Children with a newly discovered genetic variant may receive no benefit from traditional asthma corticosteroid inhalers with salmeterol and salbutamol, recent research suggests.
Such controller and emergency inhalers are often the primary treatment for asthma in children and adults around the world, with 9.3 percent of American children suffering the respiratory disease, according to the Centers for Disease Control and Prevention.
But complacency in the medical establishment about developing new treatments may be leaving many children to suffer and die needlessly, investigators at the Brighton and Sussex Medical School in the United Kingdom say. The British researchers plan to conduct a pair of large studies later this year, following a 2011 paper on the subject published in The New England Journal of Medicine.
In that study, investigators scanned the genomes of 118 children with asthma, along with those of their parents, finding a variant in the gene, called glucocorticoid-induced transcript 1 (GLCCI1), associated with poor response to inhalers. The association was supported by a subsequent analysis of data from another 935 children and adults enrolled in four separate studies. Tellingly, patients carrying two copies of the gene variant were more than twice as likely to respond poorly to traditional asthma medication, with one-third the lung improvement experienced by those with two regular copies of the gene.
In a press release about the study, Susan Shurin, deputy director of the National Heart, Lung, and Blood Institute, said that the study showed “the importance of research examining the relationship between genetic makeup and response to therapy for asthma, and underscores the need for personalized treatment for those who have it.”
Now, investigators in the UK have accepted the challenge. "Both asthma 'reliever' and 'controller' medicines may not work well in a proportion of children because the child's genetic make-up makes the medicine less effective,” study leader Somnath Mukhopadhyay told The Courier. "A simple test can determine whether a child carries the gene change and identify those who might benefit from a switch to an alternative, more effective medicine."
In the meantime, pediatricians recommend parents devise an asthma management plan for their children, given individual variations in the severity of the disease. Among considerations, children with asthma should avoid possible triggers to an asthma flare-up, which vary with age and by season. Common asthma triggers include allergens such as microscopic dust mites, pet dander and saliva, pollens and grasses, foods and medications, and viral infections including influenza and the common cold.