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Karin Yeatts,¹ Peter Sly,² Stephanie Shore,³ Scott Weiss,⁴ Fernando Martinez,⁵ Andrew Geller,⁶ Philip Bromberg,¹ Paul Enright,⁷ Hillel Koren,⁶ David Weissman,⁸ and MaryJane Selgrade⁶

¹Center for Environmental Medicine, Asthma, and Lung Biology, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA; ²Institute for Child Health, Division of Clinical Science, University of Western Australia, Perth, Australia; ³Harvard School of Public Health, and ⁴Harvard Medical School, Boston Massachusetts, USA; ⁵University of Arizona, Arizona Respiratory Center, Tucson, Arizona, USA; ⁶National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA; ⁷ University of Arizona, Tucson, Arizona, USA; ⁸National Institute for Occupational Safety and Health, Morgantown, West Virgina, USA

Abstract
Relative to research on effects of environmental exposures on exacerbation of existing asthma, little research on incident asthma and environmental exposures has been conducted. However, this research is needed to better devise strategies for the prevention of asthma. The U.S. Environmental Protection Agency (EPA) and National Institute of Environmental Health Sciences held a conference in October 2004 to collaboratively discuss a future research agenda in this area. The first three articles in this mini-monograph summarize the discussion on potential putative environmental exposure ; they include an overview of asthma and conclusions of the workshop participants with respect to public health actions that could currently be applied to the problem and research needs to better understand and control the induction and incidence of asthma, the potential role of indoor/outdoor air pollutants in the induction of asthma) , and biologics in the induction of asthma. Susceptibility is a key concept in the U.S. EPA "Asthma Research Strategy" document and is associated with the U.S. EPA framework of protecting vulnerable populations from potentially harmful environmental exposures. Genetics, age, and lifestyle (obesity, diet) are major susceptibility factors in the induction of asthma and can interact with environmental exposures either synergistically or antagonistically. Therefore, in this fourth and last article we consider a number of "susceptibility factors" that potentially influence the asthmatic response to environmental exposures and propose a framework for developing research hypotheses regarding the effects of environmental exposures on asthma incidence and induction. Key words: asthma, epidemiology, genetics, hygiene hypothesis, incidence, obesity, occupational asthma, smoking, susceptibility, windows of exposure and age (in utero, childhood, adult, elderly) . Environ Health Perspect 114:634-640 (2006) . doi:10.1289/ehp.8381 available via http://dx.doi.org/ [Online 26 January 2006]

This article is part of the mini-monograph "Environmental Influences on the Induction and Incidence of Asthma."

Address correspondence to K. Yeatts, Center for Environmental Medicine, Asthma, and Lung Biology, School of Medicine and Department of Epidemiology, School of Public Health, Campus Box #7310, CEMALB, HSD Facility, 104 Mason Farm Rd., University of North Carolina-Chapel Hill, Chapel Hill, NC 27599-7310 USA. Telephone: (919) 843-1841. Fax: (919) 966-2089. E-mail: Karin_Yeatts@unc.edu

We thank J. Douwes for comments on the manuscript draft.

Funding was provided by U.S. EPA cooperative agreement 829522 ; National Heart, Lung, and Blood Institute (NHLBI) R01HL62624 (K.Y.) ; NHLBI HL67672, HL66447, and HL56177 (F.M.) ; NHLBI HL33009 and National Institute of Environmental Health Sciences ES00002 (S.S.) .

This paper has been reviewed by the National Health and Environmental Effects Research Laboratory, U.S. EPA, and approved for publication. Approval does not signify that the contents necessarily reflect the views and policies of the agency, nor does mention of trade names or commercial products constitute endorsement or recommendation for use.

The authors declare they have no competing financial interests.

Received 3 June 2005 ; accepted 1 December 2005.