Pulmonologist and asthma expert Nizar Jarjour, MD, professor and head, Allergy, Pulmonary and Critical Care Medicine, delivered an honorary lecture at the American Academy of Allergy, Asthma & Immunology (AAAAI) conference on March 3-6, 2017 in Atlanta, Georgia. The Stephen D. Lockey, Jr., MD Lecture was entitled, “Severe Asthma Exacerbations: Mechanisms, Sequelae and Management.” This honorary lectureship was presented to Dr. Jarjour “… in recognition of (his) outstanding service to the specialty and science of allergy and immunology.”

“Clinical management of severe asthma exacerbations has been a passion of mine ever since my internal medicine residency training days,” said Dr. Jarjour, who described seeing the impact of severe asthma on emergency room patients during his residency in Chicago, Illinois. Years later, the disease burden remains high. Today, asthma “attacks” or exacerbations in the United States result in 15 M clinic visits, 2 M emergency room visits, and 500,000 hospitalizations each year.

Dr. Jarjour explained how UW-Madison research over several decades has elucidated connections between the common cold and asthma exacerbations. “That has really been possible only through collaboration of clinicians who understand asthma and scientists with very good skills in virology and molecular biology. Dr. Reed, Dr. Busse, and Dr. Eliot Dick from the state laboratory of hygiene did landmark studies in the 1980s showing that exacerbations are related to the common cold virus, and these studies have continued through collaborations between Dr. Busse, Dr. Gern, myself, and Dr. Lemanske,” he said.

Hints of this connection date back centuries, Dr. Jarjour explained, quoting Rabbi Mosheh Ben Maimon (1135-1204 CE). Known also as Maimonides, Ben Maimon wrote in his Treatise on Asthma, “I conclude that this disorder starts with a common cold, especially in the rainy season, and the patient is forced to gasp for breath day and night, depending on the duration of the onset, until the phlegm is expelled, the flow is complete and the lung well cleared.” Over the past three decades, epidemiological studies have shown that 50 to 85 percent of asthma exacerbations are related to viral infections, especially the rhinovirus which is the cause for the common cold. For this reason, pediatric hospitalizations for asthma exacerbations follow seasonal trends, peaking in fall shortly after the start of schools.

Dr. Jarjour described potential mechanisms of asthma exacerbation, including the role of eosinophils, lower airway inflammation in response to cytokines generated in the upper airway, and the direct infection of the lower airway with the rhinovirus. Studies performed at UW by Dr. Jarjour and Loren Denlinger, MD, PhD, associate professor, Allergy, Pulmonary and Critical Care Medicine, have demonstrated altered immune responses in individuals who have severe asthma that affect what happens when they experience respiratory infections. In these patients, a cold is not just a cold; due to altered innate immune responses, they experience increased rhinovirus replication in the lower airway which can be linked to asthma exacerbation. Recently, the Severe Asthma Research Program III (SARP III) clinical study identified several risk factors for asthma exacerbation, including gastroesophageal reflux disease (GERD), obesity, and uncontrolled eosinophilic inflammation.

“In this lecture, I tried to bring attention to some of the potentially modifiable risk factors for asthma exacerbations, which include eosinophilic inflammation, uncontrolled allergies, sinusitis, obesity, GERD, and poor access to care. By focusing on these factors, we can make a tremendous impact on the lives of patients and prevent costly, frightening ER visits,” said Dr. Jarjour (pictured at right, standing next to Mark F. Sands, MD, clinical professor, State University of New York at Buffalo, who chaired the plenary session during which Dr. Jarjour delivered his talk. Dr. Sands is a past president of AAAAI.).

The lectureship was made possible by an endowment to honor Steven D. Lockey, Jr. MD, a clinical allergist who co-founded the Pennsylvania Allergy Association in 1946 and who was recognized for his clinical skills and medical philanthropy service. His son, Richard F. Lockey, MD, also entered the field and eventually became president of AAAAI.

Dr. Jarjour currently serves as Senior Vice President and Chief Academic Integration Officer for UW Health, and as President of the UW Medical Foundation.

Resources:

• “Long-Standing Asthma Research Team Earns UW High Accolades, Research Dollars,” UW School of Medicine and Public Health, September 14, 2016.