Can genes take the guess work out of asthma treatment?

Published Online: January 7, 2016
 
Asthma treatment in children is usually straight forward and involves a steroid inhaler. Unfortunately, things are not so simple for about 10% of children whose asthma symptoms carry on despite a steroid inhaler, where there are three treatment options and some work better for some children. The question here is “how do we match the right children to the right treatment?”- at present this is just a matter of trial and error. There has been a suggestion from some small studies that a gene that controls the relaxation of bronchial smooth muscles in response to a drug may help target treatment to the right children. We have pooled results from five studies around the world to see if these preliminary results can be seen in a study of more than 4000 children with asthma.    

In a recent report published in The Journal of Allergy and Clinical Immunology (JACI), Turner and colleagues analysed data from asthma studies in Scotland, England, the Netherlands and the United States. Only children with asthma took part in these studies. The information gathered included their treatment, whether they had had a recent asthma attack and also samples were collected for gene analysis. The asthma treatment of particular interest is called a long acting beta agonist (LABA), and this is a long-lasting asthma relieving medication which works on the muscles lining the breathing tubes of people with asthma by causing them to relax and widen the airway. Approximately 60% of us have a change in the gene which makes the LABA work less well.

The researchers found that children with this very common genetic change were fifty percent more likely to have an asthma attack if treated with just a steroid inhaler and LABA. Children with the genetic change, who were treated with other asthma medicines did not experience increased asthma attacks. As suspected, the presence of this genetic change made the LABA treatment less effective.    

The implication of this finding is that routine testing for this very common gene may let physicians know which asthma treatment works best in children with asthma and spare them an unsuccessful “trial by treatment”. These findings now need to be properly tested in a clinical trial.  

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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