Asthma Management Failure in Emergency Department Linked to Genetic Factors

Management failure in emergency departments in children with asthma has been associated with 3 single nucleotide polymorphisms (SNP), according to a study published in Pediatric Pulmonology. These genetic factors can supplement clinical predictors in assessing emergency cases in pediatric asthma.

This prospective study included 491 children with moderate to acute asthma, all of whom were white and whose ages ranged between 1 and 17 years. The majority were younger than 6 years (73.7%), had episodic asthma (77.0%), had a virus detected (61.3%), and were boys (64.6%). Standard treatment was administered and included either oral prednisone in <1 hour of triage or 2 mg/kg of prednisone, along with inhaled salbutamol plus ipratropium bromide, depending on the severity of the individual’s condition.

The primary objective was to find factors related to emergency department management failure, defined as active asthma management ≥8 hours, returning to the emergency department within 3 days, or hospitalization. A selection of 53 candidate SNPs were examined and were chosen for prior correlation with asthma. Logistic regression with adjustments for clinical predictors of management failure was used to investigate correlations between SNPs and management failure.

A significant association was found between emergency department management failure and rs295137 in the Spermatogenesis Associated Serine Rich 2 Like (SPATS2L) gene (odds ratio [OR], 1.77; 95% CI, 1.17-2.68; P =.006). The SNPs rs7037276 and rs1342326 in the interleukin-33 (IL-33) gene were associated with lower odds of management failure (OR, 0.55 [95% CI, 0.33-0.90]; P =.02 and OR, 0.52 [95% CI, 0.32-0.86]; P =.01, respectively). The final multivariate model had significantly better predictive performance than the original model when these 3 SNPs were added (P =.0004).

Limitations to this study included the difficulty of correctly diagnosing asthma in children of preschool age, the inability to discern whether SNPs affected therapy response or the primary outcome through a clinical parameter that was not measured, and the exclusive selection of white children.

The researchers identified “one SNP in SPATS2L and two SNPs in IL-33 that are associated with significantly higher and lower odds of [emergency department] management failure in children presenting with a moderate-to-severe asthma exacerbation, respectively. While the exact roles of these SNPs need to be validated in prospective or functional studies, our findings would support their role in the modulation of treatment response to acute care in children with asthma.”

Reference

Tse SM, Krajinovic M, Chauhan BF, et al. Genetic determinants of acute asthma therapy response in children with moderate-to-severe asthma exacerbations [published online January 15, 2019]. Pediatr Pulmonol. doi:10.1002/ppul.24247