Scientists Take a Practical New Look
at a Familiar Illness
Allergic
asthma affects about 3 million children (8 to 12 percent of all children)
and 7 million adults in the United States at a cost estimated at $6.2
billion a year. Asthma episodes, or attacks - with tightness in the chest
and difficult breathing - often can be managed with drugs delivered by
small pumps that patients carry, but they sometimes strike with
life-threatening severity requiring emergency hospital treatment to
forestall death.
Asthma both as an
illness and as a cause of death has increased in the United States and
other developed countries over the past 15 years despite significant
improvements in outdoor air quality and in the face of major declines in
other pulmonary diseases, such as tuberculosis and pneumonia.
Some people, in fact,
theorize that the decline in serious illnesses may be a factor in the
increase in allergic asthma. That is, they speculate, an under-utilized
immune system may overreact to lesser threats or irritants,
inappropriately producing antibody molecules that result in a release of
histamine and other inflammatory substances in the lungs. Other
researchers implicate the increased time youngsters spend indoors - and
their resulting exposure to the carpeting and other allergen-catchers that
people in developed nations surround themselves with.
There are other
theories as well. What is known more clearly is that dust mites (which are
living creatures that produce droppings that contain a highly allergenic
protein), cockroaches, molds, pollens and domesticated animals produce
some of the substances, called allergens, known to trigger asthma attacks.
A study is now underway to determine the roles of other key environmental
agents in asthma, both in bringing on respiratory crisis and initiating
the illness in the first place. The research is being supported jointly by
scientists at the National Institute of Environmental Health Sciences and
the National Institute of Allergy and Infectious Diseases, two of the
National Institutes of Health.
MANAGING THE
ILLNESS
Reducing allergens -
getting rid of the cat, and removing the teddy bears, rugs, curtains and
lampshades in an asthmatic child's bedroom - can, along with medication,
control most asthma. So NIEHS and NIAID have co-funded an effort to help
asthma patients called TEAM, or Targeting the Environment and/for Asthma
Management. Through grants, TEAM will support researchers at seven
university research centers and one university data center. Their goal is
to design and evaluate asthma intervention strategies for underserved,
inner-city children, 4 to 12 years old.
The TEAM protocol
includes asthma-related medical treatment delivered in a health care
facility. A physicians' educational component provides state-of-the-art
education and training for primary care physicians in the medical
management of asthma.
Case management of
asthmatics and their families is provided by the asthma case managers -
registered nurses with specialized training in social work. The TEAM
intervention component monitors and improves the asthma patients' indoor
environment, cleaning up patient residences to reduce asthma episodes.
PREVENTION:
NIPPING ASTHMA IN THE BUD
NIEHS scientists will
find out if reducing dust mite and cockroach allergen levels in homes can
prevent sensitization to these allergens and thus prevent asthma from
developing.
"The hope is," as
Newsweek reported in a cover story May 26, 1997, "that if kids encounter
fewer allergens early in life, they'll be less likely to develop allergic
responses.
"Next year the
National Institute of Environmental Health Sciences will launch an
elaborate, eight-year study to see if that strategy works. In the first
phase, researchers will study 120 households to determine the best ways to
reduce allergen levels. They'll cover mattresses, steam carpets, trap
roaches and apply tannic acid* to any suspect surface.
"And once they perfect
their technique, they'll enroll 500 high-risk newborns in a trial to gauge
the effects. Half of the babies will be raised in allergen-free zones
while the other half will serve as controls, and the scientists will track
the kids' asthma rates.
"'Will we be able to
reduce the prevalence of asthma in the community?' asks Dr. Darryl Zeldin,
the NIEHS official overseeing the project. 'We don't know. Even with our
best reducing agents, we may not be able to get the allergen levels low
enough that kids aren't sensitized.'"
Keep in touch with your GP
Asthma is a long-term condition that needs to be treated on an
individual basis. Just like visiting the dentist or the optician, it's
important that your child has regular review appointments with your doctor
or practice nurse to monitor both their asthma symptoms, the treatment
they are taking and any side effects. You should visit your GP every six
months, or more regularly if your child has just been diagnosed with
asthma.
Your doctor or practice nurse will discuss with you how your child can
get the best out of your asthma treatment. They will be able to give you a
personal asthma plan which helps you to keep track of what medication your
child needs to take and what to do in an emergency.
Keep in touch with the National Asthma Campaign
Living with asthma can raise all sorts of questions of concerns. But
the National Asthma Campaign is here to help. Call the Asthma Helpline for
help and advice from asthma nurses who have the time to listen to your
concerns and discuss what's right for you, in confidence. For the price of
a local call we'll give you independent, up-to-date advice – no matter how
small your query might seem – and provide you with the most appropriate
written information from a wide range of National Asthma Campaign
materials. We can also refer you to other organisations who may be able to
help.
OTHER RESEARCH
ADDS NEW KNOWLEDGE
Five other NIEHS-funded
studies that focus on asthma are looking at inner city cockroach allergen
reduction; case management and environmental control in asthma; home
endotoxin (a byproduct of the break-up of bacteria) and childhood asthma;
environmental agents - asthma development and severity; and molecular
markers for environmentally induced asthma.
Children with an
asthmatic parent are much more likely to become asthmatic themselves - so
there is probably an important genetic role in the disease. But by looking
at the environmental aspect of asthma, researchers hope to make new
inroads in this all-too-familiar and sometimes deadly disease.
*Tannic acid is used
to denature mite allergens in carpeting.
###
NIEHS Contact: WebCenter
Page created: 13 Oct 98 | Last Modified:
19 Nov 2002
NIEHS Fact Sheet #9,
ASTHMA, 7/97
Since one of the most common cores of allergy, asthma and
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