What Anti-IgE Could Mean for the Future of Asthma

Wednesday, August 5, 2009, 12:54
Asthma
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Dick:

Why do you think we are having such a hard time, sir, getting asthma under control?

Dr. Berger:

Well, there are many reasons. The background on this is that we’ve seen a doubling of the number of people who have asthma from 1980 to the present time, from about 6 million up to about 18 million, and a lot of people believe that this surge in asthma is due to several factors. One, certainly, is that we’re better diagnosing it. We have better evaluation techniques. We certainly have better-trained physicians who are much more aware of the symptoms. The second, a lot of people believe, is because of all the time that we’re spending indoors. Dust mites, for example, that are high in areas where there’s not good ventilation such as airplanes or in sealed buildings, tend to cause a lot of asthma problems.

And there’s a very interesting theory that our immune system – which in the past has been mainly concerned with fighting off infections and basically protecting us from things such as parasites, bacteria, and viruses – in our developed society now with the use of immunizations and with antibiotic use, our immune system has kind of gotten bored with the whole idea of fighting off infections since there are no infections. And it’s starting now to have immune responses to things that are not normally a harmful substance, such as grasses, trees, weeds, dusts and molds. In a sense, there’s been a shift of our immune system to develop more allergic responses.

Dick:

You began to go in a little bit in the direction of cause, but is asthma one of those things that has a strong genetic component? Are we born with it? Are we genetically predisposed to it?

Dr. Berger:

Exactly. We are genetically predisposed. There are very good studies that show that this has a very strong genetic tendency. We certainly know in families if there is one parent who has asthma or allergies, then the chances of one of the children having it is about 50-50. If you have two parents with allergies and asthma, then it’s about 75 percent. In other words, if you have four kids, three of the four are going to be affected by allergies in some way, whether it be hay fever or sinus problems, eczema, or of course asthma. So, we do know that asthma is a genetic disease such as other diseases, such as diabetes, a history of hypertension, and heart disease. We do know there’s a very strong genetic component.

Dick:

So, for some of us at least, we don’t have a whole lot of control as to whether or not we’re going to get asthma, so maybe we need to turn right away then to treatment. And what are the treatments now currently available for people with asthma?

Dr. Berger:

One of the things that we’ve noticed over the years is that asthma is more of an inflammatory disease, and let me explain what that means. There are two components when someone has asthma. One is what we refer to as bronchoconstriction, which is a tightening of the muscles that are, in a sense, bands around our airways, what we refer to as bronchi. The second component, which is really the component that causes the long-lasting chronic symptoms, is inflammation. Inflammation involves swelling, congestion, mucus formation, and also, which is of particular concern to us now, that there’s replacement of healthy tissue with scar tissue. And so that the feeling in the past that asthma is totally reversible, we’re kind of relooking at that theory, and there are many people who believe that what is really going on is what doctors refer to as remodeling of the airway. In other words, there are permanent, non-reversible changes going on. So we’re really stressing the anti-inflammatory component, decreasing the inflammation, early aggressive therapy to prevent the irreversible changes

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