It's likely asthma has both genetic and environmental components. And health experts believe that understanding the genomics of asthma could lead to personalized treatments that are more effective, safer and perhaps even cheaper over time.
The Utah Department of Health and the Utah Asthma Task Force on Wednesday sponsored a daylong workshop titled "Asthma's Future in Utah: How Will Genomics Play a Role?"
Educators, policymakers, nurses, respiratory therapists and other health professionals at the E Center not only heard of the science of genomics but participated in a lively discussion of the ethical, legal and social issues surrounding it. The audience also got a crash course in "pharmacogenetics of asthma therapy." The goal, according to health department officials, was to create a work plan on how genomics will be folded into other asthma-related activities the department sponsors.
Dr. Marc S. Williams, who discussed both the "hope" and the "hype," quoted a nano-lecture by biologist Eric Lander: "Genome: Bought the book, hard to read." But it is on human genome research that much of the hope of emerging therapies rests.
Personalizing therapy has been widely touted as the future of medicine, but too much is still unknown about the genomics of particular conditions, including asthma. While genetics is the branch of biology that deals with heredity, including the mechanisms of hereditary transmission, genomics is the study of genes and their function. It looks at molecular mechanisms and interplay of genetic and environment factors in disease, Williams said.
When Kristina Marsh was 14, she developed symptoms, including a cough. Now a health specialist for the state, she spent years trying to find out why breathing was so hard at times. Eventually, she was diagnosed with asthma. She said she likes to think that in 100 years, a simple blood draw would yield information on what kind of medicine would best treat an individual with asthma. Such a test would, perhaps, tell her she's allergic to both aspirin and acetaminophen, something she learned the very hard way. Personalized treatment might take weeks or months, rather than years, to get the disease under control — a process that would no longer require the trial-and-error of determining which medicines work for which patients, she said.
While expectations are high, said Williams, director of Intermountain Healthcare Clinical Genetics Institute, the work so far is preliminary and often inconclusive. Much of the discussion centers around what experts think will happen.
For instance, genomics could potentially decrease costs with preventive measures, early interventions (always cheaper) and therapy that is more effective, he said. Or it could increase costs for a number of reasons, including that people would live longer, pharmacy costs would be higher and the use of gene and stem cell therapies could cost more.
In 2003, researchers finished sequencing the human genome. But the question lingers "What's it all mean?" The problem with an information overload, he said, "is we don't quite know what to do with it."
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