Author: Alan Gray

Alan Gray is the director of The World Asthma Foundation. He writes stories based on research, produces interviews and podcasts; and works on the Defeating Asthma Project and the Microbiome First Summit.
Posted on

Clean Air for Better Health: World Asthma Day and Indoor Air Quality

As we celebrate World Asthma Day, it is important to acknowledge the risks associated with asthma and the benefits of having clean air. Asthma is a chronic respiratory disease that affects millions of people worldwide. It is a condition that causes the airways in the lungs to become inflamed and narrow, making it difficult to breathe. While outdoor air pollution has been identified as a major risk factor for asthma, the air quality inside our homes and workplaces can also have a significant impact on our health.

To raise awareness about the importance of indoor air quality, the TimeToClearTheAir.com campaign aims to educate people on the simple steps they can take to improve the air quality inside their homes and workplaces. One of the key messages of the campaign is that clean air is essential for good health and well-being.

According to the World Health Organization (WHO), indoor air pollution is responsible for over 4 million premature deaths every year. Indoor air pollution can be caused by a variety of factors, including cooking, cleaning, smoking, and the use of certain household products. To achieve clean indoor air, there are several steps that individuals and households can take.

One of the most important steps is to eliminate sources of indoor air pollution. This can include switching to non-toxic cleaning products, using natural air fresheners, and avoiding smoking indoors. In addition, it is important to ensure that ventilation systems are functioning properly and to regularly clean air filters.

Monitoring indoor air quality is also crucial in identifying sources of pollution and taking steps to eliminate them. This can be done using a variety of devices, including air quality monitors and carbon monoxide detectors. Seeking professional help when necessary, such as hiring a professional to assess indoor air quality or installing an air purification system, is also important.

Air pollution is a major risk factor for asthma, and it can trigger asthma symptoms or exacerbate existing asthma. The most common sources of air pollution include traffic emissions, industrial activities, and burning fossil fuels. But indoor air pollution can also contribute to the problem, as allergens, pet dander, mold, and tobacco smoke can all cause asthma symptoms.

Clean the Air for World Asthma Day is a call-to-action that emphasizes the importance of reducing air pollution for the health of people with asthma and the general population. To Clean the Air for World Asthma Day, we need to take action on multiple fronts. One of the most important steps is to reduce outdoor air pollution, which requires government policies and action from industry to reduce emissions.

Individuals can also take steps to reduce their exposure to air pollution and improve their indoor air quality. This includes reducing the use of products that emit volatile organic compounds (VOCs), using natural cleaning products, and avoiding smoking or exposure to secondhand smoke. Ventilating indoor spaces properly and regularly cleaning air filters can also help improve indoor air quality.

In addition to these actions, individuals can support policies and organizations that promote clean air. This includes advocating for clean energy and transportation policies, supporting asthma research and education, and participating in local community initiatives to reduce air pollution.

In conclusion, clean air is essential for good health and well-being. By taking simple steps to improve indoor air quality and advocating for policies that reduce air pollution, we can reduce the risk of respiratory problems, including asthma, and enhance our overall quality of life. The TimeToClearTheAir.com campaign and Clean the Air for World Asthma Day are both valuable resources for individuals and households seeking to improve indoor air quality and promote good health.

Posted on

A Critical Window In Early Life for Microbiome and Asthma

disruption of the microbiome in the gut and lung. Image by Clker-Free-Vector-Images from Pixabay

It may seem strange, but disruption of the gut and lung microbiomes, (microorganisms found in a specific environment) is deeply rooted in the Asthma conundrum according to a growing number of medical researchers. There is a critical window in early life that affects the life a baby will live.

Disruption of the Microbiome in the Gut and Lung link to Asthma?

Word from the editor: This is part of a series of articles on the Microbiome and Asthma. The World Asthma Foundation, dedicated to Defeating Asthma aims to unpack a variety of issues including the clinical evidence that connects the Microbiome and Asthma while describing the mechanisms of this disease

This disruption referred to as “Dysbiosis” by medical experts is an imbalance between the types of organism present in a person’s natural microflora, especially that of the gut, thought to contribute to a range of conditions of ill health, including asthma.

Quote

Researchers at the Interuniversity Messerli Research Institute, Medical University Vienna and the Center for Pathophysiology, Infectiology and Immunology, Institute of Pathophysiology and Allergy Research, Medical University also located in Vienna, Austria have published:

* What causes dysbiosis?

Dysbiosis of the gut and lung microbiome may lead to increased severity of asthmatic symptoms, including airway inflammation
* Treatment with probiotics can reduce inflammation and improve asthma control
* Gut dysbiosis increases intestinal permeability which allows inflammatory molecules to enter the blood stream – this triggers an immune response that leads to chronic low-grade systemic inflammation
* Probiotic administration reduces levels of proinflammatory cytokines in circulation by increasing production of anti-inflammatory cytokines such as IL-10 and IL-22 from T regulatory cells (Tregs) within the gastrointestinal tract* There are many different types of bacteria found in both the gut and lungs – each has its own set effects on health; some promote immunity while others promote allergy responses or other inflammatory conditions like asthma

Key Findings

  • humans are mostly microbial (in terms of numbers of cells and genes)
  • immune dysfunction and misregulated inflammation are pivotal in the majority of NCDs
  • microbiome status affects early immune education and risk of NCDs
  • microbiome status affects the risk of certain infections.

Critical Window in Early Life

  • The lungs are not sterile, as doctors once thought
  • Disruption in gut and lung microbiomes can lead to asthma
  • Probiotics can reverse dysbiosis and reduce inflammation
  • There is a critical window in early life that points to whole-of-life

What You Need to Know

  1. The gut microbiome is a key player in asthma
  2. Dysbiosis of the gut and lung microbiome may lead to severity of asthma symptoms
  3. Probiotics can reduce inflammation and improve asthma control
  4. Gut dysbiosis allows inflammatory molecules into the bloodstream, triggering immune response
  5. Probiotics reduce inflammation by increasing anti-inflammatory cytokines
  6. Some gut and lung bacteria promote immunity, others promote allergy and inflammation
  7. There is a critical window in early life

disruption of the microbiome in the gut and lung. Image by Clker-Free-Vector-Images from Pixabay
Disruption of the microbiome in the gut and lung. Image by Clker-Free-Vector-Images from Pixabay

Posted on

Monoclonal Antibodies Anaphylaxis Risk For Severe Asthma Patients

Monoclonal antibodies

Most monoclonal antibodies increase the risk of anaphylaxis in severe asthma patients, according to a report published in Clinical and Translational Allergy. The study found 4 out of 5 common mAbs were associated with an increased risk of anaphylaxis. Each of the therapies had a different risk profile. One monoclonal antibody – dupilumab – exhibited a very low risk. The patients in this study were mainly young and middle-aged adults.

What You Need to Know

Monoclonal antibodies (mAbs) are a type of medication designed to work on one specific target, in contrast to conventional medications that often affect more than one site within the body. They differ from polyclonal treatments by binding specifically to a single place (an epitope) on their target protein. Monoclonal antibodies are found naturally, produced by cloned B cells called hybridomas.

For those with severe asthma, there are Clinical Safety Issues. Any severe asthmatic who experiences an anaphylactic reaction due to food or insect allergy must be made aware that the use of mAbs may cause an adverse reaction for them.

Severe asthma patients receiving monoclonal antibodies need close monitoring due to increased anaphylaxis risk, the new study found.

The report, published in Clinical and Translational Allergy, found 4 out of 5 common mAbs were associated with a heightened anaphylaxis risk, though the risk varied from therapy to therapy.

Key Takeaways

  • Monoclonal antibodies work with the immune system.
  • mAbs target cancer cells, viruses, bacteria, and other pathogens.
  • They may be beneficial in autoimmune diseases in place of other immunosuppressive agents.
  • mAbs generally prevent allergic reactions, but for some people, may cause a severe adverse reaction.
  • Regular doses of antihistamines and/or epinephrine may be used with the monoclonal antibodies.

Common monoclonal antibodies include:

– omalizumab (trade names Xolair and Omeclamox and used for allergies to asthma and insect bites)

– mepolizumab (trade name Nucala, a newer monoclonal antibody. It is used for Severe Persistent Asthma in those who have moderate to severe allergic asthma and do not respond well to conventional treatments.)

What Are Monoclonal Antibodies?

Monoclonal antibodies are secreted proteins that neutralize a pathogen or an undesirable substance. They derive from monocytes and can bind to target the protein which is responsible for activating B-cells during immune response. They function as a tool to modify the progression of disease by slowing down the symptoms of autoimmune reactions.

Monoclonal Antibodies (MAbs) function to eliminate pathogens or unwanted toxins. They may have diagnostic as well as treatment potentials in autoimmune disease-related disorders.

The World Asthma Foundation thanks the six expert researchers for their insight into how normally beneficial Monoclonal Antibodies may cause Anaphylactic reactions in severe asthmatics.

Li L, Wang Z, Cui L, Xu Y, Guan K, and Zhao B. “Anaphylactic risk related to omalizumab, benralizumab, reslizumab, mepolizumab, and dupilumab.” Published online June 3, 2021. doi:10.1002/clt2.12038

Monoclonal antibodies
Monoclonal antibodies, PR image.

Posted on

New Treatment for Asthma? Airway Collagen Affects Breathing

A new study finds that manipulating the stiffness of the collagen in the airway has an effect on breathing.

The airway consists of both a conducting region (larynx, trachea, bronchi, bronchioles) where air is humidified, warmed, and cleaned and a respiratory zone where gas exchange occurs. The airway is directly and continuously exposed to both macromechanical and micromechanical forces.

Macromechanics is the study of organ-level mechanical and material properties. Intrathoracic respiratory forces, perfusion, and cough represent some of the dynamic macromechanical forces exerted on the respiratory system. As the airway is composed of heterogeneous components (chondrocytes, epithelium, endothelium, muscle, extracellular matrix (ECM)), these constituents can be individually quantified using micromechanics.

Micromechanical properties drive the mechanotransduction in the airway, driving cell–cell and cell–matrix interactions [1].

Collagen is most abundant component in the airway extracellular matrix. It is also the primary component that determines mechanical properties of the airway. This discovery around the structure of airway cells could lead to a new treatment for asthma.

What You Need to Know

Abnormal airway collagen deposition is associated with the pathogenesis and progression of airway disease according to the researchers, Lumei Liu, Brooke Stephens, Maxwell Bergman, Anne May, and Tendy Chiang, in Columbus, Ohio.

Liu is with the Center of Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children’s Hospital in Columbus, OH.

Key Takeaways

  • collagen has a major role in airway mechanics
  • macro- and micro-scale approaches can quantify airway mechanics
  • collagen deposition affects pathologic changes in airway diseases.

The World Asthma Foundation would like to thank these experts for their research for their understanding how collagen affects healthy airway tissue mechanics is essential. The impact of abnormal collagen deposition and tissue stiffness has been an area of interest in pulmonary diseases such as cystic fibrosis, asthma, and chronic obstructive pulmonary disease. The researchers seek to provide biomechanical clues for targeted therapies and regenerative medicine to treat airway pathology and address airway defects.

airway collagen affects breathing. Image by OpenClipart-Vectors from Pixabay
Airway collagen affects breathing. Image by OpenClipart-Vectors from Pixabay

Posted on

Asthma and Sustainable Healthcare – Rodney Dietert PhD Interview

World Asthma Foundation” Defeating Asthma Series Uncovers New Hope for Asthma Management

Asthmatics: Our understanding of Asthma and the way we treat it may soon be radically different from what currently exists, due to new research on the human microbiome and how the microbiome affects asthma. Looking at Asthma and Sustainable Healthcare, keeping costs under control while delivering high quality healthcare.

In this interview with Rodney Dietert, PhD Cornell University Professor Emeritus, Health Scientist Head of Translational Science + Education for SEED and the Author of the Human Super-Organism How the Microbiome is Revolutionizing the Pursuit of a Healthy Life we learn about the benefits of Sustainable Healthcare and what we should be thinking about to get there.

Interview on Asthma and Sustainable Healthcare

World Asthma Foundation: You write about the microbiome and sustainable health care. Can you explain why this matters?

Dr. Dietert: I think that recent estimates from CDC and WHO, that global death by these non-communicable diseases like asthma, inflammatory bowel, and the like, it’s not just developed countries but developing countries as well. Is 70-75% of all deaths are from these conditions.

You might note that people live sometimes many decades with these conditions with polypharmacy. Furthermore, if you have one of those, you have a really good chance as you age of having more. That requires additional medications, each one with different side effects, and potential drug interactions can occur.

We think we’re very healthy because of longevity. But we lead a lot of our life in illness and sometimes stressing our caregivers’ system because some of these (conditions) require caregivers as well. There’s a different path. That (the present path) is not, in my mind, a sustainable path.

Testing Sustainable Healthcare

My family are well represented in some of these diseases. We know the trajectory, we’ve lived the trajectory and there’s a different way to go. Once you recognize that it starts with our interaction with the external world, and the microbiome is the interface. It’s what they see: the chemicals, drugs, food first. And what we get is what they’ve dealt with and left behind or metabolized and reacted to.

Control What Can Be Controlled

We can and should control that and it should be integrated so we’re dealing with it like the regenerative agriculture people. Dealing with the soil, the air, the water, the plants, the animals, and us as a continuum of microbial interactions, where we can really have everything be healthy and sustainable.

Reduce Disease Prevalence

If we do that, we’re going to reduce the prevalence of these diseases. The drug companies will find other ways to continue to be profitable in a sustainable way, but we don’t need to be chasing symptoms of some of these diseases but instead cure the disease.

Treating Symptoms Not Causes

Quite frankly, I think I’ve discussed in the book, we’ve cured very few of these diseases. We treat symptoms. In fact, we only treat presenting symptoms. I’ve shown how these diseases are all very much connected as co-morbid factors of each other. A child diagnosed with asthma, we know what kind of diseases are likely to show up in those groups of children with asthma as they age.

In my mind, physicians have yet to deal with that. They actually don’t do things that stop that from happening in a 30, 40, 50-year old when they see a child with asthma. They treat the symptom of the day. That’s a change and a change that would allow us to be much more sustainable in our health and in our medicine that we practice.

Asthma and Sustainable Healthcare
Asthma and Sustainable Healthcare, Rodney Dietert PdD

 

 

Posted on

Can we replace missing microbes? – Rodney Dietert Ph.D.

Defeating Asthma Series uncovers New Hope for Asthma Managementant

In this fourth in a series of interviews with Rodney Dietert, PhD Cornell University Professor Emeritus, Health Scientist Head of Translational Science + Education for SEED and the Author of the Human Super-Organism How the Microbiome is Revolutionizing the Pursuit of a Healthy Life we learn about:

* Replacing replacing missing microbes

World Asthma Foundation: Dr. Dietert can we replace missing microbes?

Dr. Dietert: There are products available and we have used a product that is a missing skin microbe. It’s very important in certain metabolic pathways that actually help provide health benefits that are beyond the skin.

Video: Can we replace missing microbes? – Rodney Dietert Ph.D.

That was one that basically was recovered in a very interesting way that involved essentially marriages between some indigenous people and others that were westernized and the microbe being able to not necessarily be removed from a remote location but being able to be a part of what we would call genetically an F1.

There are opportunities to retrieve some missing microbes. I think Dr. Blaser and his wife have done incredible work by the way as well, very much attuned and will have a lot to offer on what’s missing and where is it and can it be retrieved. I think the answer is yes. There are commercial products and we’ve actually used some of them that are the missing microbes.

It’s important to recognize that some of the indigenous peoples that have not had the same environmental experiences that we’ve had, and the same contact with modernization have microbes that are exceptionally important for health are helping prevent obesity and asthma and diabetes in those populations. Those microbes are really the protectors.

Yes, I think that reintroducing those to the extent it is possible is an extremely worthwhile effort.

I would point out that it’s a fragile situation because I think from Dr. Blaser and his wife’s work, you will learn that the indigenous populations in South America if they go into the urban areas, if their children go into the urban areas, start adopting the diet and lifestyle there, it takes no time at all for them to acquire the same set of diseases that we see so prevalent here.

World Asthma Foundation: With that, Dr. Dietert, we certainly thank you for your time, all that you do for the microbiome and the community. Good afternoon, and thanks again.

Dr. Dietert: Well, and thank you for all you do with the World Asthma foundation, Bill. Pleasure.

Posted on

Study assesses asthma treatment options in African American children and adults

Use of long-acting bronchodilators had no impact for some African American children.

A new study of African Americans with poorly controlled asthma, found differences in patients’ responses to commonly used treatments. Contrary to what researchers had expected, almost half of young children in the study responded differently than older children and adults, and than white children in prior studies.

“We shouldn’t assume that current treatment strategies for asthma are ideal for all African Americans since for many years that population was not adequately represented in research,” said Elliot Israel, M.D., senior study author and director of clinical research in the Pulmonary and Critical Care Medicine Division at Brigham and Women’s Hospital. “We found that almost half of the African American children studied responded better to increasing the dose of inhaled corticosteroids than adding a long-acting bronchodilator. Thus, adding a long-acting bronchodilator may not be the right answer for nearly half of African American children.”

The National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, funded this research to assess the best approach to asthma management in African Americans, who suffer much higher rates of serious asthma attacks, hospitalizations, and asthma-related deaths than whites. The findings appear today in the New England Journal of Medicine.

The researchers examined how to escalate or “step-up” asthma treatments for African Americans whose asthma had not been treated adequately with low doses of inhaled corticosteroids, the standard starting treatment. The treatment choices in the trial included increasing the dose of inhaled steroid, adding a long-lasting bronchodilator (used to help open airways), or both.

Based on prior studies, investigators expected that increasing the inhaled corticosteroid dose would lead to improvement in most African American children needing treatment for asthma.

The researchers found that in children under 12 years of age, either approach was effective: nearly half (46%) responded better to increasing the inhaled corticosteroid dose alone and just as many (46%) responded better to increasing the inhaled corticosteroid dose and adding a long-lasting bronchodilator.

“This study suggests that we cannot look at results from one population and extrapolate the findings to African Americans or any other group,” said Michael Wechsler, M.D., principal investigator for the NHLBI-funded Best African American Response to Asthma Drugs (BARD) study and professor of medicine at National Jewish Health in Denver. “If children do not respond to one treatment, parents and providers could consider another option because there is almost a 50% chance of having a better response.”

The multicenter study included 574 participants — about half of whom were ages 5–11 and half 12 years and older. All participants in this study had at least one self-identified African American grandparent, with an average of approximately 80% African ancestry, based on genetic testing.

Of the adolescents over 11 years old and adults, most (49%) responded better to adding a long-lasting bronchodilator than to increasing the inhaled corticosteroid dose, though 20–25% in this group showed no difference in their responses to these approaches.

Investigators also examined whether patient characteristics, including genetic ancestry, could be used to predict the response to the “step-up” treatments in the study participants. But they were unable to use genes indicative of African ancestry, or any of the other patient characteristics they measured in this group of patients, to predict treatment response.

“Although we cannot attribute the study’s findings to genetic markers of African ancestry, there could be as-yet unknown genetic variants specific to people of African descent that affect how severe a patient’s asthma is,” said Wechsler.

Before the trial began, the researchers did not expect the participants to have a better response to treatment regimens that included long-lasting bronchodilators, despite the inclusion of these agents in treatment recommendations. They said they were surprised that many (46% of the young children and 49% of the older children and adults) improved with long-lasting bronchodilators.

“These results provide new data about the management of asthma patients who self-identify as African American regardless of genetic ancestry,” said James Kiley, Ph.D., director of the Division of Lung Diseases at NHLBI. “Every person and their provider should explore all of their management choices to achieve maximum asthma control, based on their response to specific medications.”

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 https://www.nhlbi.nih.gov.

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.