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Is children's asthma made worse by inhalers?

news-113-01"Genetic tests could pave way to 'personalised' asthma drugs" the Guardian has reported, before warning that current treatments may make symptoms worse. The newspaper goes on to say that, "screening could help GPs tailor drugs to children as study confirms variations in response to asthma medications".

This headline is based on a small, proof-of-concept study that compared the effectiveness of standard treatment to an alternative asthma medication among children with poorly controlled asthma who were known to have a specific genetic variant (arginine-16 genotype).

If children's asthma symptoms fail to respond to the standard treatment (such as a reliever inhaler), their doctor will usually step up their treatment to additional, more powerful options.

Children with more troublesome asthma are usually treated with a combination of a steroid inhaler and a medication called salmeterol. However, concern has been expressed that salmeterol may be ineffective in many children, or even make their symptoms worse.

Based on previous studies, the researchers thought that children with the arginine-16 genotype would respond better to a different medication called montelukast.

The study found that montelukast was more effective at managing asthma in this group of children. Whether this study will ultimately lead to a change in asthma treatment guidelines, ushering in personalised asthma treatment based on genetic variation remains to be seen.

Larger clinical trials and cost effectiveness studies are likely to be needed before deciding whether to alter treatment and introduce routine genetic screening for asthma as the accuracy (and cost) of the testing itself will need to be considered.

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