Children's Hospital Colorado one of seven hospitals driving pediatric asthma research

Children's Hospital Colorado (Children's Colorado) is one of seven pediatric hospitals joining Childhood Asthma in Urban Settings (CAUSE), a clinical research network established by the National Institute of Allergy and Infectious Diseases (NIAID), which is part of the National Institutes of Health. As a CAUSE clinical research center, Children's Colorado will, on a national level, conduct studies to improve care for kids who have asthma. Additionally on a local level, in collaboration with National Jewish Health, Children's Colorado will lead a clinical and translational study called WINDOWS with a goal of better understanding the early-life determinants of developing chronic asthma to potentially reduce exacerbations in high-risk kids or even keep them from developing chronic asthma altogether. NIAID has awarded Children's Colorado $2.3 million over seven years to serve as a CAUSE network site and to conduct the WINDOWS study.

We are grateful to be included in the CAUSE research network and to have Children's Colorado and the metro Denver community represented in our national understanding of pediatric asthma. What makes CAUSE so effective is bringing a trifecta of science, research and a top-notch team to the children and families who live with high burdens of asthma and need help, in the heart of the place where we're already caring for these children. Our local WINDOWS study is the first of its kind, the first long-term pediatric asthma study in emergency department patients experiencing severe asthma attacks."

Andrew Liu, MD, pediatric asthma specialist and Colorado CAUSE principal investigator at Children's Colorado and professor of pediatric pulmonary and sleep medicine at the University of Colorado School of Medicine on the Anschutz Medical Campus

Currently, pediatric providers cannot determine if a young child will go on to develop asthma at an older age after experiencing asthma symptoms, such as coughing, wheezing, shortness of breath, chest tightness or pain, which can require emergency care. The CAUSE research study conducted at Children's Colorado will look for the "critical WINDOWS of time" in the development of asthma in toddlers at high risk of developing asthma.

"We typically see about 1,000 visits for severe asthma in the Children's Colorado Emergency Department on the Anschutz Medical Campus every year, so this location creates the ideal site to identify patients who have a high risk of developing asthma," said Nidhya Navanandan, MD, pediatric emergency medicine specialist at Children's Colorado, CAUSE and WINDOWS co-investigator and assistant professor of pediatric emergency at CU School of Medicine. "Once we identify toddlers who are experiencing wheezing episodes in our emergency department, our goal is to then follow their progress into early childhood to see if they go on to experience recurrent wheezing episodes, indicating chronic asthma, or if their symptoms dissipate. Understanding the early life differences in children who go on to develop chronic asthma can help us prevent asthma in the future."

WINDOWS will be a seven-year collaborative study between project leaders in the Children's Colorado Emergency Department and Breathing Institute and National Jewish Health Center for Genes, Environment & Health. Kate Hamlington-Smith, PhD, WINDOWS project lead, associate researcher at the Children's Colorado Breathing Institute and assistant professor of pediatric pulmonary and sleep medicine at CU School of Medicine, has worked with Dr. Liu on a variety of pediatric asthma studies where she investigates the effects of environmental factors on lung function. In coordination with the National Jewish Health research team, Hamlington-Smith's team will look at changes in lung function and biological responses over early childhood to determine differences between children who do and do not go on develop chronic asthma. She believes understanding these differences could lead to more effective treatments to address asthma before it develops.

The team at National Jewish Health will be led by Max A. Seibold, PhD, WINDOWS lab and analytics lead, researcher at National Jewish Health Center for Genes, associate professor of medicine at CU School of Medicine and director of Computational Biology at National Jewish Health. Seibold believes the information gained on biological development of the airways may result in the identification of novel therapeutic targets for early life intervention in airway dysfunction, stopping asthma progression.

"Computational analysis of airway samples collected from high-risk WINDOWS participants throughout early life will give us insight into how the airway matures among children who develop asthma and those who return to health by later childhood," said Seibold.

Children's Colorado is the only CAUSE clinical research center west of Chicago and will be filling a huge gap in studying children who live in the Mountain West region. Because these studies are translational, research findings from CAUSE and WINDOWS will quickly impact how children with asthma are cared for across the country and in programs such as Children's Colorado's community asthma initiatives and DECIPHeR, a school-based asthma program improving health equity for children.

Children's Colorado and the CU School of Medicine join several other children's hospitals and research entities in the CAUSE clinical research network, including:

• University of Wisconsin-Madison
• Boston Children's Hospital
• Children's National Research Institute, Washington, D.C.
• Cincinnati Children's Hospital Medical Center
• Columbia University Health Sciences, New York
• Icahn School of Medicine at Mount Sinai, New York
• Lurie Children's Hospital of Chicago

"We have high hopes that Dr. Liu's team's collaboration with the CAUSE network nationwide, and with National Jewish Health here in Colorado, will improve our understanding of asthma and help develop treatment and prevention approaches for children of low-income families living in urban communities," said Ronald Sokol, MD, director of the Colorado Clinical and Translational Sciences Institute and vice chair of pediatrics at Children's Colorado.