Cleveland Clinic Researcher Discovers Asthma's "Silver Lining"
Nearly 25 million Americans , about 8 percent of the population, have asthma. It affects more than 1 million Ohioans.
While people suffering from asthma may not be aware of it, a Cleveland researcher has discovered that there's a potentially protective aspect of the disease.
Dr. Joe Zein is a pulmonologist and asthma researcher at the Cleveland Clinic. He still treats patients for asthma but is spending more of his time in lab, trying to better understand its causes and new ways to treat it.
“Asthma is an airway disease that results from inflammation and obstruction of airways,” Zein says. “Sometimes it’s triggered by things in the environment, cat dander, pollen, dust mites. And when patients get exposed to those triggers, their airways go into bronchial spasm and they are obstructed.
"At that time you need to give them bronchial dilators to open them up, but also they need continuous therapy with what are called controllers to lower the inflammation of those airways.”
Zein says it obviously not the way humans should be interacting with their environment.
"We’re supposed to be tolerant to our environment, but sometimes mediators get secreted within the epithelial cells and the smooth muscle cells that result in that contraction,” he says.
Zein says his discovery about possible benefits of asthma grew out of simple observations shared by his medical colleagues.
“Believe it or not, we were just having a discussion and we asked ourselves, ‘When was the last time you saw an asthmatic in the ICU very sick with pneumonia?' And no one remembered when was the last time,” he says. “And we looked at large data bases and data from the Cleveland Clinic and we found that patients with asthma have half the chance of dying from an infection, so asthma is not all bad after all.”
So what causes the immunity?
“The simplistic explanation is that the immune system in asthma is very vigilant and is always active and that’s why people have inflammation in their airways," Zein says. "The fact that this immune system is always vigilant gives it a higher tendency probably to clear infections when they occur.”
“The other explanation is that the certain kind of immune activation in asthma which puts them at risk of having allergies also protects them from having what we call a TH1 reaction to infection. So even if they have an infection there is modulation of the immune system that keeps them from dying from an infection.”
So asthmatics’ immune system, since they’ve been dealing with this inflammatory cascade their whole lives, don't freak out when they get an infection.
"Because their inflammation is always active, they can clear infection quickly,” Zein adds.
“This will be our next step is to try to look in an asthma model in mice and see if, when you give them an infection, their survival and tendency to clear the inflection is quicker than mice without asthma,” he says.
Zein says a key question is whether what's going on in asthmatic people might be applied to other infection fighting strategies.
“We have struggled for 20 years to come up with medications to treat sepsis per se, not the infection,” Zein says. “Sepsis is the way your body reacts to an infection, and almost every medication has not panned out to be effective.
"Maybe it’s not one medication or a targeted therapy; maybe it’s a pathway or a different kind of inflammation. And hopefully knowing and trying to mimic what’s going on in asthmatics may help us in the future to prevent mortality from sepsis.”
Zein says that while about 3,000 people die of asthma each year, more than 100,000 people succumb to sepsis annually in the U.S.