ASTHMA, ALLERGY AND CHRONIC AIRWAY DISEASES

Asthma and allergic diseaeses are heterogeneous groups of diseases in pulmonary medicine in which advances in pharmacologic and immunologic therapies have revolutionized the associated morbidity. It then is of great concern that even in developed countries such as the United States, both the prevalence of asthma and deaths attributed to asthma are on the rise. Clearly we need to improve our ability to identify and treat this increasingly common family of disorders. Specifically, we need to identify and tailor our investigations and treatments based on allergic, environmental, and more sophisticated (e.g. genomic) paradigms. At Duke we are actively attempting to do this with a multidisciplinary approach to the diagnosis and treatment of asthma. We actively utilize our adult and pediatric pulmonologists, immunologists, respiratory therapists, and other subspecialists to develop novel modalities of treatment.

Similar to asthma, the prevalence and mortality attributed to chronic obstructive pulmonary disease (COPD) have increased. But unlike asthma, novel therapies for chronic obstructive pulmonary disease (COPD) have been slow in coming. Nevertheless, important information is being learned every day about the mechanisms of COPD and airway biology. At Duke not only do we have active basic science investigations into these factors, but we complement these with active clinical and translational studies.

Both asthma and COPD share important mechanistic pathways, and both also require further elucidation of the relative importance and interactions of host and environmental factors. Our Division has several investigators examining mechanisms and therapies of asthma and COPD, specifically in the mechanisms of airway remodeling, host immune defense mechanisms, gene-environment interactions, and pharmacologic therapies. To better understand these concepts while simultaneously provide state-of-the-art clinical care, the Department of Medicine and our Division of Pulmonary, Allergy, and Critical Care has recently created an interdisciplinary Center that focuses on clinical care for allergies, asthma and chronic airway diseases in the pediatric and adult populations. The Duke Asthma, Allergy and Airway Center, directed by Dr. Monica Kraft, has adopted a multidisciplinary approach with active participation from Pulmonary Medicine, Allergy, ENT and Dermatology.

Mission of the Duke Asthma, Allergy and Airway Center Provide state-of-the art clinical care for patients with asthma, allergic diseases and airway disease Develop preventive and treatment protocols for the identified problems Pulmonary rehabilitation/wellness Smoking cessation Nutrition Treatment of contributing factors known to exacerbate airway disease: depression, obesity Identification of factors commonly associated with airway disease: cardiac disease Community outreach through early detection and education programs Provide education in the prevention and treatment of airway diseases in adult and pediatric populations including but not limited to: Asthma Allergic diseases – lung, upper airway and skin Chronic Obstructive Pulmonary Disease (COPD) Bronchiectasis Cystic Fibrosis – mainly in adults Conduct clinical, translational, and basic research studies evaluating new therapies, interventions, assessment of contributing factors and areas of airway pathobiology to ultimately improve the health of this patient population Serve as a major focus for training programs in Allergy and Pulmonary Medicine, as well as ENT and Dermatology programs.

Monica Kraft, MD. Director Duke Asthma and Airway Center