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.

Asthma and the Microbiome – Martin J Blaser MD Interview

Defeating Asthma Series uncovers New Hope for Asthma Management

In this second interview with Martin J Blaser MD, Director of the Center for Advanced Biotechnology and Medicine at Rutgers Biomedical and Health Sciences and the Henry Rutgers Chair of the Human Microbiome and Professor of Medicine and Microbiology at the Rutgers Robert Wood Johnson Medical School in New Jersey and the Author of the “Missing Microbes – How the Overuse of Antibiotics is Fueling Our Modern Plagues.” we learn:

  • About the connection between Asthma and the Microbiome
  • About research and studies that predict Asthma in childhood
  • About bacteria not just in the stomach but in the colon
  • About C-sections and the likelihood to develop asthma
  • About the Mayo Clinic study on Asthma and antibiotics useage

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.

World Asthma Foundation: Dr. Blaser, can you help us connect Asthma and the Microbiome?

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Dr. Blaser: I’ve gotten very involved in studying the human microbiome in general, not just in the stomach, but in the colon. We and others are working on the relationship of the bacteria (microbiome) in the colon and asthma.

Again, there’s a paper that’s published. A young doctor from Denmark, Dr. Jakob Stokholm, came to work in my lab. This happened after Missing Microbes was published, so it’s not in the book. He’s part of a study in Copenhagen called the COPSAC study, the Copenhagen Open Study of Asthma in Children. They have cohorts of moms whose kids are going to have high risk of asthma, either because they have asthma or they already have a child who has asthma.

In 2010, if I remember correctly, they enrolled 750 moms with this high risk. They obtained fecal samples from the moms. They also got samples from the kids at one week, one month, and one year of life. Then they followed these kids until they were about six. The question was, is there anything that might predict who was going to get asthma at the age of six? We did a lot of work studying the microbiome in their fecal specimens, and what we found is consistent with what other people found: that the microbiome matures over time between one week and one month, and one year. It shows a pattern of maturation, but in some kids, their microbiome doesn’t mature in the normal way.

Then we made a very important observation. In those kids whose microbiome didn’t mature normally when you compare them to kids who did have normal maturation, the odds ratio, the chances that they were going to get asthma when they were six was 3, (300%) meaning a rate three times normal. Then we divided those kids by whether their mother previously had asthma or not. If their mother didn’t have asthma, the maturation pattern did not make a difference, but if their mother did have asthma, the odds ratio was 13.

We’re getting in the range of the association between smoking and lung cancer. That’s how strong that is. That was published about two years ago in Nature Communications. We have a new paper that now is in press. It is about cesarean sections. It’s known that kids born by C-section have a higher risk of developing asthma. The question is why?

From this study, again with the children in the Copenhagen study, we confirmed that kids born by C-section are more likely to develop asthma than those who didn’t. In those kids who had C-section, on average, their microbiome early was abnormal compared to those who were born vaginally. But by a year, in many of them, their microbiome had matured normally, but if it didn’t mature normally, those kids had a very high rate of getting asthma. Again, a high risk. That’s going to be published within a month or two because it’s been accepted already.

Now, what I will tell you is that with Dr. Müeller and with a graduate student in my lab, Tim Borbet, we’ve been doing a lot of mouse-asthma studies where we can experimentally give a mouse asthma or allergy. We already can show that if we perturb the microbiome early in life with antibiotics, they’re going to get more allergy and more asthma. That’s interesting because a paper was just published from British Columbia, showing that they had a really good program to diminish antibiotic use across the whole province. They showed that with diminishing antibiotic use, asthma rates are going down, so it’s all connected.

Furthermore, I’m part of another study that’s also in press. It’s going to be published probably in a month or two with scientists at the Mayo Clinic. I visited there a few years ago. The Mayo clinic is located in Olmsted County, Minnesota. It’s a pretty isolated place. In general, people don’t come, people don’t go, they stay there. It’s a very good stable population to study. I suggested to my colleagues there, why don’t you look at the effects of antibiotics in early life for certain marker diseases, including asthma and food allergy, and atopic dermatitis and allergic rhinitis. All these diseases go together. The group there is very active and outstanding, and they studied about 14,000 kids who were born in Olmsted County, and they were followed up to the time that they were 15 or 14. They had a lot of information from their health records because most of their medical care there is through the Mayo Clinic.

The bottom line is that if they received antibiotics in the first two years of life, their odds ratio of getting asthma was 2. They were twice as likely as kids who did not receive early-life antibiotics. Lots of things are pointing to the importance of the early life microbiome and the importance of when its being perturbed by antibiotics, that there’s increased risk. The relationship with moms, that’s this kind of transgenerational thing that each generation is stepping down.

World Asthma Foundation: A lot of these antibiotics are not only prescribed, but they’re ubiquitous in our diet and our food supply right?.

Dr. Blaser: Yes. Well, I’m very interested in that as well, although the prescribed antibiotic is more important because it’s higher dose. In mice, when we give low doses of antibiotics, it perturbs the immune system but not so much. When we give them the same kind of doses that kids get to treat their ear infections or their throat infections, it really perturbs their immune system and puts it on a different path. That’s also published.

Catch the video interview by clicking here .

Defeating Asthma Series Announced for World Asthma Day, May 5, 2020

 

World Asthma Foundation is supporting care of Asthma and asthmatics around the world through a new series focused on Defeating Asthma with the aim of shining a spotlight on getting to a cure

The World Asthma Foundation (WAF) exists for education and advocacy for people with asthma who suffer medically with health issues that make them highly vulnerable to the COVID-19 virus and other diseases.

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.

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

What you can expect from the WAF Severe Asthma Series

Follow along with the series (click here) as we cover a variety of topics of interest to Asthmatics. 

  • What are the various types of Severe Asthma
  • What drives Severe Asthma
  • Impact of the environment on Severe Asthma
  • For additional on Asthma and the Microbiome click here 
  • What are the treatment options for Severe Asthma
  • Real world case studies with in-depth analysis
  • University research
  • Live expert podcast and interviews
  • Healthy lifestyle resources
  • Asthma advocacy guide and communication strategies for talking with your medical team

WAF will bring fresh perspectives from experts in the field that affects Asthmatics.

What we’d like from you:

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WAF versus Asthma – It’s War

World Asthma Foundation Declares War on Asthma at ATS 2013

ATS 2013, PHILADELPHIA – The World Asthma Foundation (WAF) is declaring war on Asthma and is calling for support for May 2013, Asthma Awareness Month.

The campaign is in support of 26 million people in the United States living who are battling asthma, a disease affecting the lungs and causing repeated episodes of wheezing, breathlessness, chest tightness, and coughing. Asthma cannot be cured, but it is possible to manage the disease successfully in order to reduce and prevent asthma attacks, also called episodes according to the U.S. Center for Disease Control.

The World Asthma Foundation’s War on Asthma Campaign was announced today the American Thoracic @atsConference taking place in Philadelphia, PA. this week.

The World Health Organization estimates 300 million people worldwide suffer from asthma and 250,000 asthma-related deaths are reported annually.  It is one of the most common and costly diseases in the world and its prevalence has increased significantly in recent decades.

“We are entering a new era of public awareness of people living with chronic lung disease such as Asthma and COPD,” said Sam Louie, MD and professor of medicine and director of the UC Davis Asthma Network (UCAN). Louie is also director of the UC Davis Reversible Obstructive Airway Disease (ROAD) Center and a World Asthma Foundation (WAF) Board Member.

“People with Asthma and COPD deserve better treatment,” Louie said. “It requires that we all take responsibility, patients too, but physicians must take their empathy one step further and realize how reversible Asthma and COPD can be.”

“It really begins with empathy.” Louie said. “Empathy of healthcare providers for how Asthma and COPD 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.”

Let's Declare War On Asthma

The World Asthma Foundation provides educational resources to inform patients, medical professionals and the general public about the latest clinical advances, management and treatment options for asthma disorders.

Asthma affects people of all ages and backgrounds. In most cases, it’s not known what causes asthma and there is no cure. Certain factors may make it more likely for one person to have asthma than another. If one family member has asthma, it’s likely that other family members will also have it. Regular physical exams that include checking lung function and allergies can help healthcare providers make the right diagnoses.

With a healthcare provider’s help, patients can develop their personal asthma management plan so that they know what to do based on their symptoms. It’s recommended that patients use asthma medicines as prescribed and be aware of common triggers in the environment known to bring on asthma symptoms. Triggers are smoke (including second-hand and third-hand cigarette smoke), house pets, dust mites and pollen. They should limit or avoid exposure to these and other triggers whenever possible. The important thing to remember is that individuals can control their asthma.

To learn about how World Asthma Foundation (WAF) supports Asthma education visit: https://worldasthmafoundation.org

High Risk Factors in Asthma-COPD Overlap Syndrome

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

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.