There already some rumors – an earlier Lancet perspective named asthma a symptom “like fever” (scienceblog:doi:10.1016/S0140-6736(06)69271-4:). A new editorial now compares it to “diarrhea” (scienceblog:doi:10.1164/rccm.200703-302ED:)
asthma is but a symptom, categorically on par with diarrhea. Imagine determining the optimum treatment strategy for diarrhea based almost entirely on whether it was “mild,” “moderate,” or “severe,” and “intermittent” or “persistent.” Imagine striving to control excessive stooling while neglecting to consider the cause. Imagine trying to study the genetics of diarrhea. Imagine attempting to examine the efficacy of a new drug by enrolling everyone with diarrhea, regardless of mechanism, in one giant study and expecting the results to be applicable to an individual patient. Now, what applies to diarrhea applies equally well, or equally poorly, to that symptom complex we still refer to as “asthma.”
That’s difficult to accept – but possibly one of the major reasons why the 20 year long hunt for asthma genes largely failed. So what asthma sub phenotypes are we looking at? Some of the sub phenotypes that we defined earlier (scienceblog:doi:10.1186/1471-2466-5-1). Certainly not, it will be more the GSTM-type, ADAM-type, GERD type, low redox, high muc, small dia – you don’t need to be creative.