Campus-community project examines childhood asthma

A new Madison project doesn’t involve higher taxes or a referendum, but it does require a positive pregnancy test and a history of allergies or asthma.

This study is open to eligible couples who plan to deliver their babies in a Madison hospital. Participants who complete the study will be paid $500. For information, contact the project coordinators at (608) 263-8539.

Those are some of the eligibility criteria for a major study that seeks to explain why some young children develop full-blown asthma and others don’t. Robert Lemanske, a nationally recognized asthma expert and professor of pediatrics and medicine at the Medical School, announced details of the study at a news conference today (Nov. 18).

Known as the COAST Project (Childhood Origins of Asthma), the federally funded research is testing the suspicion that children who develop asthma by about age three do so because of a combination of heredity and viral respiratory infections.

The theory, based on preliminary human observations and laboratory research, is that a young child who is genetically predisposed to allergies or asthma and gets the right respiratory infection at the right time will develop asthma. The child who escapes either strike is at a much lower risk.

“It’s important to remember that asthma is not a single disease with a single cause, but for childhood asthma, this combination of factors might be a predominant pathway by which it develops,” Lemanske says.

Lemanske, supported by $1.3 million from the National Institutes of Health to conduct this study, is recruiting up to 200 expectant couples through clinics, physicians and an array of organizations.

“This is truly a community project,” says Lemanske. “Most of the people I’ve presented this project to are very excited and want to be part of it.”

Asthma is a disease in which the airways in the lung become inflamed and narrowed, causing sufferers to wheeze and cough as they struggle to breathe. About 4.8 million children in the United States have asthma, making it the most common chronic disease among children in the nation. All told, asthma’s direct and indirect costs total about $6.4 billion annually.

While asthma can strike at any age, for many, the disease has its roots in infancy. Studies show that young children who have asthma inherit an imbalance of immune system hormones called cytokines, which are secreted by cells. The picture is complex, but in general those who produce too much of a cytokine secreted by the TH- 2 cells, or not enough of a cytokine secreted by the TH-1 cells, end up with allergies. For example, they may be allergic to ragweed or dog dander, or develop the skin condition eczema.

Not everyone who has allergies develops asthma. Lemanske suspects a viral respiratory infection makes the difference. In the lab, Lemanske has clearly shown that animals must have a cytokine imbalance and a virus that causes a respiratory infection before they develop the features of human asthma. He suspects the same is true in young children and is focusing on a specific virus called the respiratory syncytial virus (RSV).

The hypothesis could explain why some kids have both allergies and asthma while others just have allergies alone. It also could explain why some children who have RSV stop wheezing once the infection has run its course while others continue to wheeze and later are diagnosed with full-blown asthma.

To test his hypothesis, Lemanske hopes to enroll expectant parents and children in his study. They will undergo a series of tests as experts track which children develop asthma and which don’t.

“The societal benefits of this study may be invaluable,” says Lemanske. “If we can figure out more about what starts the whole process of asthma and how these kids are characterized in infancy, we could potentially intervene sooner with appropriate therapy and better preserve lung function over time.”