Three new review articles and an Editorial on asthma will be released by The Lancet and The Lancet Respiratory Medicine ahead of World Asthma Day on May 6 and the American Thoracic Society's international conference (ATS 2014) in San Diego (May 16-21).
- Editorial - Controlling asthma
- Outdoor air pollution and asthma
- Asthma genetics and personalised medicine
- Diagnosis, management, and prognosis of preschool wheeze
The Lancet: Outdoor air pollution and asthma
The Lancet Respiratory Medicine: Asthma genetics and personalised medicine
In this review, Professor Stephen Holgate and colleagues at the Faculty of Medicine, University of Southampton, UK, and collaborators in the US, discuss genetic approaches to asthma, which have identified novel genetic targets in the pathogenesis of the disease, although so far these targets account for only a small proportion of the heritability of asthma. Recognition of the importance of disease heterogeneity, the need for improved disease phenotyping, and the fact that genes involved in the inception of asthma are likely to be different from those involved in severity, widens the scope of asthma genetics. The identification of genes implicated in several causal pathways suggests that genetic scores which capture multiple gene effects could be used to capture the individual influence of genes on the expression and treatment opportunities for this disease in individuals. Gene-environment interaction adds another layer of complexity, which is being successfully explored by epigenetic approaches that assess how the human genome is accessed. Pharmacogenetics is one example of how gene-environment interactions are already being taken into account in the identification of drug responders and non-responders, and patients most susceptible to adverse effects. Such applications represent one component of personalised medicine, an approach that places the individual at the centre of health care.
The Lancet: Diagnosis, management, and prognosis of preschool wheeze
Preschool children (ie, those aged 5 years or younger) with wheeze consume a disproportionately high amount of health-care resources compared with older children and adults with wheeze or asthma, representing a diagnostic challenge, according to this Review by Professor Francine Ducharme, of CHU Sainte-Justine, Côte Sainte-Catherine, Canada, and colleagues. Several risk factors related to genetic, prenatal, and postnatal environment are associated with preschool wheezing, and findings from several studies have shown that preschool children with wheeze have deficits in lung function at six years of age that persisted until early and middle adulthood, suggesting increased susceptibility in the first years of life that might lead to persistent sequelae. Interventions to modify the short-term and long-term outcomes of preschool wheeze should be a research priority, say the authors.