1 December 2020

Kid’s asthma: is better treatment in their genes?

Asthma Clinical Genetics Paediatrics

Treating children’s asthma according to their genotype may improve asthma-related quality of life, particularly among those whose asthma is poorly controlled, researchers say.

The findings of the non-peer-reviewed study “Effect of controller prescribing according to rs1042713 genotype on asthma related quality of life in young people (PACT): a randomized controlled trial”, were recently presented at the virtual European Respiratory Society International Congress.

About 250 children aged between 12 and 18 years who were being treated for asthma by GPs were randomised to receive either personalised treatment or treatment according to the British Thoracic Society guidelines with the LABA salmeterol in addition to a steroid inhaler.

The 121 patients who received personalised care had swabs of the inside of their cheeks to determine their genotype, using a test the researchers said cost less than €20 ($33).

A variation (the A allele) in the gene that makes the beta-2 receptor, which is targeted by asthma treatments, has previously been linked to a poor response to LABAs in children with asthma, so in the current study, children with either one or two copies of the A allele were given the leukotriene receptor antagonist montelukast instead.

Over one year, the researchers measured asthma quality of life (AQLQ, measured as a score between one and seven) as the primary outcome.

For those with tailored treatment, the improvement in AQLQ compared to standard care was statistically significant but below the clinical threshold (a score improvement of 0.16 compared to 0.25, respectively), the authors wrote.

However, those with two copies of the A allele showed the greatest improvement in AQLQ (of 0.42) compared to standard treatment.

Study lead Professor Somnath Mukhopadhyay said the personalised treatment had “a modest effect”.

“But this may be partly because the children’s asthma was generally very well controlled and only a few children experienced any serious symptoms during the 12-month period,” said Professor Mukhopadhyay, Chair of Paediatrics at the Royal Alexandra Children’s Hospital in the UK.

“Larger trials, with a focus on those with poorer asthma control, may help us determine the true benefit for children of prescribing in this way.

“These results are very promising because they show, for the first time, that it could be beneficial to test for certain genetic differences in children with asthma and select medication according to those differences.”

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