Reporting from the Front Lines of Lung Disease Research

For over 110 years, the American Lung Association has been committed to a world free of lung disease, and has been instrumental in building the lung health research community through our research grants.

Each year we connect with our researchers on the front line of lung health research at the International Conference of the American Thoracic Society (ATS)—the largest meeting of lung health doctors and pulmonary researchers in the world—to engage in and witness the discussion on patient care and the development of cutting edge research.

(Left) Harold P. Wimmer, National President and CEO of the American Lung Association with Research Team member Bradley Richmond, MD, and Scientific Advisory Committee member Neil Schachter, MD. (Right) Derek Byers, MD, PhD grant reviewer and grant recipient Peggy Lai, MD at the healthcare industry council reception.

This year, the American Lung Association Research Team is well represented at the ATS Conference. It's exciting to be able to attend and follow the careers of our current grantees, and also see the trajectory of former awardees, and how they have developed and continue to contribute to the field of lung health. All told, there are more than 24 presentations linked to Lung Association-funded research at the conference, including six different sessions on the results of our Airways Clinical Research Centers Network (ACRC).

The Lung Association's ACRC is the largest non-profit network of clinical research centers providing conducting vital research to improve the lives of people who have asthma and chronic obstructive pulmonary disease (COPD).
Below is a recap of a few of the presentations I had the honor of seeing at the ATS Conference:

• Central to the work of the ACRC Network is to develop an understanding of how chronic lung disease develops. One of our ACRC Principal Investigators, Sankaran Krishnan, MD, examined the medical history of children who had resistant airflow obstruction, which can be a precursor to more serious lung disease later in life. This evaluation found that these children are commonly diagnosed with asthma and allergic rhinitis but have varied medical histories, and a significant proportion were born prematurely. Little is understood about this population, which has slowed the development of effective therapies. Through Sankaran's research, we can help create more effective treatments for children with resistant airflow obstruction. 

• The work presented by David Kaminsky, MD, demonstrates how the data collected in each ACRC study can be examined together and analyzed to tell a larger story. Kaminsky and his team looked at data from five different studies to determine how common it is for a standard asthma breathing test to cause a patient's small airways to close off. About 70 percent of asthma patients responded in this way when given the test. The closing off of these airways suggests that the very small airways, located very far out in the lung, are involved in the patient's asthma. This is interesting because most of our current inhaler medications do not reach these very small airways. We can use this information to develop a clinical research study to test whether patients with evidence of small, outer airway abnormalities will respond better to inhalers designed to reach these outer airways. These findings will be helpful to doctors trying to select the best type of inhaler to use for each individual patient with asthma.

• Linda Rogers, MD, reported on the results of the Long-acting Beta Agonist Step Down Study (LASST), which determined the optimal way to reduce asthma medications in patients who have moderate to severe persistent asthma that is well controlled on fixed dose combination inhaled corticosteroid (ICS) and long-acting beta agonist (LABA). Asthma guidelines recommend stepping down (reducing) medication once asthma is controlled, yet there is no agreement on the best approach. Concerned about LABA safety, the U.S. Food and Drug Administration (FDA) recommended that LABAs should be used for the shortest duration required and then discontinued, suggesting that LABA should be stopped before reducing the dose of ICS. This has left clinicians confused, and because of this many clinicians do not step down asthma therapy at all if asthma is well controlled. In the year-long LASST study, we found that the two step-down regimens did not differ significantly from stable treatment, although stopping the LABA was associated with more hospitalizations and lower lung function. These data, together with recent reassuring data regarding the safety of LABAs from FDA mandated studies, suggests that with careful monitoring of stable asthma patients, clinicians should consider reducing ICS dose first before discontinuing LABA therapy.

It's exciting to see the results of all this work shared with the larger medical community. Over the years, we have seen ACRC research change the nature of asthma patient care nationwide. These are but a few examples of the breadth of that impact, and a glimpse at the ongoing work of the American Lung Association Research Team.