UW Awarded $3 Million Asthma And Allergic Disease Center Grant

Article originally published in July 1998

Involves Collaborating with Dane County Head Start To Improve Asthma Control

MADISON -- How does a sneeze turn into a wheeze? It's an important question for anyone affected by asthma. About 85 percent of severe asthma attacks are triggered by respiratory viruses, especially the common cold virus. What starts out for asthma sufferers as an irritating cough and runny nose can quickly turn into more severe complications, particularly wheezing, chest tightness, coughing and shortness of breath.

"There are a lot of questions as to how a relatively innocuous virus like the common cold virus can wreak such havoc in patients with asthma," says Dr. William Busse, University of Wisconsin Medical School professor of medicine and head of the allergy and immunology section at UW Hospital and Clinics. "For most people, a head cold lasts three to five days, and then they're fine. When patients with asthma get a head cold, their asthma can worsen. This increase in asthma severity can last for weeks and may require an increase in medications and cause an inability to sleep at night, limitations on activities and even the need for hospitalization."

Recently, the National Institutes of Health awarded Busse and colleagues a four-year, $3 million grant to find out how respiratory viruses make asthma worse. The grant will focus on rhinoviruses, chief culprits in the common cold.

The grant is a renewal of one first awarded in 1971 and which has led to several important findings, including evidence that respiratory viral infections, not bacteria, worsen asthma. Now researchers want to find out the mechanisms of that association.

In doing so, researchers will come together from molecular biology, biomolecular chemistry, molecular virology, pharmacy, medicine and pediatrics. The investigators will examine how rhinoviruses can produce acute wheezing in patients who have asthma, as well as how viral infections that produce episodic wheezing in infancy and childhood may actually lead to asthma in certain individuals. Research will be conducted using lung cells from human volunteers as well as a unique animal model which parallels how viral infection can lead to chronic wheezing or asthma in the first years of life.

"If we can find out the mechanisms, that will give us an opportunity to design more specific treatments for this problem," says Busse. "This becomes particularly important as current treatments are not always effective."

Though the research will take years, doctors say people can take several steps now to reduce the risk of asthma attacks during the cold season, which peaks during the spring and fall.

The first is preventive care, according to Dr. James Gern, a pediatric allergist and immunologist at UW Children's Hospital and a study co-investigator. "We try to give people the information they need to take care of themselves at home on an ongoing basis, instead of on an emergency basis. If they get themselves in as good a shape as possible and get a cold, it's less likely to send them over the edge.

"Secondly, those who have asthma need to develop a written care plan with their physician so they know exactly what to do when they get a cold. Increasing medications during the early stages of a cold can help prevent more severe asthma symptoms. If people wait until they're really sick, their only option is to go to the ER and nobody likes to do that."

GETTING A "HEAD START" ON ASTHMA

Unlike many research grants which put scientists in laboratories studying theoretical concepts, this grant includes funding for a demonstration project to help diagnose and treat asthma in children enrolled in the Dane County Head Start Program.

The project is the brainchild of Christine Sorkness, Pharm.D., who specializes in asthma with the UW School of Pharmacy and UW Medical School allergy and immunology section. Her collaborators at the UW and at Head Start call the project a notable success for making big inroads into a serious health problem while extending federal research dollars by using the services of an established agency.

Sorkness's previous research has shown that about 15 percent of 3 to 5 year olds in the county's Head Start Program have asthma, a figure higher than the national prevalence, but similar to what's been reported in large inner cities, such as Chicago or New York.

Sorkness speculates Head Start and inner city children share similar risk factors for asthma, including environmental exposures (smoking is a major one), ethnicity and belonging to families with lower incomes.

"We're very excited to be collaborating with Head Start because one of the ways they give kids a head start on life is through the early identification of health problems. Children at this age are very vulnerable and if we can identify asthma early and make sure they're getting good treatment, they'll hopefully go on to develop normal lung function and quality of life.

"This is also an age group that gets a lot of colds," Sorkness continues. "So while scientists are working at the basic research level, we have the perfect opportunity to be in touch with children who are exposed to colds and learn how their asthma affects them and how we can make their disease better."

The project involves working with primary care physicians, families and Head Start staff to develop and implement comprehensive asthma management plans, which include understanding the disease itself and hands-on demonstrations of asthma medications and equipment. Sorkness's early research has added to the scientific body of evidence that this strategy works: families who followed the plan were significantly less likely to require a trip to an urgent care center or emergency room for uncontrolled asthma. Children also missed less school because of their asthma, and in turn their parents missed less work. Best of all, parents felt much more confident in managing their child's condition on a day-to-day basis, so vital to reducing the risk of complications.

Recently, the Dane County Parent Council, Inc., which oversees Head Start, honored Sorkness and colleagues with the Margaret Bakken Community Award for Outstanding Commitment and Service to the Head Start Program.

Sorkness says the demonstration project, if duplicated nationally, could prove to be an efficient and effective way to improve childhood asthma outcomes. "There are a lot more communities the size of Dane County than big cities, and so we think it's important to know that asthma is just as prevalent here and that we have a mechanism to find it and treat it," she says.