Severe asthma patients in the UK and Korea are being sorted into molecular subtypes based on their genes and proteins, with the goal of matching each person to the right antibody treatment. Current practice relies on a single blood measurement—eosinophil count—to decide who gets these expensive new drugs, but that test often fails to predict who will actually benefit. Many patients are left cycling through treatments that do not work, while others may be denied therapies that could help them. The researchers aim to replace this crude approach with a detailed molecular classification, using samples from blood and exhaled breath to identify the specific biological processes driving each patient’s asthma. If successful, this precision medicine framework could transform how severe asthma is managed in specialist clinics. Instead of trial-and-error prescribing, doctors would have a diagnostic test that tells them, for each individual, which antibody treatment is most likely to work. This would give patients better control over their symptoms and reduce the burden of ineffective therapies. The same approach could later be applied to other chronic respiratory and non-respiratory diseases, potentially reshaping treatment pathways across medicine.
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In both UK and Korea, severe asthma is defined as asthma that does not respond adequately to existing treatments including steroids and bronchodilators. It affects up to 5% of asthmatics and represents an important economic burden. In the UK, the economic costs for severe asthma are estimated to be £3-4,000 per patient per year, with these costs dependent on the severity of the asthma and as to whether the patient is using oral corticosteroid therapy. In both UK and Korea, these patients are managed in specialist severe asthma centres which in the UK are commissioned by the Department of Health. Although severe asthma is considered to be a disease with different types (phenotypes), only recently have these patients been divided into groups. With the introduction of new treatments such as antibody treatments to block cytokines such as IL-5, IL-4 and IL13, a high blood eosinophil count is used to choose patients who respond to this treatment. However, we know that this measurement is not an accurate predictor of the response. A lot of work has been done in the European U-BIOPRED patients with severe asthma to define the different types of asthma by examining and classifying the genes and proteins that are expressed in the subject's blood or sputum cells. Applying this molecular classification has not yet been applied in the severe asthma clinic. We believe that this will bring advantages when used in the clinic because this can tell us for each patient the type of cellular processes or proteins that may be involved in causing the asthma, and ultimately, what type of treatments he or she might need to control the asthma. Therefore, the aim of this collaborative project between the UK (Professor Chung at Imperial College) and Korea (Professor Kim at University of Ulsan College of Medicine, Seoul) called PRISM is to introduce 'Precision Medicine' (also termed 'personalised medicine') into the treatment of severe asthma. Precision Medicine is the tailoring of treatment to the individual patient usually by using a diagnostic test based on examining proteins or genes that will guide the most appropriate treatment for this individual person so that the right treatment can be provided to the right patient at the right time. We propose to do this molecular classification in 400 severe asthma patients who will be observed over a one-year period in several centres specialising in treating patients with severe asthma in both UK and Korea. We wish to see what type of asthma and what diagnostic biomarker measured in the blood or in the exhaled breath that can tell us with great accuracy who will respond well to treatment with the antibody treatments that we have at the moment such as the anti-IL5 or anti-IL5Ra or anti-IL4Ra. For those who cannot have this treatment, we will use the genes and proteins to tell us which type of treatments that might improve their asthma. Therefore, this approach of Precision Medicine will bring newer more effective treatments to subgroups of severe asthma. We foresee that this research will tell us exactly who needs treatment with these antibody treatments, and this will allow patients to take better control of their asthma. This is a pioneering piece of research because this is the first time that this approach has been taken in the treatment of asthma or any other chronic disease. If we are successful in our objectives, this might pave the way for the establishment of Precision Medicine not only in severe asthma but also in other respiratory and non-respiratory condition, that will provide benefits to a large range of patients suffering from diseases such as severe asthma.
Andrew Menzies-Gow (Co-Investigator)Bermseok Oh (Co-Investigator)Dominick Shaw (Co-Investigator)Ian Adcock (Co-Investigator)Joo Youn Cho (Co-Investigator)Kian Fan Chung (Principal Investigator)Kyunggon Kim (Co-Investigator)Marc Chadeau-Hyam (Co-Investigator)Pankaj Bhavsar (Co-Investigator)Sun Kim (Co-Investigator)Sung-Cheol Yun (Co-Investigator)Tae-Bum Kim (Co-Investigator)Yi-Ke Guo (Co-Investigator)
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