London School of Hygiene & Tropical Medicine

Researchers from the London School of Hygiene & Tropical Medicine (LSHTM) have been awarded over £2.2m for a study focusing on the causes and characteristics of non-allergic asthma, in the hope of improving treatment or even prevention.

The CAMERA study, led by Professor Neil Pearce, Professor of Biostatistics & Epidemiology at LSHTM and funded by a European Research Council (ERC) Advanced Grant, will aim to uncover why non-atopic (also known as non-allergic) asthma occurs, and the mechanisms involved, in different settings.

In collaboration with the MRC/UVRI and LSHTM Uganda Research Unit and other international experts, the researchers will draw comparisons between children with this type of asthma in a high-income country (HIC), New Zealand, and low-and-middle income countries (LMICs), Brazil, Ecuador and Uganda. These countries have varying levels of prevalence of the disease – New Zealand and Brazil both have high prevalence, while Ecuador has medium, and Uganda low prevalence.

Until 20 years ago it was widely believed that asthma was an allergic disease caused by allergen exposure in infancy. Now it is known that there are several different types of asthma, with different causes, and which probably need different treatments.

In particular, research carried out by Neil Pearce and colleagues found that less than half of asthma cases were allergic, and most cases in LMICs are non-allergic. A previous ERC-funded project, led by Professor Pearce, found that the proportion of asthma cases that were allergic was only 35% in Brazil, 32% in Ecuador, 33% in Uganda, 34% in the UK and 50% in New Zealand.

For most asthmatics, asthma can be managed well, but many of the current treatments are targeted to those with allergic asthma, and may not work well for non-allergic asthma. This has major implications for asthma prevention and treatment, highlighting the need for novel strategies to prevent and manage non-allergic asthma worldwide.

Professor Neil Pearce said: “Asthma is a debilitating condition that can affect children’s quality of life, and affects more than 300 million people worldwide. We are delighted to be awarded this funding, which will help us learn more about the mechanisms and causes of non-allergic asthma, how they differ depending on the setting. We hope this study will provide important information that could improve both prevention and treatment for people with this disease.”

The study will examine the risk factors for allergic and non-allergic asthma in the four countries, and analyse existing comparable studies to better understand the potential causes in these different settings. It will also test the participants for several possible mechanisms for non-allergic asthma.

For this, each centre will select 160 participants – made up of 40 allergic asthmatics, 40 non-allergic asthmatics, 40 allergic non-asthmatics and 40 non-allergic non-asthmatics.

The researchers hope that this research will allow them to better understand how and why non-allergic asthma occurs, and improve understanding of how to prevent it, and how to improve the treatment.