Asthma is a common respiratory disease in children and adults alike. In fact, more than 4.6 million children in the U.S. have it.
There are two categories for the disease. The first is known as “T2-high” asthma. This type is caused by inflammation from a particular type of immune system cell called T helper 2. It used to be the most common asthma type, until the second category, “T2-low” asthma came about. It encompasses two subtypes. The first one involves less inflammation, and the second one is characterized by inflammation from a different type of T cell.
Figuring out which type of asthma a child has, especially in some of the more severe cases, can help physicians match patients with the proper treatment. Since testing options have been limited, doctors typically do a blood draw to measure levels of immune cells and antibodies. Or, they might have children breathe into a mouthpiece to measure the nitric oxide in their breath.
Unfortunately, the tests aren’t always accurate, so they only detect T2-high asthma. They’re unable to differentiate between the other subtypes, such as T17-high and low-low endotypes.
The good news is researchers at the University of Pittsburgh came up with a more precise way to diagnose the different asthma subtypes. They collect nasal swabs, then sequence the RNA that is in them. For people who have two asthma subtypes, certain genes associated with inflammation are more highly expressed. So, the researchers looked for those authentications. They then identified the third subtype through the absence of those genetic validations.
Researchers used the test on more than 450 children and teens across three studies. One was in Puerto Rico, one was in Pittsburgh, and one in both locations. Study participants were predominantly Puerto Rican or non-Hispanic African American.
This new test is especially important for Puerto Rican and African American youths who have higher rates of asthma and asthma-related deaths and are more likely to be exposed to asthma triggers like air pollution, dust, or mold. By providing a precise diagnosis, the nasal swab test can help tailor treatments to individual patients, thus improving overall health outcomes.
For treating severe T2-high asthma, a powerful new class of drugs called biologics target the immune cells that drive disease. But no available asthma biologics directly target T17-high and low-low endotypes.
By accurately diagnosing the specific asthma endotype, clinicians can prescribe more targeted therapies. This is especially important for the asthma types that aren’t studied as much, such as T17-high and low-low endotypes, which previously lacked specific treatments.
Having the right tools to test which biological pathways have a major role in asthma in children could very well help achieve the goal of improving asthma outcomes. Today’s research could pave the way for more personalized treatments, especially in the minority communities.
More articles from the March 2025 issue:
- New Weight-Loss Drugs
- Secondary Stress
- Sight-Loss Support
- PBMs and How They Affect Your Pharmacy
- White Label vs. Private Label Products
- Welcoming AI into Your Pharmacy
- AI-Powered Patient Counseling
- Diagnosing Childhood Asthma
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