NIEHS-supported research highlights the importance of taking each patient’s unique environmental exposures into account when treating asthma. The lung disease occurs when the body’s natural defenses against germs and sickness react strongly to environmental exposures like pollen or pollutants.

Asthma affects about 25 million people in the United States, including 4.7 million children and adolescents. Environmental exposures can worsen the coughing, wheezing, chest tightness, and shortness of breath symptoms linked with asthma.

Stavros Garantziotis, M.D., a lung doctor and head of the Matrix Biology Research Group at NIEHS, recently spoke with Environmental Factor for Asthma and Allergy Awareness Month. He discussed research to understand the environment’s role in asthma, how people’s immune systems react differently, and advice he gives to empower patients.

Environmental Factor (EF): What excites you most about your current research?

Garantziotis: Personalized environmental medicine — which means evaluating each person’s specific exposures and susceptibility factors and tailoring treatment specifically to their needs — I believe can help prevent or even reverse some lung diseases.

EF: How has NIEHS research informed the field’s understanding of environment-induced asthma and how to treat or prevent it?

Garantziotis: We need to see the patient in the context of their environment, which is where they live, work, and play. Looking only for asthma symptoms and ignoring the exposures that may have caused these symptoms provides an incomplete picture. It is like photoshopping the patient out of a photo — you lose a huge amount of information.

NIEHS research has started to move the needle so that doctors are more aware of the role of environmental exposures in asthma. Personally, I have been able to improve symptoms and even reduce the amount of medication my asthma patients need by thoroughly evaluating their exposure profiles and taking steps to address them. These are low-cost, low-tech, but high-impact solutions that can help patients tremendously.

EF: Tell us about your studies of a protein called TLR5 and how it relates to asthma?

Garantziotis: I am very excited about our ongoing research on TLR5, which we think plays a central role in lung disease because it helps regulate immune responses to environmental injury. For example, we found that house dust in many homes of asthma patients activates TLR5 leading to an overactive immune response. This is probably because of house dust bacteria shedding proteins that activate TLR5. Often, these bacteria are found in the excrement of house pests like cockroaches or mice. Cleaning up these sources of TLR5 activation is a simple and effective non-medication way to prevent asthma flare-ups caused by this pathway.

EF: What is on the horizon for asthma research and where do you think the field needs to go?

Garantziotis: We now understand that asthma is not just a single disease, but a syndrome. This means it is a combination of symptoms — wheezing, cough, shortness of breath — that can happen after different exposures and through the activation of different immune pathways. We are getting better at identifying which pathway is active in each patient, and we will continue improving. The next step is to recognize the exposures that either promote or perhaps even prevent asthma development. A lot more work needs to be done to help reverse the asthma epidemic.

EF: What advice do you have for people with asthma?

Garantziotis: I always talk to my patients about their home and work environments. I ask them to become detectives in their own asthma cases. Often, they start recognizing patterns of exposure and symptom associations. For example, they might feel sicker at home compared to when they are away or have more symptoms in the morning or at night. Such information helps them improve their environment and better manage their symptoms.

For the patients who are interested, I also explain what causes asthma and how to think about managing their medications depending on their symptoms. This empowers the patients to take control of their asthma and manage it with more confidence, knowing we are a phone call or email away. After all, they visit my clinic only once every six months, but they are experiencing asthma 24/7.