What if asthma is actually a rash?


By Amanda Sheppeard

2 Sep 2016

Bold new research could dramatically change the way some patients with severe asthma are treated, scientists believe.

In what is touted as a world first, researchers at with the national Centre for Research Excellence on Asthma are taking a novel approach to treating asthma as a rash, rather than a respiratory disease.

The Alfred’s Head of Physiology Service Professor Bruce Thompson is co-leader of the research and said recruitment for study was already well underway. The Alfred is just a part of the national effort involving investigators around Australia.

“It’s really changing the way we think about asthma,” he told the limbic. “It’s potentially game changing if we can pull this off. The way we are looking at the inflammation of the airways – it’s like a rash in your lungs.”

Professor Thompson said the approach required researchers to think differently. He said about 40% of people with severe asthma don’t have eosinophils in the sputum and don’t respond well to inhaled corticosteroids, which is the mainstay of treatment.

“Sometimes we can be blanketed about treatment and call it steroid-resistant asthma,” he said. “But it may be that the steroids are working; it’s just the wrong treatment.”

He said the problem did not seem to be the efficacy of the medication, rather it was the method of delivery that meant the drugs were not getting where they were needed most. A major part of this appears to be the size of the particle delivered into the lungs through a traditional inhaler.

“The particle size is just too large,” he said. “It’s like putting the steroid cream on your hand when the rash is on your arm.”

Targeted treatment using a common antibiotic with anti-inflammatory properties would be used for patients with so-called steroid resistance. This drug has been nebulised into much smaller particle sizes so that it can be inhaled.

“This hasn’t been done before, and we’re already seeing the effect of small particles,” Professor Thompson said.

Prof Thompson believes that the issue of particle size is particularly important when it comes to treating some people with asthma – and it may well be that severe asthma could be well managed with less medication if it is delivered effectively.

“Instead of titrating on dose you titrate the particle size,” he said.

Recruiting is still open for the study and he invited respiratory physicians to make contact with him via email if they had a patient who might qualify, at [email protected]

“We are looking for people with moderate to moderately severe asthma,” he said.

Professor Thompson blogged about the study recently on The Alfred’s Central Clinical News Blog, saying he believed that asthma was an umbrella term, where different mechanisms cause the same result.

“We think the root of the problem is that when the airways becoming inflamed for whatever reason, they then become distended and stiff and the lungs don’t like it,” he wrote.

“The potential of this study is big and we’re cautiously optimistic.  Even if it helps 10 per cent of the population, it will be life changing treatment. With Australia still leading the world in the morbidity rate for asthma, it is clear other treatments are needed.”

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