processes, say university researchers

A recent university study funded by the Canadian Institutes of Health Research reflects that long-term consumption of Allura Red food dye can be a potential trigger of inflammatory bowel diseases (IBDs) and potentially other inflammatory diseases processes as well.

Researchers using experimental animal models of IBD found that continual exposure to Allura Red AC harms gut health and promotes inflammation. Researchers using experimental animal models of IBD found that continual exposure to Allura Red AC harms gut health and promotes inflammation.

‘This further understanding will benefit Asthmatics as well,’ said Alan Gray, Director at the World Asthma Foundation . The human gastrointestinal (GI) tract is home to a diverse ecosystem of microbes, known collectively as the microbiota. Among its many roles, the gut microbiota regulates the immune system and protects against harmful pathogens. In fact, the largest part of the immune system, the gut-associated lymphoid tissue, is found in the gut. This network of immune cells and tissues interacts closely with the gut microbiota, influencing inflammation throughout the body including the lungs.

The dye directly disrupts gut barrier function and increases the production of serotonin, a hormone/neurotransmitter found in the gut, which subsequently alters gut microbiota composition leading to increased susceptibility to colitis.

Khan said Allura Red (also called FD&C Red 40 and Food Red 17), is a common ingredient in candies, soft drinks, dairy products and some cereals. The dye is used to add colour and texture to foodstuffs, often to attract children.

The use of synthetic food dyes such as Allura Red has increased significantly over the last several decades, but there has been little earlier study of these dyes’ effects on gut health. Khan and his team published their findings in Nature Communications. Yun Han (Eric) Kwon, who recently completed PhD in Khan’s laboratory, is first author.

“This study demonstrates significant harmful effects of Allura Red on gut health and identifies gut serotonin as a critical factor mediating these effects. These findings have important implication in the prevention and management of gut inflammation,” said Khan, the study’s senior author, a professor of the Department of Pathology and Molecular Medicine and a principal investigator of Farncombe Family Digestive Health Research Institute.

“What we have found is striking and alarming, as this common synthetic food dye is a possible dietary trigger for IBDs. This research is a significant advance in alerting the public on the potential harms of food dyes that we consume daily,” he said.

“The literature suggests that the consumption of Allura Red also affects certain allergies, immune disorders and behavioural problems in children, such as attention deficit hyperactivity disorder.”

Khan said that IBDs are serious chronic inflammatory conditions of the human bowel that affect millions of people worldwide. While their exact causes are still not fully understood, studies have shown that dysregulated immune responses, genetic factors, gut microbiota imbalances, and environmental factors can trigger these conditions.

In recent years there has been significant progress in identifying susceptibility genes and understanding the role of the immune system and host microbiota in the pathogenesis of IBDs. However, similar advances in defining environmental risk factors have lagged, he said.

Khan said that environmental triggers for IBDs include the typical Western diet, which includes processed fats, red and processed meats, sugar and a lack of fibre. He added that the Western diet and processed food also includes large amounts of various additives and dyes.

He added that the study suggests a link between a commonly used food dye and IBDs and warrants further exploration between food dyes and IBDs at experimental, epidemiological and clinical levels.

World Asthma Day Summary

On the day after World Asthma Day, May 3, 2022, we scanned the globe to find a statement that best sums up the current state of affairs regarding Asthma.

Kudos to tbe U.S National Institute of Environmental Health NIH Statement on World Asthma Day 2022: Toward Improved Asthma Care

Good enough of summary that we want to publish this in its entirety.

Asthma is a serious lung disease; causes chest tightness, wheezing, and coughing; can often be controlled with proper treatment.

Today (May 3, 2022) on World Asthma Day, the National Institutes of Health reaffirms its commitment to biomedical research aimed at preventing the onset of asthma, understanding its underlying causes, and improving the treatment of it. This chronic airway disease, which is characterized by periodic worsening of inflammation that can make it hard to breathe, affects more than 25 million people in the United States, including more than 5 million children. Left untreated, it can be life-threatening.

While scientists have made substantial progress in understanding asthma diagnosis, management, and treatment, therapies to permanently improve breathing for those who suffer from asthma remain elusive. Researchers around the globe are working steadily toward this goal while they seek to better understand and find new ways to manage the disease. They also are continuing research on the underlying causes of disparities in the incidence, care, and prevention of the disease. On the heels of recently updated management and treatment guidelines, researchers anticipate a brighter future for people living with asthma.

Three NIH institutes primarily support and conduct studies on asthma — the National Heart, Lung, and Blood Institute (NHLBI); the National Institute of Allergy and Infectious Diseases (NIAID); and the National Institute of Environmental Health Sciences (NIEHS). Other NIH Institutes and Centers also support and conduct asthma research. NIH scientists and grantees made important advances in understanding, treating, and managing asthma in 2021, which are briefly highlighted as follows:

Asthma and COVID-19

An NHLBI-funded study showed that during the pandemic, asthma attacks, also known as asthma exacerbations, significantly decreased in a large group of children and adolescents, compared to the year before the pandemic. The study also found that telehealth visits among these patients increased dramatically during this time. The study included nearly 4,000 participants aged 5-17 years with a prior diagnosis of asthma. Researchers believe a better understanding of the factors that contributed to these improved outcomes could lead to better asthma control in all children and adolescents, as researchers noted no racial or ethnic differences in health outcomes in this population.

A NIAID-funded study found that asthma does not increase the risk of becoming infected with SARS-CoV-2, the virus that causes COVID-19. This finding came from a six-month household survey of more than 4,000 children and adults conducted between May 2020 and February 2021.

Asthma Disparities

Researchers have known for decades that social determinants of health – conditions like housing, neighborhood, education, income, and healthcare access – can affect the quality of life and asthma-related health outcomes of people living with the disease. NIH scientists are now reporting new advances in understanding the relationship between social determinants of health and asthma.

Black and Hispanic children who live in low-income urban environments in the United States are at particularly high risk for asthma attacks. These children tend to be underrepresented in large trials of new biologic therapies for asthma.

In a recent NIAID-supported clinical trial, the monoclonal antibody mepolizumab decreased asthma attacks by 27% in Black and Hispanic children and adolescents who have a form of severe asthma, are prone to asthma attacks, and live in low-income urban neighborhoods.

In one study, NHLBI-funded investigators demonstrated the importance of housing interventions in improving the health of children with asthma. Poor quality housing is associated with a high level of asthma triggers – including mold, cockroach, mouse, and dust mite allergens – that can pose a health threat to children with asthma. The study showed the feasibility of using targeted interventions – including better pest management, improved ventilation, and moisture reduction – to achieve healthy housing. It showed that such interventions can result in reduced symptoms and hospitalizations due to asthma.

Environmental Exposures and Asthma

Researchers have known for years that asthma can be triggered by substances in the indoor and outdoor environment. New research shows that exposure to some asthma triggers might even occur before birth.

In an NIH-supported study that included grant support from NIEHS and the NHLBI, researchers reported that prenatal exposure to tiny air pollution particles significantly increased the risk for developing asthma in children. The study, which analyzed data from two different study cohorts, focused on a group of mothers and their children, mostly Black or Hispanic, in the Boston area who lived near major roadways with heavy traffic. It found that more than 18% of the children who were exposed to high levels of these so-called ultrafine particles in the womb developed asthma in their preschool years, compared to 7% of children overall in the United States.

An NIEHS clinical study will assess how environmental factors affect disease progression in non-smoking adults who have moderate or severe asthma. The study will focus on the microbiological and genetic factors associated with atopic asthma, also known as allergic asthma, which is triggered by pollen, dust mites, and other allergens. A better understanding of this data might lead to improved treatments for people with this type of asthma, researchers say.

Climate Change and Asthma

Studies have shown that climate change can increase air pollutants such as ground-level ozone, fine particulates, wildfire smoke, and dust, and that these pollutants can exacerbate asthma. Climate change can also affect the production, distribution, and severity of airborne allergens.

NIEHS, NHLBI, and other NIH institutes and centers are leading the NIH Climate Change and Health Initiative. This is a cross-cutting NIH effort to reduce health threats such as asthma that can develop or worsen because of climate change. The initiative will look at these threats across the lifespan and find ways to build health resilience in individuals, communities, and nations around the world. A strategic framework for the Initiative will help guide NIH investments in this area.

An NIEHS-funded study provides examples of how extreme weather events can affect asthma outcomes. For example, as heat waves and droughts become more frequent and prolonged, the risk of large wildfires will likely increase, resulting in poor air quality that makes it more difficult to control asthma. Other climate-change events can lead to longer and more intense pollen seasons, while mold and dampness in homes may cause asthma to develop or worsen preexisting cases.

About the National Institute of Allergy and Infectious Diseases (NIAID): NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.

About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives. For more information, visit www.nhlbi.nih.gov. For additional information about NHLBI’s asthma resources, visit https://www.nhlbi.nih.gov/BreatheBetter.

About the National Institute of Environmental Health Sciences (NIEHS): NIEHS supports research to understand the effects of the environment on human health and is part of the National Institutes of Health. For more information on NIEHS or environmental health topics, visit

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

The World Asthma Foundation Announces Speakers for Microbiome First Summit

On this World Asthma Day, May 3, 2002, The Microbiome First – Pathway to Sustainable Healthcare Summit organization committee invites healthcare professionals, non-communicable disease community leaders, and stakeholders to participate in the inaugural Microbiome First Summit, a virtual event taking place online at MicrobiomeFirst.org this May, 17-19, 2022. FREE to participants.

For detailed information and to register, visit: https://microbiomefirst.org/

The event, Microbiome First – Pathway to Sustainable Healthcare Summit, kicks off the inaugural event underwritten and moderated by the
World Asthma Foundation (WAF), which is pleased to announce the
following speakers:

Event Keynote
RODNEY DIETERT, PHD
Cornell University Professor Emeritus
Ithaca, NY, USA
Author of The Human Superorganism.
Keynote: “Big Picture View of Our Tiny Microbes”

Researcher Sessions
MARIE-CLAIRE ARRIETA, PHD
Associate Professor, departments of Physiology, Pharmacology, and Pediatrics, University of Calgary
Calgary AB, CANADA
Session: “The early-life mycobiome in immune and metabolic development”

JAEYUN SUNG, PHD
Assistant Professor, Microbiome Program, Center for Individualized Medicine, Mayo Clinic.
Rochester, MN, USA
Session: “A predictive index for health status using species-level gut microbiome profiling”

KATRINE L. WHITESON, PHD
Assistant Professor, Molecular Biology and Biochemistry School of Biological Sciences
Associate Director, UCI Microbiome Initiative
Irvine, CA, USA
Session: “High-Fiber, Whole-Food Dietary Intervention Alters the Human Gut Microbiome but Not Fecal Short-Chain Fatty Acids”

LISA AZIZ-ZADEH, PHD
Cognitive neuroscientist; Expert in brain imaging, autism, body cognition
Associate Professor in the USC Chan Division of Occupational Science and Occupational Therapy
Los Angeles, CA, USA
Session: “Brain-Gut-Microbiome System: Pathways and Implications for Autism Spectrum Disorder”

MARTIN KRIEGEL, MD, PHD
Chief of Rheumatology and Clinical Immunology at University Hospital of Münster
GERMANY
Associate Professor Adjunct of Immunobiology at Yale School of Medicine.
Session: “Dietary Resistant Starch Effects on Gut Pathobiont Translocation and Systemic Autoimmunity”

ERICA & JUSTIN SONNENBURG, PHD
Senior research scientist and Associate Professor in the Department of Microbiology and Immunology at the Stanford University School of Medicine.
Palo Alto, CA, USA
Session: “Gut-microbiota-targeted diets modulate human immune status”

EMMA HAMILTON-WILLIAMS, PHD
Associate Professor
Principal Research Fellow
The University of Queensland Diamantina Institute
Faculty of Medicine
The University of Queensland
Translational Research Institute
Woolloongabba, QLD, AUSTRALIA
Session: “Metabolite-based Dietary Supplementation in Human Type 1 Diabetes is associated with Microbiota and Immune modulation”

ANDRES CUBILLOS-RUIZ, PHD
Scientist, Wyss Institute of Harvard University and Institute of Medical Engineering and Science at Massachusetts Institute of Technology
Cambridge, MA, USA
Session: “Protecting the Gut Microbiota from Antibiotics with Engineered Live Biotherapeutics”

EMERAN A MAYER, MD
Gastroenterologist, Neuroscientist, Distinguished Research Professor
Department of Medicine, UCLA David Geffen School of Medicine
Executive Director, G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA
Founding Director, UCLA Brain Gut Microbiome Center.
Los Angeles, CA, USA
Session: “The Gut–Brain Axis and the Microbiome: Mechanisms and Clinical Implications”

BENOIT CHASSAING, PHD
Principal Investigator, Chassaing Lab
Associate professor, French National Institute of Health and Medical Research.
Paris, FRANCE
Session: “Ubiquitous food additive and microbiota and intestinal environment”

SEI WON LEE, MD, PHD
Associate Professor
College of Medicine, University of Ulsan
Department of Pulmonary and Critical Care, Asan Medical Center
Seoul, KOREA
Session: “The Therapeutic Application of Gut-Lung Axis in Chronic Respiratory Disease”

PATRICIA MACCHIAVERNI, PHD
Clinical and translational researcher
Research Fellow, The University of Western Australia
Perth, WA, AUSTRALIA
Honorary Research Associate, Telethon Kids Institute.
Session:House Dust Mite Shedding in Human Milk: a Neglected Cause of Allergy Susceptibility?”

LIEKE VAN DEN ELSEN, PHD
Research Fellow, The University of Western Australia, Australia
Honorary Research Associate, Telethon Kids Institute.
Perth, WA, AUSTRALIA
Session: “Gut Microbiota by Breastfeeding: The Gateway to Allergy Prevention”

PAUL TURNER, PHD
Rachel Carson Professor of Ecology and Evolutionary Biology, Yale University
Microbiology faculty member, Yale School of Medicine.
New Haven, CT, USA
Session: “New Yale Center to Advance Phage Research, Understanding, Treatments, Training, Education”

ANDRES CUBILLOS- RUIZ, PHD
Scientist, Wyss Institute of Harvard University and Institute of Medical Engineering and Science of Massachusetts Institute of Technology MIT
Boston, MA, USA
Session: “Protecting the Gut Microbiota from Antibiotics with Engineered Live Biotherapeutics”

CLAUDIA S. MILLER, MD, MS
Emeritus Professor, Allergy/Immunology and Environmental Health University of Texas San Antonio, TX, USA
Session: “Toxicant-Induced Lost of Tolerance for Chemicals, Foods and Drugs: a Global Phenomenon”

Media Supporter Content
TONI HARTMAN
PRINCIPAL
Microbiome Courses
London, England UK
Session “Educating Parents About ‘Seeding And Feeding’ A Baby’s Microbiome”

Summit Details:

The goal of the Microbiome First – Sustainable Healthcare Summit is to
improve quality of life at reduced cost by addressing the microbiome
first, as recent research shows that all of these non-communicable diseases have a relationship to the microbiome.

For additional information visit https://microbiomefirst.org/ or on Twitter at @MicrobiomeFirst https://twitter.com/MicrobiomeFirst

Asthma Rates and Mask – Good or Bad?

65% drop in serious asthma cases due to mask-wearing Israeli hospital reports

The Times of Israel reports that the Sheba Medical, an Israeli hospital reports 65% drop in serious asthma cases due to mask-wearing.

Here’s the 411 according to published reports:

• A study conducted by Sheba Medical Center found that the past year saw a 65 percent drop in serious asthma cases that required hospitalization.

• The drop was credited to widespread mask-wearing during the COVID-19 pandemic, which also helped decrease the spread of viruses such as the flu in the past year.

• By wearing masks, people are also less likely to suffer from seasonal allergies, as face coverings prevent pollen from flowers, trees, and grass coming into contact with the nose and mouth.

• The report follows Israel’s decision to drop the requirement to wear masks outdoors.

Israeli hospital reports 65% drop in serious asthma cases due to mask-wearing Jerusalemites wearing face masks walk in Jerusalem on February 04, 2021.

Asthma and Bacteriophages – What We Know Now

What is a Bacteriophage

According to the U.S. National Institute of Health, Bacteriophages (or “phages”) are viruses that can kill or incapacitate specific kinds of bacteria while leaving other bacteria and human cells unharmed. By gathering naturally-occurring phages, or by modifying or engineering phages to display certain properties, researchers hope to create novel anti-bacterial therapeutics. Researchers connect Asthma and Bacteriophages.

Impact on Asthma

Staphylococcus aureus enterotoxins (intestinal toxins) have a demonstrated effect on airway disease including Asthma in early life according to multiple studies. These bacteria are in the gut and on the skin.

Because phages eliminate bacteria by infecting them, rather by generating compounds like antibiotics which kill bacteria, phages can be used to treat antibiotic-resistant infections. In addition, some evidence suggests that combination therapy containing both phages and antibiotics could prevent bacteria from becoming drug resistant.

Although scientists have been aware of phages and their ability to kill bacteria since 1917, the  first U.S.-based clinical trials of phage therapy have only recently begun. Individual U.S. patients have received phage therapy, but only under emergency investigational new drug protocols.  

World Asthma Foundation: Dr. Papadopoulos, what prompted your research into bacteriophages?

Asthma and Bacteriophages Video

Connecting Asthma and Bacteriophages

Dr. Nikolaos Papadopoulos: For many years, we have been working on the viral aspects of allergic diseases and particularly asthma based on the observation that most of the symptoms, especially the exacerbations of asthma, followed the common cold. There has been a link well-established, with lots of papers and lots of studying on the relationship of a particular virus, rhinoviruses with asthma exacerbations. Then there were more observations about associations, about bacterial infections, again in exacerbations.

Virus – Bacteria Interaction

We have discovered that the viral aspect also drives, to some extent, persistence of asthma, which means that viruses induce factors that trigger remodeling. Repeated infections might lead you to persistent asthma. Then we started looking at the interactions between viruses and bacteria. While we were looking at these specific micro-organisms, we realized that, as many other scientists did, we were actually focusing on our own little field without giving much attention to the wider perspective of the ecology of at least the local niche, the nose or the lungs where we have found in the last decade that you do have a growth of microbiome.

Lung Microbiome

In the past, we thought that in the lungs, there was no microbiome, but in fact, we know now that there is. Of course, there is increased interest generally in the microbiome and its disturbance, what we call dysbiosis in every condition. Then when we focus, we look at asthma. Wherever there is a focus on evaluating the microbiome in health and disease, there’s almost always this dysbiosis, this imbalance. We don’t know whether this is something that causes the disease or is a cause of the disease. However, it is very important to understand these characteristics.

Less Antibiotics

For us, it has been very important to place the different organisms and their interaction within a community and try to understand whether it’s possible, instead of trying to kill everything. That’s what we do with antibiotics. Instead of trying to eliminate our enemies, rather try to balance things and see whether we can have a community which is balanced and as considered resilient to external possible enemies. This is when and how we started looking into the meta-genome, and particularly the virion of the respiratory tract. That is how this all started.

World Asthma Foundation: What were the key findings?

Dr. Papadopoulos: Our observations so far, this is something I’ve been looking into more detail. As we expected, it is much more complicated rather than saying that one microorganism goes up and another one goes down. It’s much more about the ecology of the organisms rather than specific microorganisms.

Dynamics Between Microorganisms

I think this is a major understanding, a leap forward in that we shouldn’t think of microorganisms as individual forces that shape our internal microbiome health. It is the dynamic between microorganisms. It’s much more closer to health or disease because as you have one microorganism grow, then you have less resources for the other.

It is a balance, which is dynamic and happens all the time. This is where we got into bacteriophages in particular. This was something we did not expect. Also, it was not on the list of the viruses that we were focusing on because we’re focusing on the typical RNA viruses, the ones that harm, usually, like viral viruses of flu or RSV.

Bacteriophages As Main Player

Then we saw that the main player, one of the main players within the viral communities within the virion were the bacteriophages. In fact, and I think that’s our main finding, we’re the first to suggest is that there is a deficiency of bacteriophages in the upper respiratory tract, at least of children, this is where we have studied it.

Asthma and Bacteriophages 

We are now looking into different communities, different people, different geographies, et cetera, but the observation was repeated in another cohort. We don’t have many bacteriophages in an asthmatic airway. This is associated with looser network of microorganisms and less robust interaction network between the viruses and the bacteria.

Intervention With Phages

These key findings suggest that we might be able to intervene. This is a very good opportunity for intervention because we know that bacteriophages, mostly in most cases, they don’t harm.

They are in balance with the human host because they need to be there. It’s to both our benefits to control the bacterial populations for them not to overexpand. It’s a natural ally.

There is a possibility that we might be able to intervene using bacteriophages, but of course, this is not as straightforward as an antibiotic where you just give something, you kill whatever is susceptible and then it goes away.

We’re talking now about ecological balances. We need to understand exactly what type of bacteriophage you might need, what dose, at what time, et cetera. This is what we are actually doing now.

World Asthma Foundation: Thank you. What would you like asthmatics to know?

Dr. Papadopoulos: Well, we can look at the glass as half-full, as half-empty.

Glass Half Empty

The half-empty part is that for turning bacteriophage or different bacteriophages into therapy, we do need to do lots of things. Not only understand the mechanisms and select the bacteriophages, et cetera, but also, we have to overcome lots of regulatory hurdles because in our Western society, we can’t still use bacteriophages. They are living organisms. In order to standardize a living organism to provide it as medicine, it is really demanding.

Of course, there are all these questions and you’ve seen what happens now with the vaccines, even though most of them are not living organisms, still, it is very complex and we need to be very, very careful when we are exploring it.

Glass Half Full

On the other hand, what we are understanding of the half-full aspect is that by understanding the mechanisms and the dynamics of these microorganisms, we understand why healthy living, why being close to nature, why avoiding lots of pollutants makes us healthier in every aspect. This is also for people who have asthma.

Simple Advice

We know that some very simple and daily advice, like for example, being closer to nature, like eating healthy, for example, and avoiding things that generate pollution and things that generate inflammation is something that does improve their health.

I would suggest that asthmatics, as everybody else, should embrace the idea of a healthy environment and healthy people within this healthy environment.

Asthma and bacteriophages may soon be shown to be a very useful connection.

Bacteriophages research Dr. Nikolaos Papadopoulos reports.
Dr. Nikolaos Papadopoulos reports on bacteriophage research.

World Asthma Day – May 5, 2021 – Spread the Word

World Asthma Foundation is supporting care of Asthma and asthmatics around the world. Please help those that suffer by spreading the word.

The WAF is doing it’s part by:

* Announcing the Defeating Asthma Project with the aim of shining a spotlight on getting to a cure

* Asthma education and advocacy for people with asthma who suffer

World Asthma Day May 5, 2021 Spread the Word

“We can move the needle by taking action now to make the difference for those that suffer from Asthma.” – Alan Gray, Director WAF Australia

We’ve hunkered down close to home here at the WAF. While doing so, we’re poring over volumes of available Asthma research data to share our understanding of the root causes of Asthma with emphasis on Severe Asthma.
Our ultimate goal is to understand the root cause of Severe Asthma (already considered a pandemic by many) while we aim for a cure. By banding together with other Asthmatics, including those that care about Asthmatics and clinicians that treat, we can defeat Asthma and we can do so now.

Why this Matters:

Asthma is not one disease but many and the causes underlying its development and manifestations are many including environmental issues

Asthma has reached pandemic levels around the globe

Asthma is a chronic lung disease that affects over 300 million worldwide

The projected rate will reach 400 million by 2025

Environmental exposures have been proven to play a significant role in the development of asthma and as triggers

Asthma is believed to be determined by a complicated set of one’s own genetics and environmental exposures including a multitude of toxic chemicals and the overuse of antibiotics

In the U.S., African Americans are almost three times more likely to die from asthma-related causes than the white population

Australia reported the highest rate of doctor diagnosed, clinical/treated asthma, and wheezing

Defining asthma remains an ongoing challenge and innovative methods are needed to identify, diagnose, and accurately classify asthma at an early stage to most effectively implement optimal management and reduce the health burden attributable to asthma

According to the U.S. Centers for Disease Control, The total annual cost of asthma in the United States, including medical care, absenteeism and mortality, was $81.9 Billion a year.

Bacteriophages, Asthma, Airway Inflammation and Infection

To understand Bacteriophages and their role in airway inflammation, chronic infection and Asthma, World Asthma Foundation reached out to Dr. Bollyky, immunologist and infectious disease specialist at Stanford Medical Center for an introduction to these topics.

Allergic disorders pose a growing challenge to medicine and our society. Therefore, novel approaches to prevention and therapy are needed. Recent progress in studies on bacterial viruses (phages) has provided new data indicating that they have significant immunomodulating activities. We show how those activities could be translated into beneficial effects in allergic disorders and present initial clinical data that support this hope.” – Society for Experimental Biology and Medicine

Introduction to Bacteriophages

World Asthma Foundation: Dr. Bollyky, can you introduce us to bacteriophages, their impact on chronic bacterial infections, airway inflammation and asthma?  

Video: Introducing Asthma and Bacteriophages – Airway Inflammation and Infection Interview with Dr. Bollyky, immunologist and infectious disease specialist at Stanford Medical Center

Dr. Bollyky: Yes, sure. First, just a little bit about the background of the lab and what we do. Then I’ll tell you about the bacteriophage we’re working on, and how we think it may relate to immune regulation, and airway inflammation in general.

We’re immunologists, as well as being infectious disease docs, and so my lab has worked now for a number of years trying to study immune regulation in the lung, and how populations of different regulatory cells sense allergens, and how they keep healthy folks from developing hypersensitivity to those allergens, and really where they go wrong in asthma. We’ve been doing that work about as long as I’ve been a professor at Stanford, which is about seven years. And a lot of that is funded by the NIH.

The other hat that I wear is as an infectious disease doc, and obviously anyone who has asthma will tell you that infections are among the triggers that seem to precipitate flares. 

There’s a lot of literature about asthma being related to flora, and to both episodic as well as long-term exposures to the microbial world. My lab studies a particular type of microorganism called the bacteriophage. These are viruses that are made by bacteria, and they are very abundant in your body as well as in your lungs, and really anywhere where bacteria tend to live. In the same way that you and I have viruses, your bacteria do too, and they produce these things in incredible amounts.

A fairly good rule of thumb is that you’re going to find somewhere in the neighborhood of 10 bacteriophages for every bacteria that you have at a site of chronic infection. The number is higher than that in sea water, but in most of the studies that have been done of the gut, or the oral tract, or the vagina, in spaces like this the numbers hold true. 

There’s less data in the lung, but I think you can be fairly confident that, again, anywhere where you’ve got long-term bacteria setting up shop, you have these phages. What we’ve been looking at recently is how your immune system sees these phages, and how they alter both the immune response to bacteria, but then sort of immune homeostasis in general.

One of the things that we found is that these phages tend to dampen responses to infection by bacteria, and they do that basically by being perceived as viruses, as you might expect, because that’s really what they are.

Phages and Asthma

World Asthma Foundation: How do  phages relate to asthma?

Dr. Bollyky: In two ways.

The first is, it may alter the microbiome of the lung and allow bacterial infections to persist, ironically longer than they might otherwise, because they keep immune clearance from happening. This may be counter-intuitive because most of us think of viruses as being bad for the host organisms, in this case bacteria, but both are probably true, meaning, bacteriophages are parasitized bacteria, but vis-a-vis the immune system they probably may also contribute to their persistence.

The other part about it, which is what we’ve been looking at recently, is how bacteriophages modulate the immune environment of the lung in general. There, it seems that, not unlike other viruses, that you see some interesting polarizing effects on immunity.

In all of this, there’s some very particular aspects of this that I think are relevant to the microbiome of the lung, and again, particularly to phages, but all of this highlights the complicated and, I think, fascinating immune and microbial environment of the lung in asthma, and how much we have to learn about that environment, and conversely, how many opportunities there would be to intervene in that system, if we only knew more.

Key Findings

World Asthma Foundation: What are the key findings?

Dr. Bollyky: A couple of things that folks who follow the literature will relate to. The first is there’s just been a lot more attention that’s being paid to the microbiology of the lung, and the idea – when I did my medical training, it’s getting close to 20 years now, what I learned at that time was that the lung was sterile, for example.

We know that that’s by far an oversimplification, and that there’s actually a lot of stuff going on there. Most of the past decade has been about characterizing the bacteria, and the fungi, and what have you, that are in the lung. Now, I think people are becoming alert, or attentive to the possibility, or to the fact that there are also endogenous viruses in these places, and that your lung has an ecology to it, where maybe not unlike, well, really any other ecology, the African Savanna, or your favorite fishing hole down the street.

There’s a lot of organisms that exist in competition, and in equilibrium at some points, and those are dynamic and living systems that we need to think about. That’s one trend, it’s just the attention to the microbiome and then the attention in particular to components of the microbiome.

I would put fungi in this, but also these bacteriophages that were relatively ignored until fairly recently, and then we’ve become kind of cognizant of what they do.

The other trend that I think is arising, that’s part and parcel of that in terms of asthma, is realizing that these different organisms, like fungi, like viruses and bacteria, exert opposing and, I think, important effects on the immune response, and that these things, the endogenous viruses you have, much like the endogenous bacteria, or the endogenous fungi can influence the ways that your immune system sees the rest of the world, and the ways in which it’s regulated.

Bacteriophages and Gut-Lung Interaction

World Asthma Foundation: We’ve been reporting on the Gut-Lung axis. Do you see that connection playing a role?

Dr. Bollyky: Yes, it’s a particularly interesting one too, because again, I think we tend to think of the lung in isolation, but the reality is that, both from above, in the form of your sinuses and secretions from there, but then also from below, meaning your gut.

Every time you sleep we know these secretions do go down. If you look at the microbiome of the lung, a lot of it tends to be oral flora, and a lot of it tends to be fairly transient, meaning, the studies that have been done would suggest that the bugs, the bacteria, and assuming it will probably be the case for the phages as well, but certainly the bacteria and the fungi that you have in your lung are fairly representative of the same organisms that you have in your sinus tract and in your gut. Your upper GI tract.

This ends up populating to a large extent your lungs. This big debate about whether your lungs are sterile or not really comes down to whether you think that these microbial interlopers are a part of a stable population or what their relationship is. As you are clearly aware, a lot of these same antibiotic resistance patterns, a lot of the same metabolites that your gut bacteria produces or that your sinus bacteria produce is going to end up in your lungs. Then, that’s going to influence the local immune response and ultimately asthma.

New Phage Research

World Asthma Foundation: Thank you Dr. Bollyky. What’s next?

Dr. Bollyky: We’re looking at phages and asthma models, and we’ve been studying a lot of infections, both human diseases like cystic fibrosis and in mouse models. Hopefully, I’ll be able to tell you more soon about phages and the allergens and regulatory T cell populations and that sort of stuff, and I’d love to come back.

World Asthma Foundation: We look forward to that. Thank you very much.

Dr. Bollyky: You got it.

See also Dr. Dietert’s interview about the Gut and Lung connection.

Find more information about Dr. Bollyky here.

Dr. Bollyky introduces bacteriophages, impact on chronic bacterial infections, airway inflammation and asthma