An international consortium of respiratory scientists has highlighted the key role inflammation plays in asthma and offered a new approach to predict and prevent these attacks.
The study by the ORACLE2 consortium, published in The Lancet Respiratory Medicine, was led by research clinician Simon Couillard from the Université de Sherbrooke, in Canada, who is affiliated with the University of Oxford and has received support from the National Institute of Health and Care Research (NIHR) Oxford Biomedical Research Centre (BRC).
The research found that among the key factors associated with asthma attacks were high levels of certain biomarkers – specifically blood eosinophils and fractional exhaled nitric oxide. The ORACLE2 team propose that these markers should be used in clinical settings to better predict and manage asthma attacks.
Asthma is a major public health issue that can have major consequences, including:
- A significant loss of quality of life.
- Side effects from systemic corticosteroid treatments.
- Permanently impaired respiratory function from bronchial remodelling and scarring.
- Increased medical consultations and hospital admissions.
Currently, a patient’s risk of attacks is assessed based on symptoms and the signs of respiratory damage, such as wheezing and bronchial narrowing. In this study, the research team explored the predisposing factors of asthma to better predict and prevent attacks.
“Although we are used to measuring and treat blood pressure, cholesterol and blood sugar levels to prevent heart attacks, we unfortunately still manage asthma based on downstream symptoms and damage,” Simon Couillard says.
“We respirologists act as ‘firefighters,’ who are only called in once the fire has started. Our study confirms that we can indeed identify the risk of asthma attacks early—before the fire starts. A major risk factor we found is inflammation, and the good news is that we have very effective anti-inflammatory treatments for asthma.”
The paper presents the results of a large-scale meta-analysis that overturns the traditional risk assessment models for asthma attacks.
Couillard’s team analysed data from more than 6,500 patients in 22 randomised clinical trials and demonstrated that two types of inflammation biomarkers—blood eosinophils and fractional exhaled nitric oxide (FeNO)—are powerful and synergistic predictors of asthma attacks.
Testing for inflammation can allow healthcare teams to better predict the risk of asthma attacks and so adapt treatment. The blood eosinophil count, which is already included in routine blood tests, indicates an increased risk. Since this health indicator is easily accessible from patients’ medical records, it represents a practical tool for clinicians.
The FeNO test is also available in the UK and allows medical professionals to take measurements quickly and give immediate results during consultations.
Couillard added: “These research results could influence asthma management recommendations around the world thanks to new criteria for assessing the risk of attacks. Our study has also dispelled some long-standing misconceptions.”
The study calls into questions some tests that are currently used. For example, contrary to popular belief, the response to bronchodilators (such as Ventolin) as measured by spirometry does not predict the risk of attacks, instead playing a protective role.
Treatment strategies can be optimised when inflammatory markers are raised. Patients at higher risk, who are more likely to effectively respond to inhaled corticosteroids or biologic therapies, could benefit from a more targeted and personalised treatment.
This study underscores the importance of re-evaluating risk criteria in asthma management. Using inflammatory biomarkers could transform the current strategy into a more preventive and personalised approach.
About the ORACLE2 international consortium
Led by Simon Couillard of the Université de Sherbrooke in close partnership with the University of Oxford and Leiden University, ORACLE2 (OxfoRd Asthma attaCk risk ScaLE) is a leading consortium on asthma research that brings together university research teams and pharmaceutical multinationals to improve asthma treatment.
This international collaboration is looking for more effective ways to predict and prevent asthma attacks. It is also studying how to quantify different risk factors. The overall goal for the next study is to develop a risk scale to predict asthma attacks. With ORACLE2, inflammatory biomarkers are targeted as “modifiable” risk factors for asthma attacks, just as high blood pressure and cholesterol are treated as modifiable risk factors for heart attacks.