Asthma is a chronic inflammatory disease that affects the bronchial airways and causes episodes of wheezing, coughing, chest tightness, and breathlessness. In some cases, airway obstruction is so severe that patients may even stop breathing.

Doctors at the University of Michigan C.S. Mott Children’s Hospital are not only studying what triggers asthma, they are also finding ways to have an immediate impact on patients living with the disease.

IN THE LAB

Asthma causes the airways to narrow excessively, making it difficult for individuals to breathe in and out—especially out. The airways of patients with chronic severe asthma show an increased amount of bronchial smooth muscle. Since this airway narrowing is partially caused by muscle contraction, this increase in smooth muscle mass likely plays a significant role in the development of asthma. Marc Hershenson, M.D., Director, Pediatric Pulmonology, and Professor of Pediatrics and Communicable Diseases, is studying airway smooth muscle cells in culture. Much of Hershenson’s research focuses on how these cells multiply—causing too many cells—or get bigger, through a process called hypertrophy. Hershenson says if researchers are able to block the process, it could result in less severe asthma or even less severe asthma attacks.

Hershenson is also studying how a common cold virus, rhinovirus, induces asthma attacks. The virus grows fast at 33 to 35 degrees C, which is lower than normal body temperature of 37 degrees C. Researchers have wondered how a cold virus that grows best in the upper airways of the nose can cause an asthma attack, which involves the deep airways of the lungs. His new theory is that the virus does not have to replicate down in the lower airways—it just needs to attach and enter the cells, and by doing that it sets off chemical-signaling pathways that cause airway inflammation in people with asthma.

IN THE COMMUNITY

Toby Lewis, M.D., M.P.H., Assistant Professor, Department of Pediatrics and Communicable Diseases, is part of the Community Action Against Asthma (CAAA) team. CAAA is a community-based participatory research (CBPR) program that combines study of the environmental triggers of asthma with intervention to help reduce exposure to triggers and improve the health of children with asthma. CBPR involves scientists and community members partnering to conduct research that is both important in the fight against asthma and responsive to community members’ health concerns.

Three hundred children with asthma participated in a recent CAAA study in Detroit. The program has included two years of home visits by members of the community who were trained to help identify factors that trigger asthma and work with families to eliminate these triggers from their homes. Two examples of how they helped families include allergy testing children, so that families would know what triggers are important for their child to avoid, and giving the families cleaning supplies. The program received a wonderful response from families, and most importantly the children’s health improved, with an increase in lung function and a reduction in the number of acute medical visits.

TODAY AND TOMORROW

Research is of key importance at Mott Children’s Hospital, with all the pulmonologists having special areas of interest. With funding from the National Institutes of Health, the Cystic Fibrosis Foundation, the American Lung Association, and other sources, the Division of Pediatric Pulmonology is moving forward with both basic and clinical research related to a variety of lung diseases. “We have a combined package,” Lewis reports. “Each of us has our own niche.” Basic science, early detection of disease, clinical studies, and epidemiology all are important to the program. “It is really a multifaceted approach to significant public health problems,” she adds.