January 8, 2013

expert reaction to new research into asthma treatments for children

A paper in the journal Clinical Science outlined how a simple genetic test can show whether asthmatic children have a certain genotype which prevents commonly prescribed asthma medication from being effective.

Prof Stephen Holgate CBE, MRC Clinical Professor of Immunopharmacology, University of Southampton, & Associate Editor for the Respiratory System, Clinical Science, said:

“While genetic changes that determine bronchodilator responses in asthma have been known for some time, this is a wonderful example of stratified or personalised medicine working its way into practice. While still a small trial, the results in the asthmatic children’s response to the two treatments across a number of asthma outcomes are impressive. It will undoubtedly encourage further, larger studies to be undertaken to confirm the findings in different children and adult asthmatic populations. The gene-based test is not yet available to doctors, but should become so if larger trials are equally positive.”

Prof Donald Singer, Member of the British Pharmacological Society and Professor of Clinical Pharmacology and Therapeutics at the University of Warwick, said:

“This study is important in providing evidence that simple genetic testing can be used to personalize selection of medicine in clinical practice – in this case applied to treatment choice in children with poorly controlled asthma.

“Their main outcome – less time off school because of asthma – is important both for children and their families. The authors were careful to consider poor compliance with asthma treatment as an important alternative explanation for their findings. However this is a small study and needs to be confirmed in larger well-controlled clinical trials.”

Malayka Rahman, Research Communications Officer at Asthma UK, says:

“These findings are really encouraging, although more research would be needed to confirm these and establish whether a genetic test for Arg16 should be implemented. We are keen to see more research into genes that affect responses to asthma treatments across different populations, as this exciting area of research has the potential to lead to the tailoring of better treatments for an individual based on their own genetic make-up; ultimately keeping more people out of hospital and preventing unnecessary asthma deaths in the long-term.

“In the meantime current asthma treatments are very effective so we would advise parents of children with asthma to keep an eye on their child’s inhaler use and symptoms and if they do have any concerns to discuss these with their GP or asthma nurse.”

Anna Murphy, consultant pharmacist and Royal Pharmaceutical Society Spokesperson for respiratory conditions, said:

“This paper presents a case for individualised treatment which I very much support. However although we are moving towards tailoring treatment according to genetic profile to do this effectively we need to be able to easily identify patients according to their genetic make-up, this would require mass genetic screening which is not currently feasible. Although in more complex cases, where asthma symptoms are not well controlled we are already matching treatment to the underlying cause of disease.

“It is important to note that other studies show only about 15% of children with asthma would have the genetic profile that is identified by this research.

“The study itself was designed to prove that a child’s genetic make-up can have an impact on the effectiveness of treatment rather than to advise on the specific treatments we use for children with asthma. Therefore it would not be responsible to change prescribing practice at this time.

“My advice to parents of children with asthma would be to continue with regular inhaled corticosteroids using good inhaler technique to achieve good asthma control and to prevent long-term changes within the lung caused by inflammation. If patients still experience symptoms with inhaled corticosteroids then other treatments are available.

“Salbutamol has been used since the 1960’s and salmeterol since the 1980’s both have been proven safe in large scale well conducted clinical trials. However it’s important that salmeterol and other long acting inhalers that open up the airways are always used with inhaled steroids.  Parents who are concerned about their child’s asthma symptoms should seek advice from pharmacist or doctor.”

‘Tailored second-line therapy in asthmatic children with the Arg16 genotype’ by Mukhopadhyay et al., published in Clinical Science on Tuesday 8^th January 2013.