Update in asthma 2009.

Abstract

The emergence of a novel H1N1 influenza virus in early 2009 dominated the headlines and caused much fear worldwide as the Centers for Disease Control (CDC) proclaimed a pandemic (1). The media's preoccupation with the H1N1 epidemic, however, meant less “on-air” time for debates on the safety of asthma medications, a focus of last year's update (2). Ironically, clinical asthma trials this year also shifted away from the usual asthma medications toward the use of alternative “nonasthma” medications to treat comorbidities (3, 4) or as immunomodulators (5) with the goal of improved asthma control (decreased impairment). The importance of asthma exacerbations as a marker of poor asthma control and as a risk factor for poor long-term outcomes was investigated (6). Other studies examined the prediction of and effective treatment of exacerbations (7, 8). Challenges in the treatment of severe asthma were explored (9) and novel monoclonal antibodies were studied (10–12) as potential treatment options for patients with the most severe disease. Articles published in the American Journal of Respiratory and Critical Care Medicine in 2009 advanced our understanding of the influence of genetics (13–20), gene regulation (19, 21–23), factors in early life (24–28), and the environment (24, 29–33) on the development of asthma or the modification of disease severity. Basic pathobiological studies in humans (22, 23, 30, 34–44) and in animals (21, 29, 36, 45–56) added to our understanding of specific mechanisms in different phenotypes of asthma. Overall, a few areas emerge as particular highlights of the year and we focus your attention to the topics below.