COASTing News…………….THANKSgiving 2003
We dedicate this newsletter to THANKing all our families for all that we have learned. I
realize that you don’t know what a BIG thank you that is, so we want to just make a list of
all that YOU have accomplished!!!!!!!
Some Interesting National ASTHMA facts
 it affects 14.9 million people
 it accounts for 1.5 million Emergency visits each year
 there are 500,000 hospitalizations each year
 there are over 5,500 deaths from asthma each year
 it disproportionately affects children and African American people
 it costs 11.8 billion dollars each year
And you are a part of finding out what makes this disease happen.
We enrolled 312 families and 289 children were officially included after birth. Over the
course of the first three years, 9 families did not complete the study for various reasons
Only 7 families have decided not to continue with COAST II, so we have 273 families in
COAST II. This means our overall rate of continuation with the study is 95%. This number
– all by itself - is an outstanding record of your commitment to discovering the origins of
childhood asthma.
Our families have lived in 5 different countries and 17 different states. The children were
born in six different hospitals and currently see about 130 different physicians.
The average mom is 31 years old and our average dad is 33 years old.
Our average child weighed 7 pounds and 7 ounces.
The average head size at birth was 13 ½ inches.
44.5% of the parents had allergies and 37.7% had both allergies and asthma --- only 16%
of our parents had neither allergies nor asthma (because the other parent had the allergies
or asthma).
56% of our babies were boys and 44% of our babies were girls.
66% of the babies were born outside of “normal” business hours ---- but you already knew
that!! 13% of the children were born by Caesarian section.
46% of the COAST children had RSV in the first year of life.
98% of all COAST children had RSV by the time they were 2 years old.
Only 9 of the COAST children live or are “closely” associated with living on farms. There is
a theory that “farmers” and their families are less likely to have allergies than the general
population. Therefore, it is curious that we did not “recruit” more farmer parents who had
allergies/asthma.
42% of the COAST kids were breastfed for 6 months or longer, 48% were breastfed for
less than six months.
Your children have given us over 3400 samples of nasal mucus!! 1,920 of these were
completed by the time your children were 12 months of age. Besides the COAST use of
these samples, the Wisconsin State Laboratory of Hygiene has relayed information to
physicians throughout the state about the incidence and prevalence of viruses based on
the results of your children’s nasal washes. Prior to the COAST study, the state lab
reported viral “trends” in the state by looking at the results of approximately 150 nasal
samples during the winter season ----- COAST has increased that number!!
More than 115 children had eczema at age one year.
We have processed a total of 1,735 samples of blood.
23% of our children came into contact with smoking on a routine basis.
Approximately 37,900 forms have been entered into the database.
34 of the children had food allergies by age one year.
We have paid nearly $165,000 to our kids for their “work” on the COAST study.
By age 3 years we observed that 51% of our children had never wheezed. 16% wheezed
only during the first year of life, another 16% had wheezed throughout the first three years
and 12% of the children just STARTED wheezing during their third year (about 3% of the
children wheezed at times other than these categories).
We have just completed the editing of an instructional video about the nasal wash
technique. This procedure is going to be used by the CARE network (Childhood Asthma
Research and Education network in Madison, Denver, San Diego, Tucson and St. Louis)
and ICAC (Inner City Asthma Coalition in New York, Boston, Baltimore and St. Louis).
To date, we have presented over 30 abstracts at national and international meetings and 5
papers have been accepted for publication.
Number of Children
Daycare Attendance and Sibling
Exposure in First Year of Life
100
90
80
70
60
50
40
30
20
10
0
31%
22%
23%
Neither
Daycare
N=63
N=66
23%
Sibling
N=90
Both
N=66
Only 63 of the children did not attend daycare
during the first year nor had an older sibling.
Actually, 53% of the COAST children did not attend
daycare in the first year of life, however, of those
children, less than ½ of them were in a home
without older siblings.
It is important to BRIEFLY – SIMPLY – explain our immune system.
We believe that there are two sides of our immune system. One side
works to fight infections (Th1) and the other side works to deal with other
proteins, like allergens (Th2). Perhaps our “best” health is a balanced
system that can adequately deal with any infection or protein with which a
person is confronted.
It is believed that in order to complete a pregnancy, a baby must not
trigger any immune responses in the mom. Such reactions could lead to a
miscarriage (this is simplified). The uterine environment and the baby are
set-up to be a Th2 state to support the pregnancy. As we grow, our
immune system “learns” to respond to “germs” and allergens. The
exposure to viruses and bacteria stimulates the Th1 side of the response.
According to one theory, if there is not enough exposure to infections,
then the person’s reaction is “weighted” towards a Th2/allergic response.
It is not that one type is better than the other - the goal is to have the two
systems balanced.
So, this may be why previous data has suggested that daycare
had some sort of “protective” effect on kids at age six, meaning
fewer kids who attended daycare were wheezing at age 6. In
COAST we learned that children in daycare or with older siblings
were more likely to have respiratory infections – “colds” – and to
have them more frequently than non-exposed children. These
children were also more likely to wheeze during this first year of
life. We learned that the virus that seems to be responsible for
these INCREASED number of colds was Rhinovirus –– (this is
the “common cold” virus and is considered a trigger for wheezing
in adults). Our data is similar to previous reports up to this age,
so it will be very interesting to follow them through age 6-7 years
of age.
Th1stimuli
imuli
Th2 grows without Th1
stimuli
During infancy, Th1 cytokine responses:
• At birth, if IFN-g is low the child is likely
to have more infections.
• However, if there are frequent
infections, there is more likely to be a
positive increase in the balance between
Th1 and Th2.
It is known that exposure to furred pets (and
other allergens) in the home can promote allergic
sensitization, however, our early data is
suggesting that exposure to furred pets –
specifically dogs - in early infancy may protect
against allergic diseases. These children were
less likely to have eczema, other allergies (as
noted by blood testing) and had a protein shift in
their blood (Th1) that would indicate that their
exposure to “dirt” was getting their body to
respond to “dirt” instead of “allergens”.
We have observed that children with the lowest Interferon Gamma
levels at birth (IFN-g = infection response) are likely to have more
infections. However, IFN-g rises in response to infections.
Meanwhile, all children are being exposed to allergens, and so the
IgE (allergic antibody) may increase as a result of this exposure.
Thus, children who do NOT have infections may end up with a
rising IgE - which is not offset by a rising IFN-g. Therefore, the
system is not “balanced” and the child would tend to be more
sensitive to allergies.
Dr. Rob Lemanske has talked about your children and COAST in Korea, Japan, Italy,
England, Spain, Argentina, Canada, and Germany as well as at international meetings and
meetings hosted by US agencies for other countries. Recently, I received this email from
Dr. Rob:
I presented COAST today in Orlando to a joint USA/Russia symposia
that the NHLBI (National Heart, Lung and Blood Institute) is
sponsoring and I was asked to participate in. The project was VERY
well received. Every time I present COAST and get to the
acknowledgement slide at the end, I get choked up because of all of
the wonderful people that have contributed their hearts and souls to
the project.
Therefore, at this Thanksgiving…we give thanks to you for all you have
contributed and for the privilege of being able to work with you and your
precious children.
The COAST team.