Many children suffer from uncontrolled asthma in spite of medical treatment, and asthma exacerbations are the most frequent cause of hospitalization in childhood. The prevalence of severe asthma among Danish adults is estimated at 3-15% of all patients with asthma depending on the definition, where uncontrolled severe asthma represents approximately one third of the severe asthma population. The prevalence of severe asthma among Danish children is currently unknown, but studies from the U.S. and Europe consistently report that 20-40% of children with asthma require acute medical care yearly. This demonstrates a need for improved understanding of the pathogenesis in order to improve prevention and treatment.
Given the expected relatively low frequency of severe asthma in childhood, a national joint effort is required to obtain a sufficient number of patients in studies of this specific phenotype. In this project we will establish a national clinical cohort of approximately 300 children with severe asthma across Denmark. This will be done by a national collaboration between all pediatric departments in Denmark. The children with severe asthma will be clinically examined to distinguish between cases with severe asthma vs. cases with difficult to treat asthma due to other causes (adherence, comorbidity, etc.) and assessed with multi omics approaches at a cross-sectional visit in accordance with the methodologies applied in the COPSAC cohorts. The severe cohort will subsequently be compared to mild asthma cases as well as to healthy controls from the COPSAC mother-child cohorts, where data is already available for analysis.
The objective is to identify underlying specific disease mechanisms (endotypes) that can be targeted in order to personalize and improve treatment. Furthermore, assessment (clinical assessment and sampling of biological material) will be performed during acute exacerbations during a 1-year follow-up in order to study the basis of exacerbation among severe asthma cases to develop tools to predict exacerbations, understand underlying mechanisms and predict treatment response during exacerbations. The established biobank and database of children with severe asthma will provide a valuable resource for future asthma research in Denmark.
The recruitment of project participants began in autumn 2021.
The project is a national collaboration between COPSAC and all Danish pediatric departments and is supported by Lundbeck Foundation, Børnelungefonden and Novo Nordisk Foundation.