Feature Story

AAAAI Members Making Strides in Asthma Research

Asthma research has made significant strides over the years, yet there's still much to uncover. As May marks National Asthma and Allergy Awareness Month, it's an opportune time to showcase the many ways AAAAI members continue to advance asthma research. From pediatric disparities to women's health intersections and environmental impacts, these stories provide just a few examples of the multifaceted approach AAAAI members are taking to advance the specialty and improve patient care.

Jonathan Witonsky, MD, MAS, is focused on how clinical, socio-environmental and genomic data predicts outcomes related to asthma among pediatric populations who have a disproportionate burden of asthma.

“Asthma and allergies present a substantial challenge for children, profoundly affecting their quality of life,” he said. “Moreover, these conditions highlight significant health inequities. The origins of these disparities are complex and multifaceted, resulting from an interplay of genetic, environmental, socioeconomic and healthcare access factors. Exposure to air pollution, substandard housing conditions, limited access to quality healthcare and cultural or linguistic barriers all contribute to the disproportionate impact on certain populations.”

As a pediatrician, allergist/immunologist and clinical investigator, Dr. Witonsky’s career aspirations are centered on integrating clinical, social and genomic data to reduce the disparities in asthma and allergies among children. “A critical first step in addressing these disparities and managing these conditions effectively is identifying children at the highest risk of developing asthma and allergies. By understanding risk factors and implementing early intervention strategies, we can enhance disease management, alleviate symptom burdens and potentially prevent the onset of these conditions in disproportionately affected populations,” he said.

Jonathan Witonsky, MD, MAS

His research about early-life daycare attendance and the risk of asthma and allergic diseases was recently featured at the 2024 AAAAI Annual Meeting. Findings from the research suggested that early-life exposures in daycare may be protective against allergen sensitization. The data showed that children attending daycare had clinically significant lower IgE levels and lower rates of food and perennial aeroallergen sensitization. The study, Puerto Rican Infant Metagenomic and Epidemiologic Study of Respiratory Outcomes, is ongoing, and provides an opportunity for further exploration into the influence of prenatal and postnatal social, environmental and genetic factors on childhood asthma and allergies.

Dr. Witonsky also currently has funding to study genetic ancestry-informed lung function equations to help predict asthma outcomes. “Similar to the observed population disparities in asthma and allergy, there are differences in lung function across populations,” he said. “Genetic ancestry can explain more than 15% of the variation in lung function within a racial/ethnic group. However, a critical aspect remains unclear: are the genetic ancestry-related differences in lung function primarily attributed to genetic loci known to influence normal lung function variation, or are they influenced by underlying social factors known to impact lung health adversely? Addressing these critical questions offers a pathway to inform our endeavors in advancing respiratory health across all populations and reducing health inequities,” he explained.

While Dr. Witonsky focuses primarily on the pediatric and disparity aspects of allergy and asthma, Kelly Colas, DO, PhD, the 2023-2024 Vaccines and Medications in Pregnancy Surveillance System (VAMPSS) FIT, is using her passion for women’s health to help advance asthma research as it relates to women, specifically when it comes to pregnancy. “Pregnancy can be an extremely vulnerable time for women and there can be uncertainty in what medications and exposures are safe for both mom and baby,” she said.

Kelly Colas, DO, PhD

Asthma is the most common respiratory condition women experience while pregnant, Dr. Colas explained, and around one third of women with asthma have worsening symptoms during pregnancy. While evidence demonstrates that uncontrolled asthma can have adverse effects on both mom and baby, patients sometimes hesitate to use medication during pregnancy.

“I worked at a clinic for uninsured patients and saw firsthand the detrimental effects that discontinuing asthma medication use can have,” Dr. Colas said. “I became very passionate about educating patients on medication use during pregnancy so that they are able to make an informed decision.”

Dr. Colas has a PhD in anthropology with a focus on reproductive health. She is a second-year fellow at the University of Washington in Seattle. “My PhD research helped me to gain a deeper understanding of the complexities of the interactions pregnant women have with healthcare. The methodology of my research was primarily qualitative, which highlighted the nuances of the medical decision-making process and the impact of these decisions. Through my experience in A/I during residency, I started to recognize the need for qualitative research for women’s health issues in A/I, particularly asthma. In my primary care clinic, pregnant patients commonly discontinued their asthma medications, in part due to a lack of knowledge about asthma medication. I am passionate about exploring patients’ decision-making processes, so that we can work together to optimize the health of both the mother and baby.”

Currently, Dr. Colas is working on a research project through the VAMPSS FIT Program. Early results showed that while most participants believe asthma medication is safe during pregnancy, a significant amount of participants still expressed concern. She’s now working to link participant IDs to responses, so she and her team can explore the association between medication compliance, beliefs about asthma medication use and birth outcomes. “In the future, I would love to conduct a project using qualitative research methodology to better understand patients’ concerns about asthma medication use during pregnancy and the decision-making process of utilizing asthma medication during pregnancy,” she said.

In March 2024, a study published in The Journal of Allergy and Clinical Immunology: In Practice demonstrated that adhering to asthma medication is safe for pregnant women who have asthma. Research like Dr. Colas’ is essential to helping healthcare professionals understand their pregnant patients’ concerns when it comes to asthma medication and combating medical myths and misinformation.

Yoojin Chun, MS

Our understanding of asthma must also continue to evolve as the world evolves. As climate change and extreme weather exerts effects around the world, air pollution will have an increased impact on patients with asthma. Members like Yoojin Chun, MS, computational biologist in the research group of Professor Supinda Bunyavanich, MD, MPH, MPhil, at the Icahn School of Medicine at Mount Sinai, are focusing their research around this topic. “It’s well recognized that air pollution exposure affects asthma, but our study is the first to identify how ozone and PM2.5 drive gene expression in the airway that leads to asthma,” said Chun. “This study deepens our understanding of how air pollution impacts the airways of asthma patients and reinforces to physicians and patients the importance of considering air pollution in asthma management.”

For Chun, studying how air pollution drives molecular processes is a passion that has grown throughout the years. “I was shocked when Canadian wildfire smoke turned the New York City skyline orange in 2023, while I was working on this study. Breathing became so difficult for everyone, and especially those with asthma. I now feel even more motivated to study how air pollution drives molecular processes in asthma.”

Efforts to mitigate environmental impacts, including reducing greenhouse gas emissions, improving air quality standards and promoting sustainable practices, are crucial for reducing the burden of asthma on communities. Research like Chun’s expands the mechanistic understanding of air pollution effects on asthma, which helps build a case for making nationwide changes to help the millions of patients who suffer from asthma.

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