New Nasal Swab May Detect Specific Asthma Subtype in Children: Study Reveals - Video

Researchers at the University of Pittsburgh have developed a nasal swab test for kids that diagnoses specific asthma subtype, or endotype. The findings are published in JAMA

Traditionally, asthma has been classified into endotypes known as T2-high or T2-low based on the amount of T helper 2 inflammation present. More recently, T2-low has been split into two endotypes: T17-high, which has less T helper 2 inflammation and more T helper 17 inflammation, and low-low, which has low levels of both types of inflammation.

Precise diagnosis of endotype usually involves genetic analysis of a lung tissue sample taken by a procedure called a bronchoscopy, which is done under general anesthesia. For children, especially those with milder disease, it’s not feasible or ethical to perform this invasive procedure, so clinicians have had to rely on imperfect tools, including immune markers in the blood, lung function and whether or not they have allergies.

Researchers collected nasal samples from 459 youth across three different studies. Then they analyzed the expression of eight T2 and T17 signature genes.

As expected, analysis of nasal swab samples revealed a patient’s endotype. Across studies, 23% to 29% of participants had T2 high, 35% to 47% had T17-high and 30% to 38% had low-low endotype.

For treating severe T2-high asthma, there is a powerful new class of drugs called biologics, which target the immune cells that drive disease. However, no available asthma biologics directly target T17-high and low-low endotypes.

“We have better treatments for T2-high disease, in part, because better markers have propelled research on this endotype,” said senior author Juan Celedón, M.D., Dr.P.H., professor of pediatrics at Pitt and chief of pulmonary medicine at UPMC Children’s Hospital of Pittsburgh.. “But now that we have a simple nasal swab test to detect other endotypes, we can start to move the needle on developing biologics for T17-high and low-low disease.”

Reference: Yue M, Gaietto K, Han YY, et al. Transcriptomic Profiles in Nasal Epithelium and Asthma Endotypes in Youth. JAMA. Published online January 02, 2025. doi:10.1001/jama.2024.22684