NEWS & EVENTS

NHLBI, NIAID, NIEHS and MCAN Workshop On The Indoor Environment and Childhood Asthma: Implications for Home Environmental Intervention in Asthma Prevention and Management

Name: NHLBI, NIAID, NIEHS and MCAN Workshop On The Indoor Environment and Childhood Asthma: Implications for Home Environmental Intervention in Asthma Prevention and Management
Start: 2014-06-19
End: 2014-06-20

June 19 - 20 , 2014

NIH

Description

Environmental exposures have been recognized as critical in the initiation and exacerbation of asthma, particularly in children, among whom asthma is the most common chronic disease. In June 2014, the National Institute of Allergy and Infectious Diseases (NIAID), National Institute of Environmental Health Sciences (NIEHS), National Heart, Lung, and Blood Institute (NHLBI), and Merck Childhood Asthma Network (MCAN) sponsored a joint workshop entitled "The Indoor Environment and Childhood Asthma: Implications for Home Environmental Intervention in Asthma Prevention and Management." U.S. and international experts with backgrounds in allergy/allergens, immunology, asthma, environmental health, environmental exposures and pollutants, epidemiology, public health, and bioinformatics were assembled to discuss the current state of the science with respect to the indoor environment and its effects on the development and morbidity of childhood asthma.

A primary focus of the workshop was critical review of trials and research relevant to the prevention or control of asthma through environmental intervention; sessions were divided in five working groups:

New Insights into indoor exposure assessment
New insights into indoor exposure properties and dose-response associations with allergy/asthma outcomes
Fundamental concepts and methods/Implications for environmental interventions: New insights into exposure reduction techniques
Progress and limitations of home environmental control of allergens: Primary prevention trials
Indoor environmental interventions for asthma management

Recap

Recommendations

The participants identified critical limitations and gaps in the scientific methodologies and knowledge, and proposed the following areas for future research.

Research Priorities Working Group 1:

Analytical/Technological Improvements
- Personal monitoring devices
- Expansion of arrays to include endotoxin, flagellin, markers of innate immunity, biomarkers
- Development of efficacious (and unbiased) sample collection, extraction and processing techniques for environmental microbiome samples
Enhanced data collection in population studies, e.g. birth cohorts
Environmental monitoring in immunotherapy and drug development studies to understand the impact of environmental exposures on the efficacy of immunotherapy and other drugs
Data driven environmental modification strategies
Improved metagenomic and bioinformatic techniques to define microbes taxonomically and functionally (including fungi), with the goal of isolating taxonomic or functional groups of microbes with potentially therapeutic or adverse effects.

Research Priorities Working Group 2:

How do the biochemical characteristics of allergens, such as protease or lipid binding activity, contribute to the allergic response?
What is the precise role of specific allergic adjuvants and protective microbial substances and do these adjuvants and protective substances work in concert?
What are combined, or integrated, effects of concomitant exposure to bacterial products, pollutants, and allergens on immune responses and asthma in cross-sectional or prospective observational cohort studies? How do findings regarding combined effects inform development of trials or therapeutic approaches to asthma prevention or treatment?
How can nasal brushings or other non-invasive biospecimens be utilized to understand mechanisms of action of allergens and co-exposures like bacteria or smoking on pulmonary responses?

Research Priorities Working Group 3:

Novel technologies with particle or gas filtration should be tried in multiple settings, including home and school environments, first to test their efficiency in reducing exposure and then to assess their adjunct role in treating asthma.
- Trials should include assessment of whether response to air filtration varies by asthma severity or allergic status of asthmatic children
Research focused on mold exposure reduction strategies is needed to allow the development of more targeted (and presumably effective) interventions which are appropriate for different types of climatic regions and housing stock.
Interventions should be tested that can be applied to low-income mobile populations with limited resources.
Given the cost of structural housing interventions, opportunities to design and conduct double-blind studies which test their effectiveness in improving health may be limited. High-quality observational studies that systematically study the ‘treatment’ effect of these changes for individuals with diagnosed asthma should be conducted.

Research Priorities Working Group 4:

To investigate patterns of human microbiome associated with allergic diseases, and the influence of the indoor environment on that microbiome.
To investigate the biological mechanisms that underlie the interaction between genetic susceptibility and aeroallergen and/or microbial exposure in initiating asthma
To explore the relationship between environmental exposures and epigenetic changes and the relevance to risk of asthma development
To investigate differential effects of type, dose and route of allergen exposure in the development asthma
To perform randomized controlled trials of (i) dietary interventions, and (ii) stress reduction measures, in primary prevention of asthma in ethnically diverse populations
To investigate the optimal age for intervention for prevention of asthma
For each of the major potentially modifiable factors,
- To identify the subpopulations that would benefit from the intervention, and, perhaps, the subpopulations that might be at adverse risk, or not benefit.
- To define interventions that would be of benefit to most children (e.g., smoking cessation)

Research Priorities Working Group 5:

Further defining the role of environmental interventions in asthma management
Determining the most cost- and clinically- effective approaches to environmental interventions
Determining how to effectively implement environmental interventions in healthcare, public health policy, and clinical practice.

Workshop Co-Chairs

Diane Gold MD., Harvard University
Elizabeth Matsui M.D., John Hopkins University

Workshop Participants

Avrum Spira M.D., Boston University
Joanne Sordillo Sc.D., Harvard University
Martin Chapman Ph.D., Indoor Biotechnologies
Dennis Ownby M.D., Augusta University
Petros Koutrakis Ph.D., Harvard University
Gary Adamkiewicz Ph.D., Harvard University
Victoria Persky M.D., University of Illinois at Chicago
Wanda Phipatanakul M.D., Harvard University
Brian Leaderer Ph.D., Yale University
Syed Hasan Arshad M.D., University of Southampton, UK
Ulrike Gehring Ph.D., Utrecht University, NL
Clare Ramsey M.D., University of Manitoba
Christine Johnson M.P.H., Henry Ford Health System
Augusto Litonjua M.D., Harvard University
Juan Celedon M.D., Ph.D., University of Pittsburgh
Shakira Suglia Sc.D., Columbia University
Matt Perzanowski Ph.D., Columbia University
James Gern M.D., University of Wisconsin
George O’Connor M.D., Boston University
Suzanne Kennedy Ph.D., Rho Federal Systems Division
Herman Mitchell Ph.D., Rho Federal Systems Division