The Summary
- A new paper describes a test that can differentiate between different types of asthma via a nasal swab.
- Researchers hope the test can eventually be used to help match patients with better treatments.
- The research focused on Black and Puerto Rican children, who have higher rates of asthma and asthma-related deaths than white children.
It might be difficult to identify the specifics of a child’s asthma diagnosis and determine the best course of action for them.
More than 4.6 million children in the United States suffer from the lung illness, which is frequently divided into two groups. The first, referred to as T2-high asthma, is brought on by inflammation from T helper 2, a specific kind of immune system cell. It was thought to be the most prevalent kind until recently.
T2-low asthma, the second category, is basically a catch-all for other types. It encompasses two subtypes one involving less inflammation, and another characterized by inflammation from a different kind of T cell.
Determining the type of asthma a kid has might help doctors match patients with the right treatment in some moderate or severe instances. However, there have long been few possibilities for testing: Doctors usually take blood samples to assess antibodies or immune cell counts, or they have kids breathe into a mouthpiece to measure the amount of nitric oxide in their breath.
But the tests aren’t always reliable, and they can’t distinguish between other kinds of asthma because they only identify T2-high asthma.
Therefore, by taking nasal swabs and sequencing the RNA they contain, researchers at the University of Pittsburgh created a more accurate method of diagnosing various asthma subtypes. The researchers searched for those characteristics because several genes linked to inflammation are more frequently expressed in persons with two of the asthma subtypes. The lack of those genetic markers allowed for the identification of the third category.
In a study published Thursday in the journal JAMA, they explain the new test. In three studies—one in Pittsburgh, one in Puerto Rico, and one in both places—the researchers administered the test to over 450 kids and teenagers. The study participants were predominantly Puerto Rican or non-Hispanic Black.
The analysis showed that the nasal swabs could accurately diagnose several asthma subtypes. It also found that T2-low asthma which has been associated with air pollution was most common among the participants.
Black and Puerto Rican children havehigher rates of asthma and asthma-related deathsthan white children in the U.S. and aremore likely to be exposed to asthma triggerslike air pollution, dust or mold.
The researchbuilds on previous studiesthat have similarly detected asthma via nasal swabs.
The researchers hope the test can improve the process of matching kids to appropriate asthma treatments, said Dr. Juan Celed n, one of the paper s authors and chief of pulmonary medicine at UPMC Children s Hospital of Pittsburgh.
To me, this is a necessary first step for better personalized medicine, he said.
The default treatment for any type of asthma is steroids, usually delivered through an inhaler. But in moderate or severe cases, that might not be enough. In the last decade, the Food and Drug Administration has approved several injectable or intravenous drugs for such patients. These counteract molecules that trigger inflammation in the airways, but they are largely geared toward T2-high asthma.
Celed n said the nasal swab test could help researchers identify people with T2-low asthma for the purpose of enrolling them in studies that test new treatments for that target.
Instead of treating most people the same, in a few years, we can treat you better according to the type of asthma you have, he said.
The new findings are also noteworthy because the research involved children of color, who are often underrepresented in asthma studies, said Dr. Gurjit Hershey, director of the asthma research division at Cincinnati Children s Hospital, who was not involved in the new paper.
Many studies have been done traditionally in white, European populations. To be able to have a study that really focuses on Puerto Rican and Black children is important, she said.
However, the technology isn t ready to go mainstream. Celed n said it would need FDA approval before doctors could use it.
Plus, Hershey said, more research is needed to determine if a child s asthma type is consistent throughout their youth, or if it changes in response to environmental exposures such as pollution or allergens.
The place to be cautious is, does it make sense to treat based on this? she said, referring to the nasal swab test results. We would have to do a study to figure that out.
Dr. Jessica Hui, a pediatric allergist at National Jewish Health, a respiratory hospital in Denver, also cautioned that genetic sequencing is expensive, and the results would need to be analyzed by someone proficient in studying RNA.
It s a very specialized type of analysis, she said. It s not like this is something we can implement immediately, but for sure it s an exciting direction.
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