New insights to the many aspects of asthma: “A disease of a thousand faces” Lon Chaney (1883–1930): The Man of a Thousand Faces

L Frank “Lon” Chaney, American stage and film actor, director, and screenwriter is regarded as one of the most versatile and powerful actors of the early silent film era, renowned for his characterizations of tortured, often grotesque and afflicted characters, and his groundbreaking artistry with makeup. Chaney was one of four children born to deaf parents and, as a result, learned how to communicate with his parents by using his hands and face, expressing a variety of emotions without ever uttering a single word. His ability to transform himself in silent film by using makeup techniques earned him the moniker “The Man of a Thousand Faces. ” True to its name, asthma is “A Disease of a Thousand Faces. ” This issue of the Proceedings features a variety of articles that focus on the spectrum of disease expression that relate to asthma and its many faces. The articles summarized herein contain new insights regarding associated risks, phenotypes, control, pathophysiology, biomarkers, and treatment. A previous study reported by investigators at the Mayo Clinic linked childhood asthma with an increased risk of herpes zoster in adulthood These same investigators more recently reported a waning of protective levels of measles antibody concentrations after measles immunization in children with asthma. Because it is not known how pervasive these observations might relate to other vaccine-preventable diseases, Umaretiya et al. set out to determine whether asthma is associated with an increased risk of pediatric varicella infection. By using a retrospective, populationbased, case-control format, they examined cases of breakthrough varicella among children between 2005 and 2011 in Olmsted County, Minnesota. Children with a history of asthma were found to have a higher risk of developing breakthrough varicella compared with those without a history of asthma. Based on this previously unrecognized risk, the authors suggest a two-dose varicella vaccine regimen for children with asthma. This recommendation may have additional wide-ranging implications for other immunizations in children with asthma. Nowhere is the heterogeneity of asthma better illustrated than in the many phenotypic forms in which the disease is expressed. In seeking to identify and characterize those childhood wheezing phenotypes that may relate to asthma persistence in adolescence, Pité et al. performed a comprehensive study of pediatric asthma phenotypes. By applying a multidimensional statistical model to a prospective cohort study of 308 children, they observed that preschool-age diagnoses of atopy and rhinitis were independent risk factors for asthma persistence in adolescence. By probing the all-important role of environmental factors and how they may impact asthma control and quality of life in adult patients with asthma, Hsiao et al. report the results of a study that used a structural equation modeling analysis. The authors observed that wheeze frequency, allergic response frequency, parental asthma, and asthma control were directly associated with quality of life. They indicate that body mass index, work environment, and wheeze frequency should be considered as independent risk factors when assessing asthma control and quality of life in adult patients with asthma. With a shifting to a focus on asthma pathophysiology and biomarkers, there is increasing evidence that indicates that periostin may not only be a useful predictive biomarker of Th 2 eosinophilic airway inflammation but also may be linked to the pathogenesis of airway remodeling in asthma. However, because the association between serum periostin and the magnitude of airway wall thickness remains unclear, Hoshino et al. examined the relationship between serum periostin and airway geometry in asthma. In studying 26 patients with asthma who were steroid naive and appropriate controls, the authors report results that support the pathogenetic role of periostin as a novel biomarker for both eosinophilic inflammation and airway remodeling. Increasingly important to the understanding of asthma pathophysiology is an awareness of the role of the human microbiome both as a critical inductive element in immune development and protective immunity but also as an environmental site with deleterious disease-inducing sequelae. In a novel study of the fungal microbiome in the exhaled breath condensate of 47 subjects with asthma, Carpagnano et al. evaluated