In lieu of an abstract, here is a brief excerpt of the content: According to the World Health Organization WHOthere are currently million people suffering from asthma worldwide.
Determinants of Early Childhood Asthma and Atopy Following Infant RSV Infection RSV bronchiolitis and early childhood asthma are the most common, serious, acute, and chronic conditions of infancy and childhood, respectively, and diseases that disproportionately burden vulnerable populations. This project draws together three important elements in understanding the role of RSV on recurrent wheezing and asthma inception—RSV infection severity, host response and susceptibility.
Whether mild infection confers intermediate risk or has a protective effect is an important question. The answer will influence proposals for primary asthma prevention strategies. The proposed series of investigations will aid in our understanding of the role and mechanisms through which RSV may both lead to chronic lung disease, and may protect from chronic lung disease.
Utilizing the ReSPIRA cohort, established for this investigation and described in Core B, we will investigate the relationship between infant RSV infection, host response to infection, and genetic determinants of recurrent wheezing, asthma, and allergic disease development following RSV infection.
Our specific aims are to: Utilizing the ReSPIRA cohort, which includes infants followed from early infancy through early childhood, and established through this U19 grant, this project will answer the following questions: Answering these questions will allow us to develop preventive interventions for chronic lung disease in children, and ultimately improve the health of infants and children with bronchiolitis and asthma in the U.
The long-term objective is to define the relationship between infant respiratory syncytial virus RSV infection and the host response that enables asthma inception. There is currently no vaccine to prevent either virus.
However, it is not understood why some infants merely experience a mild cold with these viruses, while others experience a more severe lower respiratory tract infection.
In addition, the impact of these viruses on later childhood health is also poorly understood. This research team has made significant contributions to the understanding of infant respiratory viral track infections and the development of asthma and allergic diseases.
This study seeks to answer important remaining questions to aid in understanding the pathogenicity of respiratory viral infections and their role in asthma and allergic disease development to help move us ever closer to primary disease prevention strategies to decrease infant and childhood morbidity.
Lower respiratory tract infections LRTIcaused by viruses such as respiratory syncytial virus RSV and rhinovirus RVare a leading cause of bronchiolitis in infants.
Infants hospitalized with bronchiolitis not only experience significant morbidity, but are also at significantly increased risk for both recurrent wheezing and childhood asthma.
We have established that respiratory syncytial viral infections appear to directly contribute to asthma causation, not just simply identify persons at risk for subsequent wheezing. Viral infections outside the infant period are also important, as they are modifiable environmental factors that have been established to be the most common cause of asthma exacerbations in both children and adults.
This proposal uses a combined, parallel clinical and experimental approach to evaluate the contribution of, causality, and mechanisms through which respiratory syncytial virus, and human rhinovirus, contribute to asthma development and disease natural history.
These studies all relate to the central hypothesis that viruses, as one significant environmental factor, alter the risk for developing asthma, as well as the natural history of prevalent disease. Specific testable questions related to this hypothesis include: PROJECT NARRATIVE The aims of this mid-career investigator award will be met by allowing the candidate to translate her experimental expertise to both mentor trainees and to direct patient-oriented studies of the progression and functional outcome of childhood viral illness in asthma development, moving from risk factor determination to intervention studies, and ultimately to disease prevention.
The investigators compare real world adherence to and effectiveness of alternative asthma controller medication regimens in these diverse populations; conduct applied methodologic research that delineates the tradeoffs among different design and analysis options for observational comparative effectiveness research; and lay foundation for future comparative effectiveness trials of pharmacogenetic tests.
Supplementation with folic acid, synthetic folate, is recommended during the periconceptional period to prevent neural tube defects NTD.
Studies in different populations have suggested an association between reported folic acid supplementation during pregnancy and increased risk of infant lower respiratory tract infection and early childhood asthma, but data are limited.
While adequate intake of folate is essential for prevention of NTDs, it is important to delineate the impact of supplementation on the risk of common respiratory and atopic diseases.
Folate plays an important role in DNA methylation, a regulator of gene expression. A causal relationship between folic acid supplementation and respiratory outcomes in children has not been established.
However, this relationship does have some biologic plausibility. In a pregnant mouse model, a diet high in methyl donors, including folate, resulted in an augmented allergic phenotype in the offspring, as seen in asthma.
There is no primary prevention strategy for atopic diseases such as asthma. Our objective is to determine whether higher maternal folate intake or the timing of this intake increases the risk of wheezing, asthma, and other atopic diseases in children.
This collective work will characterize maternal folate status using objective measures and will assess childhood wheezing, asthma, allergic rhinitis, and atopic dermatitis using validated tools and objective measures.
This will be the first investigation in a country with a national fortification program, where individuals may have high intake of folic acid from the diet.
This work will use complementary retrospective and prospective cohorts of mother-child pairs. Specific aim 1 will investigate the population-based incidence of wheezing and asthma during the first 6 years of life, by the timing of prescriptions containing folic acid filled during pregnancy in a retrospective cohort of 80, mother-child dyads from the Tennessee Medicaid population.
This innovative, cost-efficient project will have the advantages of 1 a well-characterized retrospective cohort with a large number of mother-child dyads and determination of folic acid prescriptions filled by month of pregnancy and 2 a prospective cohort that includes the rich, existing infrastructure of the CANDLE cohort with maternal and infant biospecimens, nutritional data, and prospective follow-up using validated tools and objective measures to assess respiratory and atopic outcomes.
This study has potential to inform prenatal recommendations and identify modifiable risk factors for asthma and atopy.
While many respiratory viruses have been associated with asthma exacerbations, HRV are the most common trigger of asthma exacerbations and chronic obstructive pulmonary disease COPD in children and adults.
The results of the proposed research will help guide vaccine development and elucidate mechanisms of virus-induced asthma. The findings of this work may lead to new approaches to treat and prevent asthma.It could be argued that ethical analysis in health science and policy (i.e., different from clinical or research ethics) is a relatively new domain of scholarship; thus, it is unsurprising that investigations concerning ethical issues pertaining to the particular disease of allergy are still in their infancy.
Jan 25, · However, clinical research and therapy both provide medical care and are performed by physicians with similar interventions of treatment in the clinical setting.
Experimental interventions and the best proven therapy should appear equally effective. His research interests include prevention of asthma and allergic diseases, vaccines and vaccine safety, angiodema, and how host/pathogen interactions lead to disease.
Jan 25, · However, clinical research and therapy both provide medical care and are performed by physicians with similar interventions of treatment in the clinical setting. Experimental interventions and the best proven therapy should appear equally effective. The investigators in the Center for Asthma & Environmental Health Sciences Research at Vanderbilt University focus on identifying and understanding factors important in the development of asthma and allergic diseases, with the primary focus to develop primary and secondary disease prevention strategies for the most common causes of infant and. Feb 21, · Chronic obstructive pulmonary disease (COPD) is a chronic, progressive disease with symptoms of dyspnea, increased respiration rate, sputum production, and a reduced exercise intolerance.1 In , the World Health Organization estimated that COPD was the tenth most prevalent cause for moderate to severe disability,2 and was .
Dr. Cosby's other important interests include writing and publishing poetry, keeping a garden, and spending time with his wife and two children. Apr 10, · In the Severe Asthma Research Program (SARP), 54% of patients with severe asthma had a history of sinusitis (vs 33% of those with mild asthma, and 37% of those with moderate asthma; P.
Clinical Implications of Basic Research Combined Analysis of Asthma Safety Inhaled glucocorticoids are pivotal to . The investigators in the Center for Asthma & Environmental Health Sciences Research at Vanderbilt University focus on identifying and understanding factors important in the development of asthma and allergic diseases, with the primary focus to develop primary and secondary disease prevention strategies for the most common causes of infant and.