Asthma

Coordinator: Dra. María Jesús Cruz Carmona

Study of the mechanisms underlying genesis and evolution of asthma: Long-term monitoring of a cohort of asthmatic patients.

Asthma represents a major health problem throughout the world.  There has been an epidemic increase in global prevalence of asthma in the last decades with an estimated 300 million people affected worldwide. This is particularly relevant in the developed industrialized world, which has noted a tremendous increase in the prevalence of asthma over the last 50 years. Asthma currently affects 8-12% of the population in the developed world. Patients affected by this disease are recognized to have a poorer quality of life, reduced work productivity and school attendance and comorbidities associated. Apart from individual suffering, its life-threatening chronic course makes this disease to present a high socioeconomic cost.

Asthma behaves as a spectrum of disorders initiated at different stages throughout life by a range of environmental factors interacting with a susceptible genetic background. At its simplest, asthma is divided into allergic (extrinsic) and no allergic (intrinsic) subtypes, but even within each of these 2 broad categories, there exists considerable heterogeneity with respect to underlying mechanisms, clinical and physiological manifestations, response to treatment, and natural history.

During the last three decades an improved understanding of the pathophysiology underlying asthma, have led clinicians to shift their focus from managing acute attacks to achieving asthma control.

Severe asthma accounts for only 10% of patients with asthma, but it accounts for a considerable portion of the health care costs associated with the disease. Severe asthma patients are characterized by a poor quality of life, frequent hospitalisations and high risk of severe systemic side effects resulting from oral glucocorticoid therapy and/or high doses of inhaled glucocorticoids. All in all, these characteristics confer a relevant role to this group of patients when it comes to design a research programme aimed at achieving a better control of a disease that afflicts a progressively increasing number of patients.

Unmet needs in asthma are:  The causes of the epidemic increase in asthma; Genetic susceptibility; The marginally understood interaction between environmental factors and immune system; Better sub-classification of asthma: phenotypes; New agents acting on specific pathways in pathogenesis for the use as new therapeutic approaches; Better preclinical models for translation research; Better approaches in diagnosis and prediction of treatment responses and the monitoring of therapeutic effectiveness; Better tools to analysed complex data obtained; New and better biomarkers.

In our Asthma Line at CIBERES we approach asthma as a trans-disciplinary research with expertise from clinical, epidemiological and biologist researchers to generate new therapeutic options based in a better diagnosis. With our integrative approach we will increase understanding of the mechanisms underlying the genesis and evolution of this disease.

Objectives

Our specific objectives are:

  1. To identify novel therapeutic targets and biomarkers that will allow managing asthma with a personalized approach. In this project we will focus specifically on finding out if there is a relationship between the phenotypes established in the cohort and in identifying potential biomarkers, associated either with the clinical pathways and/or to the pathophysiological pathways.
  2. To identify the risk factors of exacerbation according to the pathophysiological mechanism involved.
  3.  To build a bio-repository that stores biological samples from asthma patients for use in this project and in future studies (Asthma Biobank). The patient data collection will include: standardized medical history, clinical examination, lung function studies, Mini AQLQ, ACT and HAD questionnaires, samples of exhaled breath condensate, urine, blood and induced sputum.