The World Asthma Foundation’s symposium continues to shed light on airway mycosis, an often-overlooked factor in severe asthma. On Day 2, Dr. David Corry delivered a compelling presentation that delved into the latest research, diagnostic challenges, and potential treatment strategies for fungal-related lung diseases.
Why Airway Mycosis Matters
Airway mycosis refers to fungal infections and colonization in the respiratory tract, which can significantly impact asthma severity and overall lung health. Despite its potential to worsen symptoms, increase hospitalizations, and complicate treatment, it remains underdiagnosed due to limited awareness and inadequate testing methods
.
Dr. Corry’s research highlights the growing recognition of fungi as key players in respiratory diseases, emphasizing the need for more precise detection, treatment, and management strategies.
Advancing Diagnostics: A Game-Changer
One of the most pressing issues in diagnosing airway mycosis is the lack of standardized testing protocols. Dr. Corry introduced an open-source, cost-effective culturing technique that has the potential to revolutionize fungal detection. Unlike traditional methods that often fail to identify the presence of fungi, his approach allows for more accurate and reliable diagnosis.
However, regulatory hurdles remain a challenge. While these new diagnostic techniques are promising, widespread clinical adoption requires changes in how fungal infections are perceived and tested in mainstream medicine.
The Way Forward: Solutions for a Neglected Condition
Dr. Corry’s insights highlight several critical steps needed to improve outcomes for patients suffering from airway mycosis:
Raising Awareness – Educating healthcare providers and the public about fungal-related lung diseases can lead to earlier diagnosis and better treatment strategies. The World Asthma Foundation symposium is playing a key role in fostering this conversation.
Enhanced Diagnostics – With improved culturing techniques and new testing protocols, diagnosing airway mycosis can become more accessible and reliable. However, regulatory bodies must be open to adopting these innovations.
Investment in Research – There is an urgent need for more research into the mechanisms, risk factors, and treatment options for airway mycosis. The symposium serves as a catalyst for collaboration among researchers, clinicians, and industry leaders.
Conclusion
Airway mycosis represents a hidden yet significant burden on patients and healthcare systems. Dr. Corry’s presentation underscores the urgency of better diagnostics, increased research, and enhanced clinical awareness to tackle this neglected issue.
By advocating for change, supporting innovative research, and fostering global collaboration, the World Asthma Foundation is leading the charge in addressing airway mycosis.
Stay tuned for more insights from the symposium as we continue to explore the evolving landscape of asthma and respiratory health.
Millions of severe asthma sufferers are searching for answers, often unaware that airway mycosis—a hidden fungal infection—could be the underlying cause of their chronic respiratory problems. April 5-6, 2025 the World Asthma Foundation is hosting a groundbreaking symposium to explore this critical issue, bringing together experts to shed light on the latest research and treatment strategies.
David B. Corry, MD. Medicine-Immunology, Allergy and Rheumatology, Baylor College of Medicine
The World Asthma Foundation (WAF), in collaboration with Dr. David Corry, a renowned airway mycosis and severe Asthma specialist at Baylor University, is committed to raising awareness about this critical issue and the underlying mechanisms of severe asthma.
To address this knowledge gap and improve patient outcomes, WAF is hosting an online symposium April 5-6, 2025. This blog post lays the groundwork for the event, which will bring together experts to discuss diagnosing and managing airway mycosis in severe Asthma patients.
By fostering collaboration, the symposium aims to unveil the hidden mechanisms of fungal asthma, including the root fungal cause and empower better understanding and treatment options for patients with severe asthma.
Burden of Airway Mycosis
Misdiagnosis and Underdiagnosis: Airway mycosis often mimics other respiratory illnesses and is difficult to diagnose using standard methods, leading to misdiagnosis and delayed treatment. This can worsen symptoms and hinder overall patient outcomes.
Chronic Illness and Suffering: Airway mycosis can cause debilitating symptoms like chronic cough, wheezing, shortness of breath, and chest pain. It significantly reduces patients’ quality of life.
Economic Costs: The economic burden of airway mycosis is substantial. Direct medical costs associated with treatment and hospitalization are high. Additionally, indirect costs due to lost productivity are significant.
Challenges and Gaps in Knowledge
Incomplete Understanding of Causes: Dr. Corry’s research emphasizes the need for further investigation into the exact mechanisms by which fungi contribute to airway diseases. The complex interplay between fungal exposure, immune response, and airway inflammation remains unclear.
Mechanisms of fungal asthma are incompletely understood. Research into how fungi cause asthma has improved with the discovery of virulence factors such as proteases and candidalysin, but this has yet to translate into new therapies. Newer antifungal agents such as peptoids and many others hold great promise for better management of airway mycosis.
Limited Diagnostic Tools: Current diagnostic methods for airway mycosis are often insensitive and lack specificity. This makes timely and accurate diagnosis difficult.
Silos in Treatment Approaches: A fragmented approach often exists in managing airway mycosis. Improved collaboration between pulmonologists, allergists, immunologists, and infectious disease specialists is essential.
The Way Forward
Raising Awareness: Increased awareness among healthcare professionals and the public is crucial for earlier diagnosis and improved treatment outcomes. The WAF symposium directly addresses this need.
Enhanced Diagnostics: Dr. Corry’s work on culturing techniques offers promise for improved fungal detection. Development of more accurate and specific diagnostic tools remains essential for proper diagnosis of airway mycosis. These methods are open source and inexpensive; the main hindrance is regulatory acceptance of new protocols.
Investment in Research: Further research is required to elucidate the underlying causes of airway mycosis, identify new treatment options, and improve patient management strategies. The World Asthma Foundation symposium can serve as a catalyst for such research collaborations.
Conclusion
Airway mycosis poses a significant but under-recognized burden on patients and healthcare systems. By raising awareness, improving diagnostics, fostering collaboration, and investing in research, we can effectively address the challenges of this complex disease. The World Asthma Foundation symposium serves as a springboard for this critical work.
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.
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.
Severe Asthma News Announced at American Thoracic Society Conference
If you suffer from severe Asthma you’re not alone. As you’ve been following the World Asthma Foundation, (WAF) then you’re aware that we’ve declared war on Asthma here at the #ATS2013 annual conference where leading Asthma specialist meet. If you suffer from severe Asthma like I do, then this news from Boehringer Ingelheim (BI) will be of interest to you.
BI today announced data from Phase 2 and Phase 3 studies from the Company’s ongoing clinical trial program investigating the efficacy and safety of tiotropium in asthma. These data were presented at the American Thoracic Society International Conference (ATS 2013) in Philadelphia, Pennsylvania.
To determine whether the effect on bronchodilation and time to first severe exacerbation seen in severe asthma patients in the two Phase 3 PrimoTinA-asthma™ studies was limited to definable subgroups of patients, pre-planned subgroup analyses of the data were carried out. The PrimoTinA-asthma™ studies were replicate trials evaluating once-daily tiotropium delivered via the Respimat® inhaler in patients with severe persistent asthma.
The pre-planned subgroup analyses demonstrated that tiotropium delivered once daily via the Respimat® inhaler showed promising results across a broad spectrum of patients with severe persistent asthma who remained symptomatic and experienced exacerbations despite current treatment with at least high-dose inhaled corticosteroids (ICS) and/or long-acting beta2 agonists (LABA).
“These analyses show that the results for time to first severe exacerbation and first episode of asthma worsening found with the addition of tiotropium may not be limited to specific subgroups of patients,” said Professor Huib A. M. Kerstjens of the University Medical Centre, Groningen, The Netherlands, and one of the main authors on the presented studies. “Asthma affects patients with all kinds of medical histories and backgrounds. These results suggest tiotropium’s promise independent of patients’ baseline characteristics, providing an important clinical insight into tiotropium’s potential in asthma treatment.”
Neither the time to first severe exacerbation nor the time to first episode of asthma worsening was dependent on baseline characteristics, some of which are usually found in patients with chronic obstructive pulmonary disease (COPD), such as former smoking, non-allergic status or minimal bronchodilator response.
It was also important to investigate whether patients included in the PrimoTinA-asthma™ Phase 3 studies were identified to have asthma alone and not comorbid COPD.
In a separate study presented at ATS, further analysis of the PrimoTinA-asthma™ data suggested that improvements in lung function seen in the Phase 3 studies were related to tiotropium’s potential role in asthma and not due to comorbid COPD diagnosis, as strict criteria were used to ensure patients enrolled in the studies had a confirmed diagnosis of asthma and that patients with COPD were excluded.
“Despite current treatment options, approximately 40 percent of people with asthma remain symptomatic and may experience life-threatening asthma exacerbations,” said Tunde Otulana , MD, acting head, Clinical Development and Medical Affairs, Boehringer Ingelheim Pharmaceuticals, Inc. “Finding new advancements for the growing number of people affected by asthma remains one of Boehringer Ingelheim’s priorities, and we are encouraged to see additional data reinforcing tiotropium’s potential as an additional treatment option for asthma patients who remain symptomatic on current therapies.”
About the PrimoTinA-Asthma™ Phase 3 Studies
The PrimoTinA-asthma™ Phase 3 studies were two replicate double-blind, parallel group trials including asthma patients aged 18-75 years, with at least a five-year history of asthma, diagnosed before the age of 40 years, and life-long non-smokers or ex-smokers (10 pack-years or less) who quit smoking one or more years before study enrollment.
A total of 912 patients were randomized to receive tiotropium 5 mcg delivered via the Respimat® inhaler (n=256) or placebo (n=256) for 48 weeks. In addition to ICS/LABA, patients in the trials were permitted to receive additional background therapy, including antihistamines, anti-allergic agents, nasal steroids and omalizumab.
The primary endpoints included peak and trough forced expiratory volume (FEV1) and time to first severe exacerbation. In these studies, the rate of adverse events (AEs) reported in the tiotropium add-on and placebo add-on groups was similar. The most commonly reported AEs were asthma, peak expiratory flow (PEF) rate decrease, nasopharyngitis and headache.
Additional Data Presented at ATS 2013
In addition to the PrimoTinA-asthma™ data, Boehringer Ingelheim presented data investigating tiotropium in adult patients with moderate persistent asthma. Results from a Phase 2 double-blind, randomized, placebo-controlled, four-way crossover study with no washout periods revealed all three doses of tiotropium (1.25, 2.5 and 5 mcg) as an add-on therapy to ICS in symptomatic patients with moderate persistent asthma were statistically different (P < 0.0001) from placebo for the primary endpoint FEV1 peak(0-3h). The most promising once-daily tiotropium dose was 5 mcg delivered via the Respimat® inhaler. The overall incidence of AEs was comparable between placebo and the three tiotropium doses, and serious adverse events were rare and considered unrelated to treatment. The most commonly reported AEs were asthma and nasopharyngitis.
Tiotropium is being investigated to determine its efficacy and safety in treating asthma patients and is not currently approved for this indication.
About the UniTinA-Asthma™ Clinical Trial Program
The PrimoTinA-asthma™ studies are a part of the comprehensive Phase 3 trial program UniTinA-asthma™, which includes 18 clinical trials in adults, adolescents and pediatric patients across different asthma severities who remain symptomatic on current treatment with inhaled corticosteroids. The program includes more than 4,000 patients in 150+ sites globally.
About Asthma
Asthma is a chronic disease characterized by airway inflammation and bronchoconstriction. When a person with asthma comes into contact with an asthma trigger (e.g. infections, pollen, smoke), their airways can become inflamed, swollen and constricted and excess mucus is produced. These reactions can cause the airways to become narrower and irritated, making it difficult to breathe. People suffering from asthma experience recurrent episodes of wheezing, breathlessness, chest tightness and coughing. Asthma attacks occur when symptoms become more intense or frequent.
As of December 2012, an estimated 300 million people worldwide suffer from asthma. Estimates have shown that the number of people with asthma could grow by an additional 100 million people worldwide by 2025.
By avoiding asthma triggers, one can help to reduce the severity of asthma. Although asthma cannot be cured, appropriate management can control the disease in many patients. However, many patients still suffer from uncontrolled asthma despite the available treatment options. They can continue to have symptoms and lifestyle restrictions and might even require emergency care.
Leading Respiratory Forward
Through research, treatments and patient-centric support services, the Boehringer Ingelheim lung health portfolio is designed to help address the challenges people living with a lung disease face every day. Leveraging the company's cutting edge science and leadership in chronic obstructive pulmonary disease (COPD), Boehringer Ingelheim is researching new treatment approaches where needs persist. It is the company's goal to make a difference in the lives of patients with COPD, asthma, lung cancer, idiopathic pulmonary fibrosis and other respiratory diseases.
About Boehringer Ingelheim Pharmaceuticals, Inc.
Boehringer Ingelheim Pharmaceuticals, Inc., based in Ridgefield, CT, is the largest U.S. subsidiary of Boehringer Ingelheim Corporation (Ridgefield, CT) and a member of the Boehringer Ingelheim group of companies.
The Boehringer Ingelheim group is one of the world's 20 leading pharmaceutical companies. Headquartered in Ingelheim, Germany, it operates globally with 140 affiliates and more than 46,000 employees. Since it was founded in 1885, the family-owned company has been committed to researching, developing, manufacturing and marketing novel medications of high therapeutic value for human and veterinary medicine.
As a central element of its culture, Boehringer Ingelheim has a demonstrated commitment to corporate social responsibility. Involvement in social projects, caring for employees and their families, and providing equal opportunities for all employees form the foundation of the global operations. Mutual cooperation and respect, as well as environmental protection and sustainability are intrinsic factors in all of Boehringer Ingelheim's endeavors.
In 2012, Boehringer Ingelheim achieved net sales of about $19.1 billion (14.7 billion euro). R&D expenditure in the business area Prescription Medicines corresponds to 22.5% of its net sales.
For more information please visit www.us.boehringer-ingelheim.com
SOURCE Boehringer Ingelheim
New Asthma Trials Shows Promise – Let’s Declare War on Asthma Starts Now!
#ATS2013. The World Asthma Foundation (WAF) is covering the American Thoracic Conference #ATS2013 this week in search of solutions for Asthma suffers everywhere. To that end, press reports published today reflect that a new type of asthma drug meant to attack the underlying causes of the respiratory disease slashed episodes by 87 percent in a mid-stage trial, making it a potential game changer for patients with moderate to severe disease, researchers said on Tuesday.
“Overall, these are the most exciting data we’ve seen in asthma in 20 years,” said Dr. Sally Wenzel, lead investigator for the 104-patient study of dupilumab, an injectable treatment being developed by Regeneron Pharmaceuticals Inc and French drugmaker Sanofi in reports to Reuters.
The drug also met all its secondary goals, such as improving symptoms and lung function and reducing the need for standard drugs called beta agonists.
Although far larger trials will be needed to confirm findings from the “proof of concept” study, researchers expressed optimism. They noted that dupilumab has also shown the ability to tame atopic dermatitis, or severe eczema, an allergic condition that is not well controlled by current treatments.
Results of the 12-week asthma study are being presented on Tuesday at the annual scientific meeting of the American Thoracic Society in Philadelphia.
WAF in our effort to Declare War On Asthma will be following this story very closely. Stay tuned for in depth interviews on this topic.
Ginger compounds may be effective in treating asthma symptoms
#ATS2013 PHILADELPHIA ? Gourmands and foodies everywhere have long recognized ginger as a great way to add a little peppery zing to both sweet and savory dishes; now, a study from researchers at Columbia University shows purified components of the spicy root also may have properties that help asthma patients breathe more easily.
The results of the study were presented this week at the ATS 2013 International Conference.
Asthma is characterized by bronchoconstriction, a tightening of the bronchial tubes that carry air into and out of the lungs. Bronchodilating medications called beta-agonists (?-agonists) are among the most common types of asthma medications and work by relaxing the airway smooth muscle (ASM) tissues. This study looked at whether specific components of ginger could help enhance the relaxing effects of bronchodilators.
“Asthma has become more prevalent in recent years, but despite an improved understanding of what causes asthma and how it develops, during the past 40 years few new treatment agents have been approved for targeting asthma symptoms,” said lead author Elizabeth Townsend, PhD, post-doctoral research fellow in the Columbia University Department of Anesthesiology. “In our study, we demonstrated that purified components of ginger can work synergistically with ?-agonists to relax ASM.”
To conduct their study, the researchers took human ASM tissue samples and caused the samples to contract by exposing them to acetylcholine, a neurotransmitting compound that causes bronchoconstriction. Next, the researchers mixed the ?-agonist isoproterenol with three separate components of ginger: 6-gingerol, 8-gingerol or 6-shogaol. Contracted tissue samples were exposed to each of these three mixtures as well as unadulterated isoproterenol and the relaxation responses were recorded and compared.
At the conclusion of their study, the researchers found that tissues treated with the combination of purified ginger components and isoproterenol exhibited significantly greater relaxation than those treated only with isoproterenol; of the three ginger components, 6-shogaol appeared most effective in increasing the relaxing effects of the ?-agonist.
Once they were able to demonstrate that the ginger components enhanced the relaxing effects of the ?-agonist, they turned their attention to learning why. First, the researchers wanted to determine if the ginger components might work by affecting an enzyme called phosphodiesterase4D (PDE4D). Previous studies have shown that PDE4D, which is found in the lungs, inhibits processes that otherwise help relax ASM and lessen inflammation. Using a technique called fluorescent polarization, they found that all three components significantly inhibited PDE4D.
Next, the study looked at F-actin filaments, a protein structure which previous studies have shown plays a role in the constriction of ASM, and found that 6-shogaol was effective in speedily dissolving these filaments.
“Taken together, these data show that ginger constituents 6-gingerol, 8-gingerol and 6-shogaol act synergistically with the ?-agonist in relaxing ASM, indicating that these compounds may provide additional relief of asthma symptoms when used in combination with ?-agonists,” Dr. Townsend noted.”By understanding the mechanisms by which these ginger compounds affect the airway, we can explore the use of these therapeutics in alleviating asthma symptoms.”
Dr. Townsend and her colleague, Dr. Charles Emala, hope future studies will enable them to gain a better understanding of the cellular mechanisms that facilitate ASM relaxation and to determine whether aerosol delivery of these purified constituents of ginger may have therapeutic benefit in asthma and other bronchoconstrictive diseases.
Remote Patient Monitoring and Telehealth for Asthma Interview with ERT
Respiratory disease affects millions of people across the globe, with chronic lower respiratory diseases having the fourth highest mortality rate in the U.S. alone. Effective drug treatment is in high demand, which stresses the importance of respiratory clinical testing.
In the three minute with Michael Taylor, Senior Director, Healthcare Solutions at ERT we learn:
•How ERT is spearheading remote patient monitoring and telehealth for Asthma and COPD patients that provides a dedicated centralized spirometry for providing the most comprehensive clinical respiratory services and devices to ensure accurate data and efficient trial management.
•Why the WAF War on Asthma is important to him
According to ERT the key is having the right study resources in place and a centralized approach to drive the highest quality data.
May Lead to Limited Access to Asthma Therapies and Testing
ATS-2013 – In the three minute with David S. Wilson, M.D, FCCP, with the Lung Institute at Columbus Regional Hospital we learn:
•How the proposed American Thoracic Society (ATS) Asthma Treatment Guidelines Present Problems for Patients that May Lead to Limited Access to Asthma Therapies and Testing
May Lead to Limited Access to Asthma Therapies and Testing
•Why the WAF War on Asthma is important to him
Interview with Grace E. Hardie, PhD, RN, UCSF, SF State Associate Professor San Francisco State University
Our understanding of how ethnicity influences how patients describe their asthma symptoms and how ethnicity impacts airway responsiveness is extremely limited. Ethnic influences on symptom
description and airway responsiveness were the subject of a 2010 study of induced bronchoconstrictor administration in African Americans and Hispanic, Latino & Mexican Americans with mild asthma (Journal of Asthma, 2010; 47:1-9).
If healthcare professionals are better able to understand the ethnic differences in symptom descriptors and airway responsiveness, then treatment decisions that are both culturally and ethnically sensitive may be applied and outcomes may be improved.
Using a standardized methacholine (McH)challenge (bronchoconstrictor) procedure a doubling dose (0.078-10mg/ml) of McH was used that would result in a 30% fall (PC30) in FEV1. Mild asthma was defined as FEV1?70% of predicted. Baseline FEV1 was comparable for both groups. Mean age of African Americans was 30.3 y and mean age of Hispanic/Latino/Mexican Americans was 30.9 y. Ethnic differences in both airway hyperresponsiveness and symptom presentation were documented. The dose of McH at PC30 for African Americans was 2.6 mg/ml; Hispanic, Latino & Mexican Americans was 2.62 mg/ml. The dose of McH at PC30 reflects the significance of the degree of airway hyperresponsiveness experienced by both ethnic groups during episodes of acute asthma. African Americans used only upper airway ethnic word descriptors (EWD) at PC30 including itchy throat, tight throat, voice tight, & itchy neck. Hispanic-Mexican Americans at PC30 used both upper and lower airway EWDs to describe their symptoms:
Upper airway: voice tight, itchy throat, itchy inside throat & chest, & tickle cough: Lower airway EWDs were-sore lung-chest, wheezing, can’t get air in/out. The EWDs reported and their differences across the differing ethnicities reflect the uniquely different perception of acute bronchoconstriction for each ethnic group. For the health professional, the EWDs provide an opportunity to expand our understanding of ethnic differences in symptom presentation and, also, to determine symptom management.
What is not fully understood is the relationship between EWDs, the regulation of beta-adrenergic airway responsiveness and ethnicity. The current word descriptors of wheezing, shortness of breath and chest tightness were derived from studies enrolling primarily Caucasian adults. These EWDs need to be expanded and revised to reflect our more diverse ethnic populations. As health care professionals asking your asthma patients what their primary asthma symptoms are when they seek care for an acute episode is an essential step forward if symptom management for all diverse ethnic groups are to be improved.
High Risk Factors in Asthma-COPD Overlap Syndrome: Highly Prevalent But Grossly Underappreciated
By Tinka Davi, World Asthma Foundation
The statistics are staggering:
Every four minutes someone dies of COPD or chronic obstructive pulmonary disease.
Every day nine people die from asthma.
But what takes a higher toll is a combination of the two diseases, which is recognized as Asthma-COPD Overlap Syndrome or ACOS.
Because this syndrome has not received much attention by the medical community, the frequency of deaths due to ACOS alone has not been compiled.
ACOS, which was formerly called “asthmatic bronchitis,” is a commonly experienced, yet loosely defined clinical entity. It accounts for approximately 15 to 25 percent of the general population of obstructive airway diseases who experience worse outcomes compared to asthma or COPD alone.
Patients with ACOS have the combined risk factors of smoking and atopy such as hay fever. These adults are generally younger than patients with COPD and experience acute exacerbations or attacks of their breathing requiring immediate attention with higher frequency and greater severity than lone COPD.
Physicians and other healthcare professionals at UC Davis have taken their clinical experience and research nationally to increase public awareness.
“ACOS is concerning because it’s much worse in terms of exacerbations, or acute attacks of breathlessness, as compared to COPD.” said Amir Zeki, MD, assistant professor of medicine pulmonary, critical, and sleep medicine at the Center for Comparative Respiratory Biology and Medicine at the University of California Davis School Of Medicine.
Samuel Louie, MD and Amir Zeki, MD
Exacerbation is an acute flare up or worsening of the disease usually over two to three days that causes patients with asthma, COPD or both to seek immediate medical attention and a change in their daily medications.
An exacerbation is a flare up or worsening of the disease, otherwise known as an “attack.”
With an acute attack, the risk of hospitalization, need for steroids, days of missed work or school increases with ACOS, Zeki said. The prevalence of frequent exacerbations in ACOS is nearly two-and-a-half times higher than COPD and risk of severe exacerbations in ACOS is twice as high as COPD.
Zeki and Samuel Louie, MD are collaborating efforts to educate the medical field and the public about ACOS.
Louie, professor of medicine, is director of the UC Davis Asthma Network (UCAN) since 1998 and director of the UC Davis Reversible Obstructive Airway Disease (ROAD) Center, which serves adults and adolescents in Northern California who have difficult to control asthma, bronchiectasis and COPD.
“We are entering a new era of public awareness of people living with chronic lung disease such as asthma and COPD,” Louie said. “Our mission at UC Davis is to transform health care by integrating and provide quality patient care services these conditions, which promote patient education and safety, social networking, and to align our goals with national efforts to transform people’s lives. But we can achieve success without recognizing the clear and present danger from not recognizing the Asthma-COPD Overlap syndrome.”
The incidence of ACOS is becoming more prevalent. “One in five patients in our clinic will likely have ACOS,” Zeki said.
Louie agrees. “When patients learn what they have, they begin to look for more information and help. That is where we have to be ready to provide comprehensive services that are integrated and coordinated to help patients and their families navigate the complex modern health care system,” he said.
That’s why the two physicians are zealous in their efforts in providing ACOS education, not only for patients but to the medical community which is not as familiar with the syndrome as it is with asthma or COPD. They’d also like to see extensive research for treatment options.
“There’s no cure for asthma and there’s no cure for COPD, but we can treat them to improve their quality of life and prevent acute exacerbations,” Zeki said.
However, standard treatment options are not as aggressive as needed to treat the asthma-COPD syndrome.
“It really all begins with empathy.” Louie said. “Empathy within healthcare providers for how asthma, COPD and ACOS patients suffer when they are given prescription drugs without education on an individual level. We have to ignite that empathy by increasing awareness and providing education.”
The two physicians are board members of the World Asthma Foundation, which provides educational resources that inform patients, medical professionals and the general public about the latest clinical advances, management and treatment options for asthma disorders, including ACOS.
“I am convinced that every patient who lives with asthma, COPD or ACOS has character and intelligence but what they often lack is willpower.” Louie said. “And when physicians and their colleagues think COPD is ‘irreversible,’ that is like a nail in the coffin to patients, but nothing could be further from the truth. There are no cures as Dr. Zeki said, but then there is no cure for diabetes or heart disease either.
“People with asthma, COPD and ACOS deserve better. It requires that we all take responsibility, patients too, but physicians must take their empathy one step further and realize how reversible asthma, COPD and ACOS can be” Louie said.
Willaim Cullifer, executive director of the World Asthma Foundation, said, “This is a fascinating new development in the understanding of asthma and COPD and it’s fantastic to be on the forefront of educating the public and the healthcare community about this issue.”
With their concern and enthusiasm for serving ACOS patients as well as those living with asthma alone or COPD alone, the dedicated physicians are bound to make a difference, hopefully in their lifetimes.
“My hope is to gain a better understanding of this syndrome, which may indeed be on the continuum of airway diseases such as COPD and asthma,” Zeki said. “We hope to garner the support and funding needed to study it given its high prevalence and public health significance.”
“When you get done taking care of the disease, you’re taking care of people,” Louie said.
“We must fight indifference. The only way to do that is to get the word out that we all have much more to achieve together to empower patients with reversible obstructive airway diseases.” Louie said.
