University of Iowa Children's Environmental Airway Disease Center (1998-2003)
- Publications: (1998-2003)
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Center Director: David Schwartz
Research at the Iowa Children's Center focused on the how airway disease develops and affects children from rural communities. Iowa researchers found that the incidence and severity of asthma in rural children is similar to that of children raised in urban environments the Iowa children do not appear to be protected. Another finding is that viral infections appear to increase sensitivity to other environmental exposures. Products of bacteria and fungi are prevalent in the rural environment and may be specific triggers but are often non-specific for asthma. However, Iowa researchers found that exposure to endotoxins, a component of many bacteria, can trigger asthma, including fixed airways disease in an animal model. Center research has also described mechanisms by which respiratory syncytial virus (RSV), a virus that triggers asthma, can escape antiviral mechanisms in the airway and pathways that the virus uses to trigger inflammation. The Center also found that a structured intervention program can lessen the severity of asthma symptoms. In many rural areas, the unit of community is often the school district, which may encompass more than one small town. University of Iowa researchers developed a community coalition (CARE-Net) to address issues of science, education and health care delivery appropriate for a rural setting.
Primary Environmental Exposures: Grain dust, endotoxin, bacteria and fungi
Primary Health Outcomes: Asthma
Project 1: Mechanisms that Initiate, Promote, and Resolve Grain Dust/LPS Induced Inflammation
This project addressed a fundamental issue in childhood asthma: why only a minority of children who wheeze at an early age develop lifelong persistent airway disease. Studies at the Iowa Center have shown that mice exposed to grain dust, endotoxin or LPS can develop the classical features of asthma airflow obstruction, reversible airway inflammation, persistent airway hyperreactivity and airway remodeling. The major strength of these studies is that they are modeled on the physiologically relevant concept that understanding grain dust-induced asthma will require understanding the effects of intact dust on the human airway. They also represent collaborative endeavors between the laboratories of Drs. Nauseef, Denning, Moreland, Weiss, and Schwartz and include parallel studies with mouse and human model systems.
Project 2: Multi-component Intervention Study of Asthma in Children from Rural Communities
There are conflicting findings about the prevalence of asthma among farm and non-farm children, and this project sought to estimate asthma prevalence and morbidity and determine differences between the two groups. The study population consisted of rural children ages 6-14 years enrolled in 10 school districts in 2 noncontiguous rural Iowa counties from 2000-2002.
Project 3: Role of RSV Infection and Endotoxin in Airway Inflammation
Airway infection with RSV is associated with worsening airway function in infants and young children with asthma. A better understanding of factors which determine successful host defense against RSV may uncover new approaches to control or prevent RSV infection and its effects on airway inflammation and function in asthma. Effective pulmonary clearance of the virus requires epithelial cell participation in type I interferon-dependent immunity. Another aim is to uncover strategies for selectively modifying damaging viral effects but not beneficial immunity.
Project 4: A Model to Study the Development of Persistent Environmental Airway Disease
A multicomponent intervention model was designed for the Rural Childhood Asthma Study (RCAS) reflecting the health care and environmental issues of children in rural areas. The RCAM model includes asthma counselor visits and individualized recommendations to the child's primary care provider generated by counselor worksheets and reviewed by the study physician-pharmacist-counselor intervention team in weekly rounds.