If your child struggles asthmaIdentifying the exact cause may soon become very easy. Researchers have developed a quick and non-invasive nasal swab test that can pinpoint the immune system trigger behind a child’s asthma. This breakthrough could lead to more targeted and effective treatments for this common condition.

According to the National Institutes of Health, asthma affects about 1 in 10 children in the United States and is the most prevalent chronic disease in children. However, it is far from a one-size-fits-all disease. This varies greatly from child to child, depending on what is causing their airways to swell. These variations, known as asthma subtypes or endotypes, are important for understanding how to treat each case.

“Accurate diagnosis of asthma endotype is the first step toward better treatment,” said Dr. Juan Celadón, chief of pulmonary medicine at UPMC Children’s Hospital of Pittsburgh. “Asthma is highly variable, with different endotypes driven by different immune cells that respond differently to treatment.”

Traditionally, diagnosis of these endotypes required invasive procedures, such as sampling lung tissue under anesthesia of the child. These tests are not only expensive but also impractical for children with mild asthma. As a result, doctors have to rely on less accurate methods such as blood tests and lung function assessments to make an educated guess about a child’s asthma subtype.

A simpler, more accurate solution

The new nasal swab test described in a study published in the Journal of the American Medical Association offers a simpler and more accurate alternative. The researchers analyzed nasal samples from nearly 460 children, focusing on eight specific genes associated with immune cells that drive asthma inflammation.

The study included children from Puerto Rican and African American backgrounds, because these groups have disproportionately higher rates of asthma and worse outcomes. The results were promising – the nasal swab test accurately identified whether a child had T2-high, T17-high, or low-low asthma.

– T2-high asthma is driven by T helper 2 cells and is the most well-researched subtype, for which targeted treatments are already available.

– T17-high asthma, which is caused by T helper 17 cells, and low-low asthma, where no cell type is predominant, currently lack specific treatments.

The trial has the potential to transform the care of children with T2-high asthma and could direct them toward powerful new drugs targeting the immune cells responsible for their condition. Researchers found that about 29% of the children in the study fell into this category.

Expanding research opportunities

Dr. Celadon believes this new test could also advance research into the less understood T17-high and low-low subtypes. “We can now begin to develop treatments for these endotypes,” he said.

Additionally, the test may shed light on why asthma outcomes vary during puberty. “Before puberty, asthma is more common in boys, but its incidence increases in women in adulthood,” Celadon said. “Is it related to endotype? Does the endotype change over time or with treatment? “These are questions we can begin to answer.”

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