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Research

Pharmacogenomic-Based Treatment of Ambulatory Asthma

Inhaled corticosteroids (ICS) are the most effective treatment of persistent asthma in children6 but there is variability in response that may have a genetic basis. Montelukast, a leukotriene receptor antagonist, is an alternative controller medication. Also, there is some evidence that genetic variation in leukotriene pathway candidate genes or transporter proteins contribute to variability in response.

It is our hypothesis that selection of pharmacotherapy based on genetic variations will decrease exacerbations and cost to treat asthma in children. We will test this hypothesis through the following aims:

  • Collect salivary samples from all new patients evaluated in the Pediatric Pulmonary Clinic, isolate DNA and store in the Center for Pharmacogenomics;
  • Prospectively collect data on asthma exacerbations (ED visit, hospitalization or short course of oral steroids) and costs;
  • Genotype samples for selected genetic polymorphisms and test for associations with exacerbations; and
  • Conduct a randomized controlled trial comparing pharmacotherapy selected by NIH guidelines v genetic based stratification.

We anticipate seeking funding from UF CTSI for aims 1 and 3 and submitting an RO1 for aim 4 once there is sufficient pilot data.

Adherence to NIH/EPR3 Guidelines for ED and Hospital Treatment

There is variability in adherence to NIH Guidelines for the treatment of acute asthma in our ED and in-patient service. It is our hypothesis that improving adherence will decrease admissions from the ED and shorten length of stay of those requiring admission. Our aims are: 1) collect data on adherence to the guidelines for 3 months; 2) provide education and clinical pathways based on guidelines to ED physicians, hospitalists, and respiratory therapists/ nurses; and (3) measure adherence and determine the extent of reductions in hospital admissions and hospital length of stay.

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