Comment: As athma incidence rises, tailor treatments better

With multiple types of asthma, better research and targeting of treatments are needed for equitable care.

By Matthew C. Altman / For The Herald

Every year, the number of people living with asthma continues to grow in the United States, with about 1 in 12 Americans affected according to the Centers for Disease Control and Prevention. Here in the Evergreen State, we lead as one of the nation’s highest for the prevalence of asthma.

With worsening air quality and pollution, including locally — last October, Seattle ranked first for worst air quality worldwide — people living with asthma are at risk for experiencing increasingly harmful effects. Multiple respiratory infections, including the common cold, RSV, influenza and covid-19, can also elevate the threat of one’s health when living with this lifelong disease. Our environment is signaling an alarm that we must do better for those living with asthma, and it starts with increasing education among clinicians, patients and communities.

Unfortunately, even in research and clinical practice, multiple types of asthma tend to get lumped together, preventing any focus on targeted therapies for specific types and different demographics. There are very different types of airway inflammation that may cause asthma in one person or another, and this can vary based on age, race or ethnicity, environmental exposures, and other factors. Historically, most clinical studies on asthma therapies are performed predominantly in white non-Hispanic adults, with fewer pediatric clinical studies and overall lack of inclusion of diverse populations. As a result, we often have relatively poorer understanding of their efficacy or safety for children and non-white populations, despite these being the populations most affected by asthma.

These pitfalls also make it very difficult to uncover preventive methods for different age groups, races and ethnicities. Even though asthma is considered the most common chronic disease in children, underappreciation of disease burden and under-treatment persist, especially in those with limited access to health care. Asthma-related hospital admissions may also reveal an increase in severity, poor disease management and/or the lack of access to appropriate treatment. And yet research is proving that vulnerable groups are being disproportionately affected and that new, targeted therapies are desperately needed.

In a recent paper that our research consortium, Childhood Asthma in Urban Settings (CAUSE), published, we found that elevated air quality index values are associated with asthma attacks, and lowered lung function in children living in low-income urban neighborhoods, and critically we identified molecular linkages between individual pollutants and asthma attacks. By understanding these mechanisms, we can now begin looking at targeted treatments that consider the impact of one’s environment and exposures. As far as treatments, we’ve found that a biologic asthma therapy called mepolizumab can reduce asthma attacks among children in low-income Hispanic and Black communities, an important finding, albeit the other critical finding in that study was that the therapy only works in certain children depending on their airway inflammatory subtype. This means it can be highly effective for some urban children with asthma but definitely not for others, and this can be identified in advance.

All this research makes the case for further studies and development of new, targeted therapies, particularly as we see air pollution consistently worsen, Americans become sicker with diseases that can trigger asthma, like obesity, and increasing cases of illness caused by respiratory infections.

As we continue to learn through research what works and what doesn’t, clinicians and communities can act now by staying educated on the latest asthma approaches to guide their understanding and treatment for patients. This is no longer just an issue of raising awareness but raising our capability to give our patients the best prevention strategies and treatments that we can.

Dr. Matthew C. Altman, doctor of medicine and master of philosophy, is a principal investigator at the Benaroya Research Institute, Center for Systems Immunology, and an associate professor at the University of Washington.

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