Study Shows Biologic Basis for Difficult-to-Treat Asthma

asthma inhaler

Asthma is a frustrating condition for patients, parents and doctors alike, for many different reasons.

From my perspective, it’s frustrating because not all patients respond well to treatment; in fact, 40-70% of patients do not respond optimally to the treatments we currently have for chronic and acute asthma.

As a pediatric allergist and immunologist, I am discouraged that there aren’t better treatment options for this subset of patients and as a researcher, I want to understand why corticosteroids don’t help them. So my research team and I embarked upon a study to see if we could find a biologic reason for this discrepancy.

Medication compliance and environmental and socioeconomic factors have long been considered barriers to successful asthma treatment. But when patients are hospitalized for asthma, their situations are the same. They’re receiving the proper doses of medicine at the right time and their environment is consistent. And yet some respond well to corticosteroids and others don’t. With a mostly controlled environment, this offered the perfect backdrop for us to determine if any biologic factors play a role.

We studied the genes of patients who were hospitalized for asthma and determined that those patients who responded well to corticosteroids and those who didn’t have differences in the expression of the gene VNN-1. In other words, VNN-1 gene expression is required for corticosteroids to work during an asthma attack.

So what does this mean for patients who have hard-to-treat asthma? A couple of things: It first means that we have a biomarker – a biologic basis to explain why patients don’t respond well to corticosteroids. This exciting first step means that one day down the road if a patient isn’t responding well to treatment we could potentially test for VNN-1 expression (more research is being conducted in this area to determine how viable this is).

Second, if we determine that this patient with hard-to-treat asthma does not have the proper VNN-1 expression, this biomarker opens the door for us to try a new and different therapy. We are currently studying potential drugs for this purpose.

Patients with difficult-to-treat asthma account for over 50% of the healthcare costs associated with asthma. I am excited about the findings in this study because it could potentially lead to a different and effective treatment for patients who fall into this category.

Gurjit Hershey, MD, PhD

About the Author: Gurjit Hershey, MD, PhD

Gurjit Hershey, MD, PhD is the director of the Division of Asthma Research and a pediatric allergist and immunologist at Cincinnati Children’s. Her clinical interests include asthma, allergic rhinitis, food allergy and uticaria. Her research interests are related to the genetics of allergy and asthma, cytokines and signaling pathways.

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Comments

  1. Craig Black April 22, 11:32
    Dear Dr. Hershey, Thanks so much for your very interesting post. Is there a published article on the study you refer to? I am presently gathering as much information as I can on asthma phenotypes and the genetics of asthma, and clearly this fits right in to that topic. Thanks! Craig Black, PhD, RRT-NPS, FAARC Director, Respiratory Care Program The University of Toledo craig.black@utoledo.edu
    • Rachel Camper
      Rachel Camper April 23, 08:50
      Hi Craig, here is a direct link to the study. http://www.jacionline.org/article/S0091-6749%2815%2900261-4/abstract You'll need a login/password to access information past the abstract.
  2. Maryann Katterjohn May 10, 21:44
    I am 63 years old and had a history of asthma since 3 years of age. I was on daily medication and needed steroids usually twice a year. I was diagnosed with Celiac Disease 6 years ago. Once I eliminated gluten from my diet, my asthma symptoms and gut issues, went away! I have not needed any asthma medications for 5 years. Any research going on with this connection? I know CF is a disease that involves both lungs and gut-why not asthma?
  3. Kevin Gates July 02, 08:14
    The strict follow-up medically for asthma is an option not to be overlooked ever. Parents awareness for asthma preventive steps and appropriate asthma medical care and management makes big difference. Fought smoothly and cared earlier.