Asthma is an obstructive respiratory disease that affects approximately 300 million people worldwide. It is caused by chronic inflammation of the lower respiratory system and is influenced by both genetic and environmental factors. An individual’s genes can predispose them to asthma and allergic sensitisation. In addition to this, exposure to allergens, pollution and the development of respiratory infections can all contribute to the severity and development of asthma. Genetic variations create a challenge for the management of asthma and prevent the ability to have generic therapeutic strategies. The number of individuals diagnosed with asthma is continuing to grow and is even predicted to increase to 400 million by 2025. Considering the growing number of people affected by this disease, there is a vital need to increase the efficacy of treatments, and introduce new methods of intervention.
One strategy aimed to prevent asthma is allergen avoidance as well as allergen immunotherapy. There is a high association between the development of asthma and allergic sensitisation. The link between these two factors has been demonstrated in a 2017 study which reported that infants who were hospitalised or taken to the emergency department for wheeze, who had known allergies at the commencement of the study were 12 times more likely to develop asthma by 8 years of age. Immunotherapy can be used to prevent asthma by interfering with the pathology of asthma including the long-term progression of the disease and minimising allergic sensitisation. One study which tested sublingual (under the tongue) immunotherapy in children with grass allergies demonstrated that the children who did not receive the immunotherapy had a four times greater rate of asthma, indicating that sublingual immunotherapy can have a protective effect on asthma.
Other traditional methods of asthma prevention include treatment with inhaled corticosteroids which act to reduce the inflammatory process responsible for asthma. Alternative methods of prevention have been discussed and studied including supplements during pregnancy such as vitamin D which has been demonstrated to contribute to lung development during the prenatal period and early life. Researchers are also investigating how the microbiome can influence asthma development. While our knowledge is currently limited, it is believed that a well-diversified microbiome may be protective against the development of asthma. Additionally, there is the possibility to use biomarkers to not only predict the development of asthma, but also to personalise the treatment of asthma.
Given the rapid increase in the population of individuals affected by asthma, there is a growing need for effective therapy strategies. Considering asthma is influenced by both environmental and genetic factors it is apparent that in addition to prevention of asthma triggers, further research is needed to personalise therapeutic strategies. With continued research into methods of both genetic and environmental prevention for asthma, there is hope that therapeutic strategies will not only increase in efficacy but may include a more personalised approach.
Source: Maciag, M.C. & Phipatanakul W. (2020). Prevention of Asthma. Targets for Intervention. CHEST. 158(3), 913-922. http://doi.org/10.1016/j.chest.2020.04.011
