Asthma is a clinical syndrome that is well recognized by health care practitioners, yet
asthma pathogenesis still remains poorly understood. Asthma affects approximately 20 million
Americans, who suffer around 5,000 deaths annually. More than 70% of people with asthma also
suffer from allergies. Although many advances in understanding the pathophysiology of asthma
have been made in the past few decades, more studies are necessary to achieve a more thorough
understanding of asthma at the cellular and molecular level.
The majority of murine models suggest asthma and "allergic" responses involve activation of
Th2 cytokine pathways, including IL-4 and -13. Similarly in humans, several lines of evidence
support a large role for Th2 adaptive immunity. These include the large majority of asthmatic
patients with atopy; the measurement of increased amounts of Th2 cytokines, including IL-4
and IL-13 in the airways and sputum of mild asthma; and most recently, the observed efficacy
of anti-IgE therapy in "allergic" asthma. However, other data, including the large numbers of
subjects with atopy and no asthma, suggest Th2 adaptive responses are insufficient to explain
many aspects of asthma. Whether and how innate and adaptive immune pathways interact in human
asthma is not clear, with few studies beginning to address these interactions in vitro and in
vivo.
For this reason, the investigators of this study would like to prospectively enroll patients
with known asthma and follow them through an asthma exacerbation, while treating them with a
standardized protocol. Over six week's duration, the investigators would like to study
patients by collecting physiologic data such as spirometry, and biologic material in the form
of sputum, nasal scraping, venous blood, exhaled breath and sputum. It is our aim to fully
characterize the impact of the prostaglandin/cycloygenase/eicosanoid pathway as it relates to
asthma exacerbation and recovery.
Completion of this study in human asthma may provide new mechanistic insights into how
relationships between innate and adaptive immune responses influence the course of an asthma
exacerbation. The information obtained from this research and the corresponding studies may
lead to innovative medical therapies and insight into the role of the epithelium and its
interactions with both innate and adaptive immunity.