CTC New Letters!  November 2007

A message from Dr. Ramsdell about the UCSD Airway Research Center

Smoking out a killer:

Study to look at chronic pulmonary disease

Reprinted by permission

By Cheryl Clark
STAFF WRITER

October 17, 2007

SAN DIEGO – Most patients suffering from chronic obstructive pulmonary disease are smokers, but why do only 20 percent of smokers get the condition?

Could air pollution, workplace chemicals, dust or certain lifestyles heighten a person's risk of coming down with emphysema, chronic bronchitis or other symptoms of the incurable disease? Or might family history and genetics be the real culprits?

To find the answer, researchers from UCSD Medical Center are joining colleagues at 15 other universities nationwide to launch the largest-ever study of pulmonary disease. The five-year project is backed by a $37 million grant from the National Heart, Lung and Blood Institute.

Clairemont Mesa residents Jim Dobbins, who has chronic obstructive pulmonary disease, and his sister, Doreen, are longtime smokers who plan to volunteer for a five-year study of pulmonary disease.

“The real question is: Why do those 20 percent get it?” said Dr. Joe Ramsdell, a professor of clinical medicine at UCSD. “It's obvious that it's more than just smoking; our hypothesis is that it's in their genetic makeup.”

Ramsdell and his fellow researchers will enroll about 10,500 people who are older than 40, have used cigarettes for at least 10 years and still smoke. One thousand of those participants will come from San Diego County.

About 11.4 million people in the United States suffer from chronic obstructive pulmonary disease, and 12 million others are believed to have it but haven't been diagnosed.

The disease is the nation's fourth-leading cause of death. It is responsible for about $21 million annually in health care costs.

Symptoms of the disease, which isn't contagious, include conditions that restrict airflow in the lungs, a chronic cough with mucus and shortness of breath that's worsened even by everyday activities such as getting dressed.

The San Diego portion of the study will focus on recruiting Latino and black smokers. Researchers want to know why these smokers, among other things, often respond differently from whites to medications used to treat the disease.

Another goal of the project is to identify genetic markers that may signal higher risk of pulmonary disease.

“Some people who smoke their whole lives don't develop problems. Look at George Burns,” said Paul Ferguson, executive director of UCSD's Clinical Trials Center.

Half of the people who join the new study will have been diagnosed with chronic obstructive pulmonary disease. The remaining participants won't have the condition.

Ramsdell and Ferguson said they hope to enroll pairs of siblings in which one person has the disease and the other doesn't. Since these siblings have similar genetic makeups, the parts of their DNA that are different may hold some clues.

Two who plan to volunteer for the project are Jim Dobbins, 58, and his sister, Doreen, 56, both of Clairemont Mesa.

Both have smoked for several decades. While Jim was diagnosed with chronic obstructive pulmonary disease 11 years ago, Doreen has remained healthy.

Jim Dobbins thinks he's genetically predisposed.

“It runs in my family. It killed both my parents and my grandfather,” he said. “But why is my sister clean, when she has smoked almost as long as I have?”

July 7, 2006

 UCSD Researchers Study Antibiotics to Ease Asthma Symptoms

 Researchers at the University of California, San Diego (UCSD) Medical Center will enroll patients in a new national study to ascertain if a prolonged antibiotic treatment will ease asthma symptoms. Previous research has shown that nearly 60 percent of patients who experience uncontrolled asthma symptoms are not aware they have a chronic airway infection. This finding has initiated a nationwide study sponsored by the Asthma Clinical Research Network of the National Institutes of Health/National Heart, Lung, and Blood Institute to determine if clarithromycin (trade name Biaxin), an antibiotic, will help relieve asthma and its symptoms.

UCSD Medical Center is one of eight centers participating. Joe Ramsdell, M.D. and Stephen Wasserman, M.D., UCSD Professors of Medicine, are Principal Investigators for the UCSD site.

“People have difficulty controlling their disease for a number of reasons,” said Ramsdell. 

 He said practitioners know that ongoing exposure to allergens can often lead to uncontrolled asthma symptoms. Such enduring exposures include cigarette smoke and inadequate medical treatment that results when patients do not regularly use their controller medicine. Ramsdell said a chronic infection in the airways is one of the most intriguing possibilities for uncontrolled symptoms.  A low-level respiratory infection may cause inflammation that does not respond to typical asthma treatment.

 “We think this infection may cause a persistent release of chemicals in the airway that can thicken the airway and make the airway muscle more sensitive,” said Wasserman. “This may lead to chronic breathing difficulties and more frequent asthma attacks.”

 He added that previous studies have suggested that chronic airway infections caused by a special class of organisms may be more prevalent in asthma sufferers whose symptoms are difficult to control. These organisms are amenable to treatment with the class of antibiotics called macrolides, but the treatment would likely need to be of longer duration than doctors commonly prescribe for acute infections, he said. 

 The study is designed to confirm the organisms’ presence in patients with difficult asthma, and whether prolonged antibiotic treatment will clear up the infection and improve asthma symptoms. 

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