Approved research

Brain mechanisms underlying symptom perception in asthma

Lay summary

This research aims to understand the brain networks underlying symptom perception in asthma. In up to 60% of people with asthma, symptoms may be `inaccurate` or discordant - meaning that symptoms poorly (but variably) reflect medical markers of lung function and inflammation. Discordant symptoms are associated with emotional stress and with worse asthma outcomes, leading to increased suffering and use of healthcare resources. Our recent work suggests that brain networks associated with emotion communicate with those that regulate breathing and breathlessness. With the Biobank brain imaging data, we would test whether dysfunction in these pathways explains discordant asthma symptoms. Asthma affects 5-10% of the UK population, and is associated with £1.2 billion health care costs p.a. in the UK. The proposed research will help improve the diagnosis and treatment of asthma in the following ways: 1) Better phenotyping: Asthmatics with the most discordant symptoms represent a `difficult to treat` and poorly understood group, and the Biobank brain imaging data gives an unparalleled opportunity to understand which brain networks may be aberrant in these people. 2) New targets for individualised treatment based upon brain biomarkers - e.g. new and repurposed therapies that may target networks identified above. Brain scans will be analysed and compared to both clinical measures (lung function and blood counts) and psychological measures (anxiety, depression, and breathlessness). The asthmatic participants will be compared to a control group of participants, and will also be stratified to investigate whether groups of asthmatics can be identified whose breathlessness is more susceptible to psychological factors or to clinical disease measures. Their brain structure and function will be analysed to see whether these participants have noticeable differences in how areas of the brain ?communicate? with each other, and in particular those areas involved with emotional regulation and symptom perception. The participants to be included in this research would be all participants (i.e. ~11,000) in the Biobank that have undergone brain imaging. From this we will select cases of asthma (~1,200 participants) and carefully matched controls without asthma (matched for variables including age, sex, socioeconomic status, education, comorbidities, drug therapy etc).