At Asthma UK, we think it’s just not good enough that we don’t have the tools to accurately diagnose asthma. This can lead to asthma being left undiagnosed – as well as wrongly diagnosed – and can create confusion for people with asthma, as our Clinical Lead, Dr Andy Whittamore, explains.
In December, we highlighted how asthma diagnosis is a grand challenge for the 21st century. At a time when pressures on NHS finances are increasingly acute, it’s vital to ensure that the millions of people with asthma across the UK are receiving the right treatment for their asthma, while reducing the waste that arises from taking ineffective treatments.
To help forge a way forward, we brought together a small group of leading asthma researchers, medical specialists and people with asthma at the British Thoracic Society’s Winter Conference to discuss how we can shape the direction of asthma diagnostics research.
The challenge of asthma diagnosis
From the outset there was clear agreement on the importance of accurate tools to enable healthcare professionals to diagnose specific types of asthma, ensuring that people receive the right treatment. This view was echoed by Lehanne Sergison, one of Asthma UK’s Research and Policy Volunteers, who noted that people with a range of different asthma symptoms will often be given similar treatments by their healthcare professional. There was also agreement that asthma diagnosis would need to be simple, non-invasive, inexpensive and suitable for use by GPs and nurses.
“How can we live in a world where asthma is very common, but there’s no one test that can accurately diagnose an individual? Patients and clinicians need an objective test.”
– Dr Stephen Turner, Senior Lecturer, University of Aberdeen
However, there are challenges. Our understanding of asthma biomarkers – molecules, genes or characteristics that can indicate what’s happening in your body and signs of asthma – remains limited. Large scale collaborative research projects, such as U-BIOPRED, have greatly improved our understanding but there is still much that we do not know. And while the latest diagnostic tools are showing promise, there are barriers to progress such as the potential for misdiagnosis and the risk to companies of sharing valuable intellectual property.
Finding the best biomarkers for asthma
Colleagues suggested a long-term, comprehensive study that used a test or combination of tests to diagnose and then treat people with suspected asthma, trying different treatments and then looking at which biomarkers best predicted the response to treatment. Tests might include diagnostic tests that are currently in use such as peak flow, spirometry and FeNO testing but also include new tests such as blood eosinophil count, urine samples and measurements of compounds in breath.
“A more accurate asthma diagnosis will mean healthcare professionals can determine the most appropriate medicines to treat each individual.”
– Lehanne Sergison, Asthma UK, Research and Policy Volunteer
There was much debate about how such a study might be achieved and the group acknowledged that improving asthma diagnosis could be a lengthy challenge. But lessons could be drawn from the development of diagnostic tools for cystic fibrosis, which involved extensive preliminary work before relatively simple tests were developed.
Turning ambition into reality
To stimulate progress colleagues expressed an appetite for a ‘grand challenge’ funding call – one that is not limited to asthma specialists but that could bring together people from academia, industry and other sectors, to rapidly develop new asthma diagnostic tests. Working with specialists in other conditions, such as epilepsy where no simple diagnostic tests currently exist, might also help to find a way forward and perhaps even enable a new test to have added value beyond asthma.
So in 2017, Asthma UK will be exploring how we can bring together businesses, universities, funders and investors, and create links between potential collaborators. We hope to build on the optimism shown at our discussion in December, and move closer towards the development of a single, rapid test for the diagnosis of asthma, helping to improve the lives of millions of people with asthma.
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