The origins of asthma, impact of caregiver depression and safety of LABAs

October 8, 2018

At least in some parts of North America, October has brought cooler temperatures, wonderfully colorful foliage and a decrease in fall pollen counts. Those of us who see patients naturally turn our thoughts to illnesses that we see more with colder weather. Central to that is asthma, which is the emphasis of this month’s Annals of Allergy, Asthma and Immunology. We have a variety of reviews, perspectives and original research that address the various components of this complex illness. I assure you that there is a wide variety of offerings and warn you that once you start reading, you will have trouble putting this issue down. I want to call your attention to a couple of articles that are truly “must reads.”

The first is a review by Rebecca Scherzer, MD, and Mitchell Grayson, MD, FACAAI, from Columbus, Ohio who “start at the beginning” discussing the origins of asthma in both adults and children. They discuss the classic allergen association but expand that with issues related to altered microbiome, viral illnesses, obesity, aspirin sensitivity and smoking which may play a role in asthma COPD overlap syndrome. This is a precision medicine discussion that combines the risk from genetics, environmental exposures and lifestyle choices (i.e. diet, smoking, etc.) that contribute to the multiple presentations of asthma that we see in our clinics.

Another very interesting review by Beatrice Wood, PhD, and colleagues that describe the impact of caregiver depression on children with asthma. This adds a dimension of biosocial mechanisms to the pathophysiology of childhood asthma and emphasizes the need for the clinician to look for, recognize and deal with this situation when present. It is critical for the clinician to recognize that caregiver depression risk can be impacted by family stress dynamics and socioeconomic status which may have direct impact on the immune system of the child. It can also possibly contribute to stress and depression in the child as well as the caregiver. This suggests the need for family counseling of children for whom caregiver stress/depression has been identified to moderate/mitigate the negative immune and clinical effects associated with this family dynamic.

Finally, I want to mention a perspective by Joseph Spahn, MD, FACAAI, from Denver who presents a strong argument to support the safety of long acting bronchodilators (LABA) and gives an interesting history of the controversy. As our therapies become more complex for our severe asthma patients, safety is always a fundamental consideration, but this opinion piece will provoke us to look at big picture “risk-benefit” scenarios as we move forward in caring for our more severe asthma patients.

As always, I hope you find this month’s issue of Annals useful and interesting. Your comments are always welcome!

Gailen D. Marshall Jr., MD, PhD, FACAAI