The ORACLE2 consortium study, published in The Lancet Respiratory Medicine, was led by research clinician Simon Couillard from the Université de Sherbrooke in Canada, who is affiliated with the University of Oxford and has received support from the National Institute of Health and Care Research Oxford Biomedical Research Centre.
The research found that among the key factors associated with asthma attacks were high levels of certain biomarkers – specifically blood eosinophils and fractional exhaled nitric oxide. The ORACLE2 team propose that these markers should be used in clinical settings to better predict and manage asthma attacks.
Asthma is a major public health issue that can have major consequences, including: significant loss of quality of life, side effects from systemic corticosteroid treatments, permanently impaired respiratory function from bronchial remodelling and scarring, and increased medical consultations and hospital admissions.
Currently, a patient’s risk of attacks is assessed based on symptoms and the signs of respiratory damage, such as wheezing and bronchial narrowing. In this study, the research team explored the predisposing factors of asthma to better predict and prevent attacks.
The paper presents the results of a large-scale meta-analysis that overturns the traditional risk assessment models for asthma attacks.
Professor Ian Pavord from the Respiratory Medicine Unit in the Experimental Medicine Division was a part of the team who analysed data from more than 6,500 patients in 22 randomised clinical trials and demonstrated that two types of inflammation biomarkers—blood eosinophils and fractional exhaled nitric oxide (FeNO)—are powerful and synergistic predictors of asthma attacks.
Testing for inflammation can allow healthcare teams to better predict the risk of asthma attacks and so adapt treatment. The blood eosinophil count, which is already included in routine blood tests, indicates an increased risk. Since this health indicator is easily accessible from patients’ medical records, it represents a practical tool for clinicians.
The FeNO test is also available in the UK and allows medical professionals to take measurements quickly and give immediate results during consultations.
The study calls into questions some tests that are currently used. For example, contrary to popular belief, the response to bronchodilators (such as Ventolin) as measured by spirometry does not predict the risk of attacks, instead playing a protective role.
Treatment strategies can be optimised when inflammatory markers are raised. Patients at higher risk, who are more likely to effectively respond to inhaled corticosteroids or biologic therapies, could benefit from a more targeted and personalised treatment.
This study underscores the importance of re-evaluating risk criteria in asthma management. Using inflammatory biomarkers could transform the current strategy into a more preventive and personalised approach.
Read the full paper on the Lancet website: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(25)00037-2/fulltext