What did the project achieve?
“Our results are very promising because they show, for the first time, that it could be beneficial to test for certain genetic variations for children with asthma and prescribe their medication accordingly,” says Professor Somnath Mukhopadhyay of the Royal Alexandra Children’s Hospital in Brighton. “Although more work is needed, we hope that this personalised approach to care could help improve the quality of life and provide better symptom control for young people living with the condition.”
Asthma affects one in every 11 children in the UK.1 Children with the condition cough, wheeze and have difficulty breathing – which can seriously impact on their quality of life. Although there are medicines that can help to control their symptoms, they don’t work equally well for all children.
The researchers were investigating whether it is beneficial to examine specific variations in a child’s genetic makeup through a simple, inexpensive saliva test – and then using this information to decide whether to prescribe a drug called salmeterol or another medicine called montelukast.
The trial involved 241 young people between 12 and 18 years who were being treated for asthma by their GPs. Half received current standard treatment that does not involve any genetic testing while the others were prescribed personalised treatment. The researchers followed the children for a year, monitoring their quality of life through a questionnaire asking them about their symptoms, whether their normal activities were limited by their asthma and how their asthma made them feel.
“We found out that children who received personalised treatment – and particularly those with a certain genetic makeup – had improvements to their quality of life compared to those on standard treatment,” says Professor Mukhopadhyay. “While we only saw a modest effect, this may be because the children’s symptoms were generally very well controlled at the start of the study – leaving limited room for further improvement.”
Larger trials focused on children with poorer asthma control may help to determine the full benefit of this personalised approach to care in the future.
- Asthma UK. Asthma facts and statistics. https://www.asthma.org.uk/about/media/facts-and-statistics/ [website accessed 14 September 2020]
This research was completed on
Around 1.1 million children in the UK have asthma, a lifelong condition that affects breathing.1 When asthma is managed well, children can lead a full and active life. However, Professor Somnath Mukhopadhyay, of Brighton’s Royal Alexandra Children's Hospital, has uncovered evidence that a commonly used asthma medicine, called salmeterol, may offer little benefit to some of the children who are taking it. He is investigating whether children’s genetic makeup should be taken into account when deciding whether to give them this asthma medicine or an alternative – whether this improves children’s quality of life and gives better control of their asthma.
How are children’s lives affected now?
One in every 11 children in the UK has asthma – one of the highest rates worldwide.1
“Children with asthma cough, wheeze and have difficulty breathing,” explains Professor Mukhopadhyay. “The children’s symptoms can mean they miss school and make it difficult for them to participate in playground games and sports. Some have to be admitted to hospital.”
Indeed, every 18 minutes a child is admitted to hospital in the UK because of asthma.1
Effective medicines are available, but a child’s response to treatment is currently unpredictable. This project focuses on a medicine called salmeterol. According to reports, tens of thousands of children may be taking this medicine in the UK, but evidence suggests it might not work for around one in seven of them.2-5
The consequences of ongoing asthma symptoms can be far reaching: “Children with poorly controlled asthma can develop low self-esteem because they fall behind their peers in football, PE and schoolwork. The family often sleep poorly as the child is coughing,” says Professor Mukhopadhyay.
How could this research help?
“We are investigating whether a new approach to treatment, where prescribing is personalised according to a child’s individual make-up, improves children’s quality of life and provides better control of their asthma,” says Professor Mukhopadhyay.
Treatment that is tailored in this way to a person’s genetic features is often called ‘personalised therapy’.
At the moment, doctors commonly prescribe salmeterol to relieve asthma symptoms if children don’t benefit enough from other medicines. But evidence suggests salmeterol may not work properly in children with a certain genetic makeup.
Professor Mukhopadhyay is investigating whether it helps to take children and young people’s genetic makeup into account when deciding whether to give them salmeterol or an alternative medicine called montelukast. A simple and inexpensive saliva test can provide the information needed to guide decision making.
“Our ultimate aim is to make the most of the treatments we’ve already got for asthma, so children get the medicines that suit them best – and they can enjoy the best possible quality of life,” says Professor Mukhopadhyay.
1. Asthma UK. Asthma facts and FAQs. http://www.asthma.org.uk/asthma-facts-and-statistics Website accessed 3 January 2014.
2. Lipworth BJ et al. Tailored second-line therapy in asthmatic children with the Arg16 genotype. Clinical Science 2013; 124: 521–528.
3. BBC News Health. Spit test ‘improves’ asthma care http://www.bbc.co.uk/news/health-20931946 Website accessed 3 January 2014.
4. Turner S et al. Prescribing trends in asthma: a longitudinal observational study. Arch Dis Child 2009; 94: 16–22.
5. Office for National Statistics. UK population estimated to be 63.7 million in mid-2012. Chart Population pyramid for the UK; mid-2012 compared with mid-2001. http://www.ons.gov.uk/ons/rel/pop-estimate/population-estimates-for-uk--... Website accessed 12 February 2014.
|Project Leader||Professor Somnath Mukhopadhyay MBBS MD PhD FRCPCH|
|Project Team||Professor Brian J Lipworth BMedSci MBChB MDProfessor Colin NA Palmer PhDProfessor Helen E Smith BM BS MSc DM MRCGP FFPHMDr Steve W Turner MBBS MD FRCPCHProfessor Jonathan Grigg BSc MBBS MRCP MD FRCPCH|
|Project Location||Academic Department of Paediatrics, Royal Alexandra Children's Hospital, Brighton and Sussex Medical School|
|Project Location Other||Asthma and Allergy research Group, University of Dundee Pat Macpherson Centre for Pharmacogenetics, Medical Research Institute, Ninewells Hospital and Medical School, DundeePrimary Care & Health Services, Brighton & Sussex Medical School, University of SussexChild Health, University of AberdeenCentre for Paediatrics, Blizard Institute, Queen Mary University London|
|Project duration||3 years|
|Date awarded||15 November 2013|
|Project start date||1 May 2014|
|Project end date||1 September 2019|