Severe Asthma: Drilling Down to Specifics

Studies carried out by the European U-BIOPRED project found that patients with severe asthma continue to have symptoms despite good adherence to medication and investigated ways of diagnosing asthma through biomarkers.

A small portion of asthma patients—approximately 5%—fail to control their asthma despite good adherence to multiple medications. These asthmatics have difficulty breathing almost continuously and also frequently experience serious, life-threatening asthma attacks that require emergency room visits and hospital admissions. A hallmark for severe asthma is steroid dependence.

Researchers from the EU-funded U-BIOPRED project presented findings concerning patients with severe asthma on September 9, 2013, at the European Respiratory Society (ERS) Congress in Barcelona. Their findings confirm what many clinicians have suspected: Patients with severe asthma are actually less likely to respond to standard treatments than are patients with mild asthma.

The study involved the initial analysis of a cohort of patients enrolled in this far-reaching research project. The U-BIOPRED project will collect more than 3 million samples from 300 children and 700 adults with severe and non-severe asthma, and will also assemble a control group of people without asthma. The goal is to develop approaches that will create personalized action plans for each asthma patient’s unique constellation of symptoms.

This study’s findings include:

• Despite regular oral corticosteroid use, more than half of adults with severe asthma continued to have greater airway obstruction than patients in the mild/moderate cohort.
• Corticosteroid-treated adult patients with severe asthma experienced severe exacerbations even when taking high doses.

Among children, the results were somewhat different:

• Children with either severe or mild/moderate asthma had similar levels of airway obstruction.
• Children with severe asthma, however, had higher FeNO levels (fraction exhaled nitric oxide, a biomarker of airway inflammation sometimes used to diagnose asthma).

The U-BIOPRED project also presented a study at the ERS Congress that included a trial of an electronic “nose” designed to analyze asthma patients’ breath samples for molecular patterns. Molecular pattern identification could allow us to move away from patient-reported or clinician-observed clinical symptoms, and address the disease through biomarkers. If successful, this platform would be able to diagnose asthma severity non-invasively. This study, which included 57 severe asthma patients, identified common patterns in 4 sub-groups. More study is needed before this device is ready for use in the clinic.

“The findings of both these studies take us one step closer to understanding more about severe asthma,” said Peter Sterk, project leader for U-BIOPRED, in a press release. “We know that people with this condition suffer from repeated exacerbations of symptoms and do not respond as well to treatment, but we don’t know why this is the case. In order for us to help improve the lives of these people, we need to make a full biological and clinical ‘fingerprint’ of each patient, by embarking on a huge analysis of data including a wide-range of samples from CT scans, to sputum samples, analysis of a person’s genetics, and results from bronchoscopies. The U-BIOPRED project is doing that, and we are confident that it will take us one step closer to developing personalized treatment for this condition.”

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.