Asthma is a heterogenous disease of the lower respiratory tract unified by the presence of airway inflammation and airway hyperresponsiveness or constriction in response to various stimuli: viruses, allergens, pollution, tobacco smoke, exercise, cold air, etc. More than 7% of the U.S. adult population carries a diagnosis of asthma. Among adults with asthma, many comorbid conditions impact the severity of their asthma and response to therapies. These conditions include obesity, which affects more than 40% of adults with asthma, and chronic rhinosinusitis with nasal polyps and NSAID allergy known as aspirin-exacerbated respiratory disease (AERD) which impacts 7% of adults with asthma. Both subgroups of asthma have increased asthma symptoms, poorer asthma control with currently available medications, and high rates of asthma exacerbations that lead to oral steroid use. Our lab is focused on the role of innate immune cells and mediators in adult-onset asthma with the goal of finding new and personalized treatment options for adults with asthma.
Our prime areas of interest include:
Aspirin-Exacerbated Respiratory Disease (AERD):
Aspirin-exacerbated respiratory disease (AERD) is the clinical triad of asthma, chronic rhinosinusitis with nasal polyps, and respiratory reactions to inhibitors of cyclooxygenase-1(NSAIDS) such as aspirin, ibuprofen and naproxen. Ongoing projects in AERD include:
Investigating the mechanisms of the therapeutic response to daily aspirin therapy.
Establishing the mediators and the pathways responsible for sex differences in disease burden and clinical manifestations.
Understanding the role of prostaglandins in AERD severity and treatment response.
Determining how patients with AERD respond to the growing list of biologic therapies approved for severe asthma and/or nasal polyps.
Asthma with comorbid obesity:
Adult-onset asthma is characterized by multiple phenotypes, each with their own unique mechanisms and clinical features. Among the different subtypes of adult asthma, we are currently focused on the fascinating pathways uniquely involved in asthma in the setting of obesity. The airway inflammation in obese asthma involves either 1) classical allergic asthma pathways which are modified by obesity and related metabolic dysfunction or 2) non-allergic pathways driven by the systemic inflammation of obesity and related metabolic dysfunction. Our team is exploring various treatment targets in asthmatics with obesity through electronic health record data and translational studies.