Dr. Albert Rizzo:
This episode marks a couple of firsts in the history of our show. Since we launched in the summer of 2020, this is our first live recording and our first repeat guest, Dr. Ann Dixon, Director of Pulmonary and Critical Care Medicine at the University of Vermont Medical Center and star of our January 2021 episode on asthma management guideline updates.
You met with her in person at the American Thoracic Society 2023 International Conference in Washington, DC this week for a conversation around highlights from the annual meeting, her ongoing involvement in clinical airway research, and her volunteer work and leadership role with the American Lung Association.
We hope you enjoy our catching up with Dr. Dixon.
So Dr. Dixon, you have an important role at the American Lung Association. You're a national board member and you also are chair of our Scientific Advisory Committee. But before we get into that, I really want our listeners to understand what your field of interest is, the research you're doing, and what are some of the things you found at ATS to be exciting and some takeaways.
Dr. Ann Dixon:
Absolutely. Well, my field of interest is in the area of obesity, metabolic dysfunction, and lung disease. I actually got interested in this because of a study we did about 20 years ago as part of the American Association Airway Clinical Research Centers. We found that a very high proportion of our participants in the clinical trial with asthma had obesity, and they responded completely differently to the medication that we started them on. That really launched my research career.
So I've been working in this field of metabolic dysfunction, obesity, and asthma now for about 20 years, and we've made a lot of discoveries. We've found that some people have asthma from childhood and gain weight over time, which complicates their asthma. There's also a group who develop asthma as they get older because of obesity. The work we have done has really informed that.
Now we're beginning to understand how metabolic dysfunction—so related to inflammatory mediators produced by adipose tissue, high insulin, and other things that cause diabetes—also affects the lung. This came out at this meeting: when obesity and asthma react together, metabolic dysfunction is critically important.
In asthma these days, we're using a lot of drugs that target very specific pathways, like eosinophils, which are cells that can cause inflammation. But now I think we really need to target obesity and metabolic dysregulation in people suffering from both obesity and asthma.
Dr. Albert Rizzo:
I was able to attend one of the sessions earlier today that you and others were in, and a takeaway I got from that was the role of weight loss in people with asthma.
Dr. Ann Dixon:
Yes, actually we published a pilot study last year through the ALA’s network. We did a weight loss intervention using an internet-based program at two centers with 40 participants. We found that losing five percent of their weight led to a significant improvement in asthma control scores. That threshold of about five percent seems very important.
Even modest weight loss can meaningfully improve asthma outcomes. On the flip side, gaining weight is not good for breathing, and some medications for poorly controlled asthma, like prednisone, can worsen weight gain.
Dr. Albert Rizzo:
Getting back to your role at the ALA as chair of the Scientific Advisory Committee, one of the main things SAC does is oversee the research program, including awards and grants. Could you share more about that?
Dr. Ann Dixon:
Absolutely. I’m really proud of our grants program. The American Lung Association is committed to funding research that will have a major impact on lung health. Our priorities include lung cancer, interstitial lung disease, and allergic airway disease.
We aim to fund the next generation of researchers and particularly those from underrepresented backgrounds to ensure diverse patient populations are studied. Many senior researchers have shared that their first research grant came from the ALA, which is rewarding to hear.
Dr. Albert Rizzo:
The other pillar is the ACRC—the Airways Clinical Research Network. Can you tell our listeners about that?
Dr. Ann Dixon:
Yes. I’ve been part of the network since 2001; it started in 1999 with 19 centers, now expanding to 40 sites across the U.S. The network conducts important research to impact lung health and inform treatment guidelines.
We’ve studied topics such as flu vaccination in asthma patients, gastroesophageal reflux disease management in asthma, and dietary supplements like soy. While some trials were negative, they were important in preventing unnecessary treatments.
Currently, the Lung Health Cohort Study is recruiting healthy young adults aged 25–35 to identify determinants of peak lung health and early predictors of disease. We’ve recently reached 1,000 enrollees, and the plan is to follow them for 30 years.
Dr. Albert Rizzo:
I also met a young woman who enrolled in the study last year; the follow-ups are easy and involve portable spirometry and a few questions. This retention is key for long-term outcomes.
Dr. Ann Dixon:
Yes, it’s an important study. Robbie Callahan likens it to the Framingham study for lung disease—we’re looking for the “cholesterol” of lung disease.
Dr. Albert Rizzo:
Beyond awards and the ACRC network, the ALA is enhancing co-funding through the Research Institute. Could you share your thoughts on that?
Dr. Ann Dixon:
We’ve explored partnerships with other non-profits like the ATS, CHEST, and Allergy Foundation. The goal is to support early-stage innovations and access a diverse group of investigators. Collaborations can advance research in lung health and help identify emerging and difficult problems.
Dr. Albert Rizzo:
We also fund health equity awards through these partnerships and programs like the Harold Amos Medical Faculty Development.
Dr. Ann Dixon:
Yes, it’s exciting to support disparities research and mentor emerging researchers. We also aim to convene expert panels—including clinicians, patient advisory groups, and industry experts—to address critical issues in lung health.
Dr. Albert Rizzo:
Thank you for extending your visit here in DC and for everything you’re doing in research and with the ALA.
Thanks again to Dr. Dixon for coming back on the show and to you for tuning in to our first live recording before our June episode on lung cancer care delivery. You can revisit recent episodes, like our conversation with Dr. Pyle Gupta on allergic pathways and respiratory disease.
Be sure to subscribe and rate Lungcast on your preferred listening or watching platform, and visit lung.org and hcplive.com for more news and resources.
Until next time, I’m Dr. Albert Rizzo, reminding you: if you can’t breathe, nothing else matters.
