Asthma is one of those conditions that can strike the very young and stay with them as they head into old age, often developing over many years into the more serious illness Chronic Obstructive Pulmonary Disease (COPD).
Incurable at the moment, asthma is the ultimate example of an illness that sufferers must learn to live with, relying heavily on drug regimes, with the ageing process presenting distinctive challenges often caused by prolonged exposure to asthma which permanently narrows the airwaves.
For many people, however, the story starts long before middle and old age and charity Asthma UK is among those organisations concerned that not enough is being done to help young asthma sufferers.
It is concerned that hospital admissions for children across England have increased by 15 per cent, according to data released from the Child and Maternal (CHiMat) Health Intelligence Network. The organisation says that this is of particular concern given that reducing child hospitalisation rates is one of the priorities set by the Government Kay Boycott, Chief Executive of Asthma UK, said: “It is extremely worrying that the number of children being admitted to hospital because of asthma has risen.
“These figures make it abundantly clear that we urgently need to see renewed commitment to improve basic asthma care across the NHS. We desperately need a full and systematic NHS asthma audit to pinpoint specific improvements that need to be made to stop children with asthma ending up in hospital.”
About 200 people of all ages are hospitalised in the UK because of their asthma every day and three will die and, against that backdrop, much of the research being conducted into the illness focuses on prevention rather than cure.
Prevention a big focus for researchers
For example, scientists at the University of Edinburgh, led by Senior Asthma UK Research Fellow Dr Henry McSorley, have discovered that parasites could protect against asthma, potentially leading to new treatments.
Dr McSorley and his colleagues found that in a mouse model of asthma, secretions of a parasitic worm called H. polygyrus can suppress the release of a chemical called interleukin 33 (IL-33), resulting in a smaller immune response to allergens and less damage to the lungs.
IL-33 is an important chemical in asthma. Belonging to a family of messengers called cytokines, IL-33 is rapidly released in response to allergens or damage in the lungs and ‘raises the alarm’ in the immune system. High levels of IL-33 have also been found in the lungs of people with severe and steroid-resistant asthma, potentially making it an important target for asthma therapy.
Dr McSorley said: “In populations where parasitic worm infection is common, the rate of asthma is low; in contrast, in the developed world over the last 100 years, parasitic infection has become rare, and over the same time asthma has become far more common.
“This has led researchers to propose that parasitic infections protect against asthma, and in their absence, we are predisposed to it.This is the first example of a secretion that can suppress this pathway in asthma and we hope to further dissect the molecules and mechanisms involved in this suppression, with the aim of identifying new medicines that will help people with the condition.”
Dr Samantha Walker, Deputy Chief Executive of Asthma UK, who funded the study, said; “Previous studies have looked at infecting asthma patients with parasites such as hookworms to test whether this might ease their symptoms. If we can find a way of isolating the product that leads to this protective effect and use this to develop new medicines – in a similar way that salicylic acid was isolated from willow bark to use as aspirin – this would be far better. This is a major achievement for Dr McSorley and we look forward to seeing how his research progresses.”
It’s a dog’s life as research raises intriguing possibilities
Across the Pond, similar work carried out in America has suggested that exposure to dust (a major trigger of asthma attacks) from homes with dogs may alter the immune response to allergens and other asthma triggers by affecting the composition of the gut microbiome—the community of microbes that naturally colonize the digestive tract. The findings help demonstrate how environmental exposures may protect against airway allergens and asthma, according to the team.
The study, led by researchers at the University of California, San Francisco, the University of Michigan, Henry Ford Health System in Detroit and Georgia Regents University in Augusta, was supported by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.
Previously, the researchers found that infants who live in homes with dogs are less likely to develop childhood allergies. They then showed that dust collected from homes with dogs contains a wider range of bacteria types than dust gathered from homes without pets.
In the current study, they show that dog-associated house dust can play a key role in preventing allergic inflammation. Feeding young mice dust from a home with a dog protected the animals against airway inflammation triggered by cockroach allergen. Compared to mice fed dust from a pet-free home or those not exposed to dust, mice exposed to dog-associated dust had fewer of the cells and immune-modulating chemicals involved in allergic responses. The researchers obtained similar results when they exposed dust-fed mice to a different allergen.
In addition, the investigators found that exposing mice to dog-associated dust altered the composition of the mouse gut micro biome.
The animals’ lower intestines contained high levels of the bacterium Lactobacillus johnsonii. Feeding mice live L. johnsonii reduced inflammation triggered by cockroach allergen or infection with respiratory syncytial virus, two risk factors for childhood asthma. These results, say the team, suggest potential new strategies to prevent and treat certain allergic diseases and lung infections.
COPD- Why it’s good to talk
Also concerning health professionals is the prevalence of COPD, which can afflict long-term asthma sufferers.
COPD, which in 2010 surpassed stroke to become the third leading cause of death in the United States, is a serious lung disease which over time makes it harder to breathe. It most often occurs in people age 40 and older with a history of smoking but as many as one in six people with COPD have never smoked.
COPD also can occur in people with a genetic condition known as alpha-1 antitrypsin deficiency or through long-term exposure to substances that can irritate the lungs, such as dust or fumes.
The illness is diagnosed with a simple test called spirometry, which can be conducted in a doctor’s office. The test involves breathing out as hard and fast as possible into a tube connected to a machine that measures lung function.
It affects an estimated 24 million Americans but as many as half of those affected remain undiagnosed and researchers who conducted a recent survey believe that is down to lack of willingness among sufferers to discuss their condition.
The researchers who conducted the web-based survey released by the National Heart Lung and Blood Institute (NHLBI) of the National Institutes of Health found that a reluctance among patients to talk about COPD was a major barrier to diagnosis of the disease.
They believe that this is partly because symptoms of the disease – such as shortness of breath, chronic coughing or wheezing, production of excess sputum, or a feeling of being unable to take a deep breath – come on slowly and worsen over time, leaving many to dismiss their symptoms and delay seeking diagnosis and treatment until the disease is advanced.
James Kiley, Ph.D., director of the NHLBI Division of Lung Diseases, said: “A good conversation between patients and providers about COPD can make a real difference for disease sufferers. It’s no secret that early diagnosis and treatment can improve daily living for those who have COPD but you can’t get there without an open line of dialogue in the exam room.
“That’s why patients and providers need to be aware of COPD, its risk factors and symptoms, how it affects daily life and what can be done to help get them back to doing the things they love.”
The survey did, however, find a dramatic increase in the numbers of current smokers, a key COPD risk group, who had discussed their symptoms with their doctors – from 42 per cent in 2009 to 67 per cent in 2013. Overall, 26 percent of adults who reported experiencing these symptoms stated they had not discussed these symptoms with their doctor or health care provider.
Researchers say that physicians also missed opportunities; 82 percent of current smokers who reported symptoms had a conversation with their doctor about their smoking history, but only 37 per cent of former smokers, who are also at risk, reported a similar conversation.
According to the survey, COPD awareness issues contribute to the problem; three of the top reasons cited by people with COPD symptoms who did not talk to a doctor were ‘I did not think of it‘, ’I’ve had these problems for years‘ and ‘these problems will just go way in time.’ Only 18 per cent of symptomatic people who discussed their symptoms heard their provider mention COPD.
James Kiley said: “Regardless of positive developments, the challenge remains that more than one in three Americans do not know what COPD is or how it affects them – and less than half understand that COPD can be treated.
“COPD is the only major chronic disease where deaths are not decreasing. It is critical for people to understand whether they may be at risk and recognise their symptoms as early as possible.”
There are hopeful signs, though. Recently, the U.S. Food and Drug Administration approved Anoro Ellipta (umeclidinium and vilanterol inhalation powder) for the once-daily, long-term maintenance treatment of airflow obstruction in patients with COPD.
Curtis Rosebraugh, M.D., M.P.H., director of the Office of Drug Evaluation II in the FDA’s Center for Drug Evaluation and Research, said: “Anoro Ellipta works by helping the muscles around the airways of the lungs stay relaxed to increase airflow in patients with COPD. The availability of new long-term maintenance medications provides additional treatment options for the millions of Americans who suffer with COPD.”
Anoro Ellipta is a combination of umeclidinium, an inhaled anticholinergic that affects the muscles around the large airways and stops the muscles from tightening, and vilanterol, a long-acting beta2-adrenergic agonist (LABA) that improves breathing by relaxing the muscles of the airways to allow more air to flow into and out of the lungs.
The safety and efficacy of Anoro Ellipta were evaluated in more than 2,400 patients with a diagnosis of COPD. Those treated showed improved lung function compared to placebo. However, the FDA approved Anoro Ellipta with a patient medication guide that includes information about potentially serious side effects in some cases.
Anoro Ellipta is manufactured by GlaxoSmithKline, Research Triangle Park, N.C.
