Category Archives: Asthma

Psychoneuroimmunological Pathways: Social Stress & Inflammation

Alexy Grey art

A recent study from researchers at the UCLA Cousin’s Center for Psychoneuroimmunology revealed a connection between brain activity in the regions that respond to stress and anxiety in social situations and inflammatory immune responses. This lends support to the mind-body (psychology-physiology) connection in the exacerbation of diseases like asthma, cardiovascular disease, cancer, and depression. I was excited to blog about these findings because they are relevant to my ongoing research “Life Stress, Social Problem Solving and Asthma”.

Essentially, I am hypothesizing that asthma patients who can more effectively cope with and adapt to stressful life situations will have better control over their asthma and have a better quality of life. The pathways that I suggest in my model are behavioral (i.e. medication adherence, seeking follow-up care, environmental asthma management strategies, etc), psychological (i.e. more effective coping and problem solving results in less anxiety and stress) and biological (i.e. anxiety and stress are associated with changes in immunology/inflammation and airway physiology).

The findings of the UCLA researchers are looking at the biological pathways from a very direct angle; measuring brain activity and inflammation in concert. While these findings are interesting and support the mind-body connection on a new level, there is still something lacking in terms of payback. That is to say, even if we can understand the tendencies and mechanics of the mind-body connection what good will come of it?

Perhaps my training has skewed my perspective but I suggest that the good will come from psychology and the science of health behavior. We can teach people coping skills and encourage them to engage in more adaptive life strategies. This can change their perception of their abilities to cope, changing their experience of stress, improving their disease self-management and, as this study suggests, support balance in the immune system.

Asthma Community Network – New website!

I usually like to reserve this blog for research news, but I also like to focus on asthma since that has been my research and career focus for the past few years.

A new online community website has recently caught my attention and deserves recognition:
Asthma Community Network – Communities in Action
ACN web screen shot
“The Network is supported by the U.S. Environmental Protection Agency in partnership with Allies Against Asthma, a program of the Robert Wood Johnson Foundation and the Merck Childhood Asthma Network, Inc. (MCAN), a nonprofit organization funded by the Merck Company Foundation.”

They just refurbished the site and it’s one of the best, if not the best, online resource for asthma care professionals, community organizations and patients. The site is extremely user friendly and well organized. Finding materials on a specific topic or resources in your area couldn’t be easier. Highlights of the site include:

-Resource Bank
-Webinar Catalog
-Program Search
-Discussion Forum
-Events Calendar
-Mentorship for program development

Like the name suggests, this website is meant to be an online community of asthma champions, it will only get better the more people use the site. I want to commend the organizations that support that website and encourage those involved with asthma, community education, or anyone suffering with asthma to visit this website!

Advancements in Asthma Treatment

Since I’m studying asthma and work on asthma education issues almost every day I wanted to blog about two advancements in asthma treatment.

The first, which is still in testing, is a genetic test that can identify which patients will respond well to steroid therapy. Corticosteroids, most commonly inhaled, are used to reduce inflammation in asthma patients. However, around 35% of patients do not respond to this sort of treatment. These genetic tests will help avoid unnecessary side-effects and help guide the treatment in a more effective direction.

The second treatment advancement I wanted to share was just approved by the FDA. Long-term inflammation in the lungs caused by severe and persistent asthma can create scar tissue in the lungs. This extra tissue makes the patients airways thicker than they should be, increasing the likelihood of asthma attacks. The thickening of the lung tissue is also known as “airway remodeling”. This component of asthma is very difficult to treat with medication and up until recently was essentially irreversible.

bronchial thermoplasty device

Using this new device, the Alair Bronchial Thermoplasty System (a catheter with electrode tip and controller unit) doctors can expose the thickened smooth muscle in the airways to radiofrequency energy reducing airway thickness thereby making breathing easier and attacks less likely. It is a very “hammer on nail” type approach, yet effective nonetheless

It should be noted that this treatment is not for all. Only adult patients with severe and persistent asthma will be good candidates. Read more about the procedure on the Alair website.

Yoga reduces general inflammation

yoga_bio

A newly published study has found that the regular practice of yoga can lower the levels of pro-inflammatory cytokines in the blood stream. Cytokines are signalling molecules that regulate the various cellular components of inflammation, an immune-based response to threat (physical or psychological). Long-term inflammation contributes to many health conditions including cardiovascular diseases, arthritis, and asthma.

In this study conditions of stress were implemented through tasks such as holding their bare foot in very cold water, or solving increasingly difficult math problems without a calculator. The researchers also found that those who practiced yoga had less dramatic responses (less increase in cytokine activity, less self-reported anxiety and stress) to the stressors.

The results of this study speak to the wide-ranging benefits of yoga, and other relaxation techniques. This study also highlights the fact that we can train ourselves to have less severe reactions to stressors in our lives. Over time these benefits can really add up, resulting in long-term improvements in physical and mental health.

Public Health, Air Pollution and Global Warming

interconnected issues
The Lancet is currently featuring a new research and publication series that examines public health and global warming. There is still disagreement on whether or not global warming exists, and if it does, whether or not it is caused by human activity. As that argument has persisted concerns about how human activity impacts our immediate health has come to the forefront.

The same types of air pollution that are believed to cause global warming are known to cause and exacerbate diseases like asthma, cardiovascular disease and cancer. If governments are dragging their heels in disbelief about global warming maybe they need to take a look at the current rates of these diseases and the economic health costs associated with air pollution. Asthma alone is estimated to cost the U.S. $18 Billion, annually.

Reducing air pollution will not only help prevent climate change, but has an almost immediate positive impact on the health and well being of the entire human race, and reduces the economic burden accrued from pollution-related diseases. The public health benefits garnered from reducing air pollution are just as relevant as keeping the planet healthy. Even if you don’t believe in man-made global warming there are still plenty of reasons to reduce our energy consumption and emissions.

Onwards, to the future!

Health Impacts of Energy Usage Influencing Policy: Coming soon to political theater near you!

The production and usage of energy is accompanied by “hidden costs” such as the health care needs that results from the use of these energy sources. For example, coal may be cheap, but using it to produce electricity causes respiratory illness, impacts cardiovascular disease, etc, which puts unnecessary strain on our health care system, our economy, and has a negative impact on our collective health, productivity and quality of life. Currently, the prices of oil, coal, natural gas, wind, solar, nuclear power etc do not reflect the health effects imposed by their production and usage.

Coal plant = disease and health care costs

That is about to change thanks to a new report from the National Research Council. The NRC, which serves to “improve government decision making and public policy, increase public education and understanding, and promote the acquisition and dissemination of knowledge in matters involving science, engineering, technology, and health”, has taken account of the hidden health costs associated with the production and usage of various forms of energy. The report found that in 2005 the United States incurred $250 billion dollars in hidden costs associated with energy production and use. The majority of the cost can be attributed to “health damages from air pollution associated with electricity generation and motor vehicle transportation”.

These reports provide policy makers with a more complete picture of the advantages and disadvantages associated with particular energy sources. It seems the government is starting to take a more holistic view of our energy usage, and the state of national health and economy.

As statistics like these become more visible and pertinent, the reasons to support clean energy mount (and the continued use of dirty energies starts to seem, well, idiotic).

Reasons to use and support clean energy, like wind and solar:
1. Abundant/Available/Renewable.
2. Minimal negative impact on health and environment.
3. Reduces dependence on foreign oil supplies (increases national security and national independence).
4. Could support manufacturing sector in the United States, creating jobs, supporting the economy.
5. Sets a good example for the rest of the world/helps re-establish the U.S. as a legitimate leader in the global community.

Reasons to continue supporting and using dirty energy, like coal and oil:
1. It is too risky to invest in clean energies when the economy is in a fragile state (??)
2. ?????

It may cost more in the short-term to support new energy technologies. But, in the long-term making these difficult decisions can ultimately serve our greater interests in public health, the economy and national security. As we move forward (the U.S. and humans as a whole), it will be interesting to see if research like this is put to use, in policy formation and decision-making (governmental and public/individual).

I’m featured on Clean Air Council’s frontpage!

Check it out! My work educating health care providers about air pollution and respiratory health was recently featured on Clean Air Council’s homepage. The picture is from the presentation to the staff at The Penn Lung Center.

Read my blog entry about this program or visit the CAC site for more info.

If you would like me to present to your organization, just contact me! smccormick (at) cleanair.org

Ozone pollution and the immune system

Vehicle Exhaust + VOC + Sunlight=OzoneWith my work at Clean Air Council on air pollution and respiratory health I’ve come across some very interesting research of how the body and immune system are affected by air pollution.

Let’s take ozone for example. Ozone is cheekily described as “good up high, bad nearby”. In other words, ozone in the atmosphere is a good thing because it filters dangerous solar UV radiation, but ozone at ground-level is unfavorable because it is toxic to the body, causing coughing, respiratory inflammation, chest pain, etc, and can contribute to health issues such as asthma and cardiovascular disease.

What I find to be particularly interesting are studies like Devlin et al. (1997) that provide insight into the variety and complexity of the body’s responses to specific pollutants.

First, a little background information. When a toxic substance enters the body our immune system responds with a myriad of cellular and molecular changes (represented by the presence of “markers”) that are meant to neutralize or minimize the threat posed by the substance. These changes can be measured, and thus a substance can be identified as dangerous to the body because it elicits certain biological responses.

Inflammation is one example of an immune system response to a potential threat. Many studies use measurements of cell markers of inflammation in fluid inside the lungs to find out if a substance is toxic. However, inflammation markers are not the only measure of how much of a threat something poses to our bodies. For example, Devlin et al. also measured a marker called lactate dehydrogenase, an enzyme released when cell are injured or die.

Interestingly, some markers (eg. inflammation markers) stopped appearing after extended ozone exposure, in other words their response was attenuated. This suggests that the body stops responding negatively to ozone. So the question remained, “IS OZONE BAD FOR US?”.

But, other markers, namely lactate dehydrogenase did not attenuate, and was found to be present throughout elongated and repeated exposures to ozone. This suggests that ozone does continue to damage the body.

I am no cellular or molecular biologist, so bare with me. But, from what I gather, these variations in response at the cellular and molecular level hint at the complexity of the immune system. Now I am sure others have a better explanation, but for my own sake I would like to offer one possible explanation for the observed differences in inflammation and lactate dehydrogenase response and say that it is partly a function of limited resources and demand. This isn’t supposed to be economics, so let me explain.

The fact that inflammation markers are found to attenuate after repeated exposures suggests to me that the immune system is capable of re-allocating those resources in the face of inescapable adversity. Put another way, the immune system is often talked about as a sense organ and can make “decisions” based on the sensory input. In this example, the immune system detects a threat to the body (ozone) and the body initiates it’s first line immune response, inflammation. Since the exposure to ozone did not abate, and inflammation is an entirely ineffective response to ozone (granted inflammation is great at neutralizing an infection, but inflammation doesn’t do much to stop or protect us from ozone), the immune system “knew” to withdraw/attenuate the inflammation response. In this way the immune system does not employ brut force methods to dealing with toxins, but has the ability to try a certain approach and sensing whether or not it is working, and if not, then it stops using that approach. Very cool!

Not so cool was that the researchers found that the participants cells continued to release lactate dehydrogenase, indicating that the cells were still injured during both acute and long-term exposure to ozone. What this suggests then is that while ozone may not pose a long-term threat to our health via extended periods of inflammation (which can lead to disease such as asthma and cancer), one way or another ozone does continue to injure the cells that make up the lining in our lungs. Thus, ozone needs to be avoided and the levels of it in our environments should be reduced.

I think this sort of research is interesting but also very important for human health in general. We need to continue to investigate how various chemical compounds impact our bodies. A great area of uncertainty stems from the rise of nano technology and molecular manufacturing. There are many unanswered questions about whether or not these synthetic materials that are built on a molecular level will pose health threats, particularly to our respiratory system and immune system. I bet we will see a surge of research in these areas in the coming years.

Out with the old, in with the new: Two potential avenues for asthma treatment!


That inhaler may look cool, but what’s inside may change in the coming years, and that, too me, is what’s really cool.

Currently, asthma is primarily treated with two types of  medicine; corticosteroids (long acting, anti-inflammatory) and bronchodilators (fast-acting, airway opening).   There are others (i.e. antihistamines, decongestants, immunotherapy injections) but the two previously mention types of meds are far and away the most commonly prescribed.  Even though these drugs are effective, there are side effects/drawbacks.  Some are less serious, such as tremors, or mild agitation, but other reports, even if rare, are pretty scary.  For example, some research has indicated that if a patient over-relies on bronchodilators, as opposed to taking their daily maintenance anti-inflammatory medication, they may end up worsening their condition (Salpeter et al. 2004). Even scarier, is the FDA’s investigation into Singulair’s effect on mood and suicidality.

Both of these a fore mentioned medications work at a relatively superficial level. And, as just mentioned, the existing medications have physiological side effects but can also effect the mind, mood and behavior. Fortunately, two new possibly superior treatment avenues have recently emerged.  Actually, the stories hit press over the course of two days!  (It is a very exciting time for asthma research!)

Researchers at the University of Pennsylvania, right here in Philadelphia, have discovered that a form of communication between cells, known as “cellular crosstalk” is responsible for the creation of smooth muscle matter in the lungs (and cardiovascular system).

One aspect of asthma, especially severe and chronic asthma, is that repeated irritation and inflammation causes airway walls to become thickened.  These researchers are suggesting that new treatments may interject on this specific type of cellular communication, thereby disrupting the creation of unnecessary airway muscle.  While it is great that we are beginning to understand some of the underlying etiology of asthma to this degree, this avenue for treatment will not likely be applicable to the majority of asthma sufferers who have a mild or moderate severity.

The second recent advancement in the asthma treatment research field was the discovery of an enzyme linked to initiation of inflammation (aldose reductase).  The researchers at University of Texas Medical Branch at Galveston found that aldose reductase is the enzyme primarily responsible for the initiation of allergic inflammation in the lungs (one of the primary characteristics of asthma).  The great new is that aldose reductase inhibitors have already been proven effective in animal models for other disorders such as atherosclerosis, and colon cancer. The researchers claim that this form of treatment may also be able to be inhaled, and have a much longer lasting effect.

Only time, research and clinical trials will tell, but it’s great to see that we are closing in on treatments that could be more effective, work on a deeper level, and have less side effects than the current medications.