On World Asthma Day — May 1, 2018 — the National Institutes of Health (NIH) stands with people worldwide to renew our commitment to advance understanding of asthma and develop effective strategies to manage, treat, and ultimately prevent the disease.

A new three-minute NIH video (see sidebar) provides a glimpse into the stories of patients and doctors who are working to advance research. Patients discuss the impact asthma has had on their lives. Investigators highlight promising areas of research and the critical role that clinical trial volunteers play in combatting the disease.

Reducing burden of disease

Asthma is a chronic lung disease characterized by episodes of airway narrowing and obstruction, causing wheezing, coughing, chest tightness, and shortness of breath. An estimated 235 million people worldwide, including 24.6 million in the United States, have asthma.

The disease can reduce one’s quality of life, and it is a major cause of missed time from school and work. Severe asthma attacks may require emergency room visits and hospitalizations, and they can be fatal. NIH is committed to reducing the burden of this disease, which disproportionately affects minorities and families living at or below the poverty line.

Supporting all stages of research

NIH conducts and supports all stages of asthma research, from basic studies in the laboratory to human clinical trials. Clinical research volunteers are essential to developing new interventions and treatments, and NIH expresses our gratitude to all the individuals and families who have participated in these clinical studies.

Along with NIEHS, two other NIH institutes support and conduct studies on asthma — the National Institute of Allergy and Infectious Diseases (NIAID) and the National Heart, Lung, and Blood Institute (NHLBI). Each institute focuses on a specific area of asthma research, with the common goal of developing improved strategies for management, treatment, and prevention of this chronic disease.

Research at NIEHS

Garantziotis is the medical director of the NIEHS Clinical Research Unit. He also leads the institute’s Matrix Biology Group. (Photo courtesy of Steve McCaw)

Asthma research conducted by NIEHS scientists focuses on the complex relationships among the environment, the immune system, and asthma. Stavros Garantziotis, M.D., leads the Natural History of Asthma With Longitudinal Environmental Sampling(https://joinastudy.niehs.nih.gov/studies/nhales/) (NHALES) study at the NIEHS Clinical Research Unit.

NHALES examines how the environment affects asthma symptoms. In particular, Garantziotis and colleagues are investigating how the microbiome — the microbes naturally present in and on the body and in the home — may be associated with asthma activity.

NIEHS also funds researchers who study the impact of environmental exposures on asthma.

Projects include the following.

• Pioneering the development of sensor systems that measure personal exposure to environmental triggers of asthma.
• Clinical trials examining reductions in indoor air pollution exposures to improve asthma control.
• Innovative data science tools that integrate nationwide environmental data. 

These efforts promote better asthma prevention and management strategies. Several studies are specific to high-risk populations, including children and the elderly.

Research at NIAID

NIAID supports asthma research focused on understanding the immune responses that lead to asthma, as well as developing asthma prevention strategies and treatments to improve life for those with the disease.

As part of its broad asthma portfolio, NIAID sponsors two major programs.

• The Inner-City Asthma Consortium (ICAC) studies the causes of asthma in urban children and works to develop treatments to improve asthma.
• The Asthma and Allergic Diseases Cooperative Research Centers (AADCRC) program researches the origins of asthma.

With nine centers around the country conducting state-of-the-art human, basic, and applied animal model research, AADCRC aims to understand the causes of asthma and the mechanisms underlying development of severe asthma.

ICAC supports nine clinical research sites located across the United States, including the Improving Pediatric Asthma Care in the District of Columbia (IMPACT DC) asthma clinic at Children’s National Health System. IMPACT DC is led by Stephen Teach, M.D., chair of the Department of Pediatrics at Children’s National.

Research at NHLBI

NHLBI’s broad asthma research portfolio includes efforts to understand the biology of disease development, progression, and severity, and to optimize treatment for patients. Children’s National is a clinical site for the Oral Bacterial Extract (ORBEX) study, which is testing new ways to prevent or reduce wheezing in infants, a major risk factor for later development of asthma.

Severe asthma, which disproportionately affects women and minorities, is an area of emphasis for NHLBI. Research in the laboratory of Stewart Levine, M.D., in NHLBI’s Division of Intramural Research revealed that apolipoproteins — proteins in blood that typically transport fats into and out of cells — play a role in asthma severity.

Based on this research, NHLBI scientists have developed a potential new asthma treatment — a synthetic protein that mimics the function of an apolipoprotein that is associated with better lung function in people with asthma.

In addition, the new NHLBI clinical trials network, Precision Interventions for Severe or Exacerbation-Prone Asthma (PrecISE), will conduct early clinical trials with novel interventions in severe asthma patients, to identify the best interventions for specific groups of patients.

NHLBI also funds the Asthma Empowerment Collaborations to Reduce Childhood Asthma Disparities. This program supports clinical trials to evaluate Asthma Care Implementation Programs (ACIPs) that provide comprehensive care for children at high risk of poor asthma outcomes, and it also includes measures of the ability to implement and sustain the ACIPs in specific communities.

These examples represent only a small portion of NIH efforts to reduce the global burden of asthma. NIH is grateful to all those who help make advances in care possible — from scientists and health care professionals to clinical research volunteers, advocates, and educators. Together, we can advance our shared mission to develop and implement effective strategies for the management, treatment, and prevention of asthma.