Future Research Directions in Asthma. An NHLBI Working Group Report

Abstract

Asthma is a common chronic disease without cure. Our understanding of asthma onset, pathobiology, classification, and management has evolved substantially over the past decade; however, significant asthma-related morbidity and excess healthcare use and costs persist. To address this important clinical condition, the NHLBI convened a group of extramural investigators for an Asthma Research Strategic Planning workshop on September 18-19, 2014, to accelerate discoveries and their translation to patients. The workshop focused on (1) in utero and early-life origins of asthma, (2) the use of phenotypes and endotypes to classify disease, (3) defining disease modification, (4) disease management, and (5) implementation research. This report summarizes the workshop and produces recommendations to guide future research in asthma.

Keywords: asthma; disease modification; implementation; phenotype; prevention.

Figure 1.

Preventive strategies and disease-modifying therapies for asthma. The immune system and lung structure pathobiology in asthma arise from developmental pathways and exposures. Asthma exacerbations and progressive decline of lung function are morbid outcomes for asthma. Standard treatment is focused on reversing bronchoconstriction with β-adrenergic agonists (relievers) and treating inflammation with corticosteroids (long-term controllers) to alleviate the downstream signs and symptoms of asthma. Disease-modifying asthma therapies target upstream effectors and mechanisms underlying asthma pathobiology. Preventive strategies require understanding of the critical windows of environmental exposures over the life-course and the personal biological predispositions that put individuals at risk for development of asthma or its progression.