A team of specialists at the Research Institute of St. Joe’s Hamilton have developed a personalized approach to asthma treatment that is leading to remission in two-thirds of patients.

Asthma is a complex disease that can manifest differently in each patient. Despite this, many patients are treated with a common steroid because it can help improve breathing. The problem is that treatment with steroids can be hard on a person’s body, making it a difficult therapy to maintain over the long term.

Under the new, highly individualized protocol developed at St. Joe’s, specialists study a person’s airway to determine what cells and proteins are present. They also image individual lungs to determine where breathing problems are occurring in each patient. From there, the team can determine whether a person’s asthma is being caused by inflammation in a particular area of the lung or if a certain protein is involved.

This specific information allows clinicians to prescribe a treatment that is personalized to the needs of the patient.

“We get referred patients from all over Ontario who have failed other treatments. We have more tools at our disposal and we customize treatments to meet the patient’s specific needs,” said Dr. Parameswaran Nair, a staff respirologist at St. Joseph’s Healthcare Hamilton who led the study, published the September issue of the American Journal of Respiratory and Critical Care Medicine.

The study found that the St. Joe’s treatment protocol resulted in remission in 66 per cent of patients – in other words, two-thirds of patients were able to discontinue steroidal treatment, stopped having disease flare-ups and developed complete symptom control. The study found that 62 per cent of those enrolled in the study also achieved improved lung function as a result of the treatment protocol.

Peggy Tyers is one of the patients referred from across Ontario. An avid squash player and triathlete, Tyers was diagnosed with asthma about 20 years ago and was quickly prescribed Prednisone, a corticosteroid commonly used to treat asthma attacks and flare ups.

After years of struggling with ineffective treatments and hospitalizations, Tyers was referred to Dr. Nair and was able to transition off Prednisone to non-steroidal biologic treatments with positive results.

Before starting the personalized treatment, Tyers sometimes had to leave meetings due to uncontrollable coughing. “I'm thankful it’s not happening anymore. It’s allowing me to work again, train again and travel again. And I never have to excuse myself, ever, because I’m having a problem breathing,” says Tyers.

After treatment with Dr. Nair, Tyers has been able to return to sport and fitness – winning her club’s squash title and finishing atop the Multisport Canada Triathlon Series women’s 60-69-year-old short-distance division in 2023.

“Once your breathing is back you start to feel good again. At my age I have no intention of cutting back. I can breathe and I can exercise. I feel sometimes like I’m healed from asthma, and nobody says that.”

“These exceptional outcomes highlight the potential of this research to provide life-changing results for so many people living with asthma,” said Dr. Nair, who is also the Frederick E. Hargreave Teva Innovation Chair in Airway Diseases and a professor of medicine at McMaster University. “This is an important step forward in the treatment of this disease that will allow people living with asthma to have a better quality of life.”

The breakthrough builds on decades of innovation at St. Joe’s, where the Firestone Institute of Respiratory Health (FIRH) has helped establish Hamilton a global leader in asthma care. The FIRH sputum lab, originally established by the late Dr. Frederick Hargreave, continues to be a cornerstone in respiratory innovation under Dr. Nair. The research team, in collaboration with Dr. John Brennan and the Biointerfaces Institute at McMaster University are now developing point of care tests to assess airway inflammation in sputum and nasal secretions.

“The key to this protocol’s success in achieving asthma remission is our ability to assess airway inflammation in sputum to guide therapy,” said Dr. Nair. “Our sputum lab offers a unique clinical service to patients on a scale that is not offered anywhere else in the world.”