Asthma: further prevention
Screening allows for more targeted treatment, but the future of asthma prevention and management is still very hard to predict
Posted: 12 May 2016
If you’ve missed yesterday’s episode of this week’s feature on asthma, click here.
Writer: Saša Jankovic
Genetic screening for asthma could help prevent attacks, but we are not quite there yet.
What could change?
Iles says, in theory, this new method of screening could “allow more targeted treatment”, but still “would not necessarily prevent all asthma attacks”. For now, he says asthma should continue to be treated in accordance with BTS/Sign guidance, with review of the patient to determine if a medication improves, maintains or worsens a patient’s control.
He says this review is “very important and is very effective when undertaken, but unfortunately these simple steps and principles are often missed even in basic care. This is a very important message to stress because if we did the basics well we would see a significant improvement in care.”
So what else can be done for children living with asthma to prevent attacks? Godden says there is “nothing to prevent asthma at the moment that I’m aware of. Some people say pets might be protective but other people say the opposite. Some say breastfeeding cuts down the likelihood, but these are all small percentages and they are multifactorial.”
His advice is that children should “avoid passive smoke; use bronchodilators (the blue inhaler) before exercise if they get wheezy, even if they feel well; be prepared to step up or step down their ‘asthma control’; and get on the right medication for the individual – part of which could be to do with their genotype.”
Aside from that he says consideration of allergy testing can be “very useful for the difficult asthmatic”, but he suggests only going down that route “if the parents and doctor agree that it would be clinically beneficial for the child, as it is expensive and painful”. The child’s GP can arrange allergy testing, and there are two common types: a blood test when you look for a specific type of antibody, and skin prick testing, although Godden adds that “neither of these are perfect but are possibly the best we have at the moment, but families have to be sensible about it.”
He says the future of asthma treatment is “notoriously hard to predict. It may be possible, it may even be likely, that a gene test in the future will help you decide what treatment will work best for each child, but most clinicians believe asthma is multifactorial where genes play a part in asthma combined with environmental factors.”
But he says “genes are not the be all and end all; it’s genes and environment that clinicians look at”, which is why he adds: “In 2016, I see no place for screening children for asthma. I’m not dismissing Aberdeen’s study because in the future it may be highly useful to target drugs to people’s genotypes, but currently there remains quite a gap between clinical research and practical use on the shop floor, and there is still some way to go before we can use this helpfully.”
Iles agrees that there is a way to go before asthma screening is a viable option. He says: “[Aberdeen’s] work is exciting, but not relevant to the majority of asthma patients in primary care at the moment, but maybe in a few years.” For the time being, his advice remains that “all clinicians should be up-to-date with current guidance. If we cannot get the basics correct we will not be able to determine the utility of the exciting new work above.”
Join us tomorrow for the last episode of this week’s feature on asthma as we’ll be discussing facts and figures
To keep up to date with the latest developments and to receive updates on how Asthma UK is working with healthcare professionals to improve asthma care visit: www.asthma.org.uk/professionals/sign-up or call Asthma UK's Helpline on 0300 222 5800 to speak to the charity's expert asthma nurses who are here to support healthcare professionals.