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.
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