What did the project achieve?
“We found that children with asthma who were allergic to fungi and in some cases had fungi in their lungs, appear to have asthma that is more resistant to treatment, worse lung function and are more likely to experience acute asthma attacks,” says Dr Erol Gaillard of the University of Leicester.
“As a result, we are now screening all children attending our asthma clinic for fungal allergies – and then closely monitoring them for declines in their lung function and asthma control,” he adds.
Asthma affects around 1.1 million children in the UK.1 Around one in twenty have severe asthma – experiencing breathing difficulties almost all of the time and regular serious asthma attacks.2 Although it is known that adults with asthma and allergies to fungi and fungi present in the lungs have worse lung function, there are limited data available in children.
To explore this, Dr Gaillard’s team carried out lung function tests, allergy testing and looked for the presence of fungi in the airways of 186 children – 62 with mild or moderately severe asthma, 48 with severe asthma, 36 who had been admitted to hospital with an acute asthma attack – and 40 healthy children.
“We found that fungal allergies were more common in children with severe asthma compared to those with milder forms,” says Dr Gaillard. “Healthy children were not allergic to any fungi that we tested.”
“More children with severe asthma had fungi in their lungs compared to those with milder asthma,” he adds. “And a significantly greater number of children who had recently had an acute asthma attack had fungi in their airways compared to those with stable asthma.”
Knowing that children with allergies to fungi have worse lung function has implications for their treatment.
“We are now using this knowledge to better tailor treatment for children with asthma, which we hope will lead to improvements in their symptoms and quality of life,” says Dr Gaillard.
Further interventions may also include more regular home visits to understand the home environment better and advise parents on building or other measures that could help reduce a child’s exposure to fungi.
“We have now generated a large amount of data underpinning the importance of fungi in severe asthma,” says Dr Gaillard. “We hope our results will ultimately lead to greater awareness, safer, less damp housing and a better environment for children – which may reduce the incidence of severe asthma in the future.”
- Asthma UK: facts and statistics https://www.asthma.org.uk/about/media/facts-and-statistics/ [website accessed 15 October 2019]
- NHS England: Childhood asthma. https://www.england.nhs.uk/childhood-asthma/ [website accessed 15 October 2019]
This research was completed on
The prevalence of asthma is increasing, especially among children. For those with severe disease, frequent flare-ups, hospitalisations and side effects of treatment can make quality of life poor.1 Dr Erol Gaillard, of the University of Leicester, is investigating a possible link between severe asthma and the presence of fungi in children’s airways (small tubes that carry air into the lungs). His findings could lead to a clinical trial of anti-fungal treatment, with the aim of improving the lives of children with severe asthma.
What is the problem and who does it affect?
Around 1.1 million children in the UK have asthma.2 Around 1 in 20 of those children has severe asthma, which remains difficult to control despite large doses of medicines.3,4
“Severe asthma can be really quite disabling for the child and can disrupt family life considerably,” explains Dr Gaillard. “Children can suffer symptoms on a daily basis, which disturbs their sleep and limits their activity. They may be unable to take part in PE lessons, or go on school trips, and have frequent flare-ups. It’s common for children to be admitted to hospital three or four times a year for several days at a time. The children can miss significant amounts of school. Sadly, the severity and unpredictability of asthma attacks can cause lots of anxiety.”
Treatment options for severe asthma are limited. Children often need high doses of medicines called corticosteroids, which are linked to problematic side effects.
“Unfortunately, we don’t know much about why a child’s asthma might become severe,” says Dr Gaillard. “Medication works for the majority of children with asthma, keeping their symptoms under control, but children with severe asthma don’t respond so well to medication and we don’t know why.”
What is the project trying to achieve?
“We are trying to find out why some children’s asthma becomes severe,” explains Dr Gaillard. “We think that children with severe asthma might be more likely than other children to have fungi growing in their airways and to be allergic to fungi. We are testing whether or not that’s true. Does the presence of fungi make the children’s asthma worse and stop them from responding to treatment? We are trying to find out.”
Around 40 children with severe asthma, 60 children with mild-to-moderate disease and 40 children with no history of asthma are joining the study.
“If we find that there is a link between severe asthma and fungi in the airways, then the next step would be to investigate whether anti-fungal treatment makes children’s lives better,” explains Dr Gaillard. “We would also investigate what sorts of disease processes are triggered by the fungi, which could eventually lead to totally new treatments.”
What are the researchers’ credentials?
Dr Gaillard is using cutting-edge research techniques that will be central to the success of this study. He is supported by colleagues from the University of Leicester who are world experts in the role fungi play in diseases of the airways, including asthma.
- Global Initiative for Asthma. Pocket guide for asthma management and prevention. Updated December 2011. http://www.ginasthma.org/guidelines-pocket-guide-for-asthma-management.html Website accessed 3 October 2012.
- Asthma UK. Asthma and your child. http://www.asthma.org.uk/about-asthma/my-child-has-asthma/asthma-your-ch... Website accessed 12 September 2012
- Asthma UK. What is severe asthma? http://www.asthma.org.uk/about-asthma/what-is-severe-asthma/ Website accessed 12 September 2012
- Lang A et al. Severe asthma in childhood: assessed in 10 year olds in a birth cohort study. Allergy 2008; 63: 1054-60.
|Dr Erol A Gaillard PhD MRCPCH
|Professor Andrew J Wardlaw FRCP PhDDr Catherine H Pashley PhDDr HC Pandya MBCHB MRCP MD
|Department of Paediatrics, Leicester Royal Infirmary and Department of Infection, Immunity and Inflammation, University of Leicester
|Project Location Other
|Department of Respiratory Medicine, Institute for Lung Health, Glenfield Hospital, Leicester
|26 July 2012
|Project start date
|1 March 2013
|Project end date
|31 March 2017