A NEW metabolomics-based approach can predict asthma attacks up to five years before they occur, offering a potential breakthrough in asthma risk stratification and prevention.
Why Predicting Asthma Attacks Remains Challenging
Asthma affects more than 500 million people worldwide and remains a major cause of morbidity, emergency care use, and healthcare costs. Asthma exacerbations, commonly referred to as asthma attacks, are unpredictable and can occur even in patients who appear clinically stable.
Currently, clinicians lack reliable biomarkers to identify which individuals are at highest risk of future attacks. Traditional clinical indicators, including symptom frequency and lung function, often fail to distinguish between patients who will remain stable and those who will experience severe exacerbations.
Metabolomics Reveals Key Biochemical Ratios
In this study, researchers analysed data from three large asthma cohorts comprising more than 2,500 participants. The analysis integrated up to 25 years of electronic medical records with sequential blood-based metabolomics profiling.
Using global and targeted mass spectrometry, investigators measured circulating steroids, sphingolipids, and microbial-derived metabolites. While individual metabolite levels showed some associations with asthma outcomes, the most powerful predictor was the ratio between sphingolipids and steroids.
Sphingolipid-to-steroid ratios were strongly associated with five-year asthma exacerbation risk in both discovery and replication cohorts, with highly significant p values across analyses. A predictive model based on 21 of these ratios achieved excellent performance, with an area under the curve of 0.90 in the discovery cohort and 0.89 in replication, outperforming current clinical risk measures.
Clinical Implications and Future Directions
The ratio-based model was able to distinguish high- and low-risk patients with approximately 90% accuracy and, in some cases, predicted differences in time to first exacerbation approaching one year. This suggests that metabolic imbalance may precede clinical deterioration long before symptoms emerge.
The findings support the development of a practical, cost-effective blood test that could identify patients at high risk of asthma attacks while they are still clinically stable. Such a tool could enable earlier intervention, personalised treatment strategies, and improved long-term outcomes.
Reference
Chen Y et al. The ratio of circulatory levels of sphingolipids to steroids predicts asthma. Nature Communications. 2026;DOI:10.1038/s41467-025-67436-7.
