Researchers at Mass General Brigham and Karolinska Institutet have unveiled a groundbreaking method that can predict asthma exacerbations up to five years in advance with remarkable accuracy. This innovative study, published in Nature Communications, marks a significant leap forward in asthma management and prevention.
Asthma, a chronic respiratory condition affecting over 500 million individuals globally, poses a substantial burden on healthcare systems due to frequent exacerbations, commonly known as asthma attacks. These episodes contribute to increased morbidity and healthcare costs. Despite its prevalence, clinicians have struggled to identify reliable biomarkers that can predict which patients are at high risk for future attacks. Existing methods often fail to differentiate between patients with stable conditions and those prone to severe exacerbations.
A Metabolomic Approach to Asthma Prediction
The research team analyzed data from three extensive asthma cohorts, encompassing over 2,500 participants, supported by decades of electronic medical records. Utilizing a high-throughput technique known as metabolomics, they measured small molecules in the blood of individuals with asthma. This approach led to the discovery of a critical relationship between two classes of metabolites: sphingolipids and steroids, which are pivotal in asthma control.
Specifically, the study found that the ratio of sphingolipids to steroids could predict the risk of exacerbation over a five-year period. In some instances, this model could differentiate the time-to-first exacerbation between high- and low-risk groups by nearly a full year.
“One of the biggest challenges in treating asthma is that we currently have no effective way to tell which patient is going to have a severe attack in the near future,” said Jessica Lasky-Su, Associate Professor at the Channing Division of Network Medicine at Mass General Brigham and Harvard Medical School.
Implications for Prevention and Treatment
The findings offer a potential solution to a critical unmet need in asthma care. By measuring the balance between specific sphingolipids and steroids in the blood, clinicians can identify high-risk patients with 90 percent accuracy, enabling preemptive interventions.
“Our findings solve a critical unmet need. By measuring the balance between specific sphingolipids and steroids in the blood, we can identify high-risk patients with 90 percent accuracy, allowing clinicians to intervene before an attack occurs,” Lasky-Su continued.
Craig E. Wheelock, Principal Researcher at the Institute of Environmental Medicine at Karolinska Institutet, emphasized the robustness of this approach. “We found that the interaction between sphingolipids and steroids drives the risk profile. This ratio approach is not only biologically meaningful but also analytically robust, making it highly suitable for development into a practical cost-effective clinical test,” he stated.
Path Toward Precision Medicine
The researchers believe that these findings represent a significant step toward precision medicine for asthma. A clinical assay based on these ratios could be easily implemented in standard laboratories, aiding doctors in identifying patients who appear stable but have underlying metabolic imbalances.
However, the researchers caution that further validation is necessary before this test can be widely adopted in clinical practice. Additional studies, including direct clinical trials and cost-effectiveness analyses, are required to confirm these promising results.
“The ratio of circulatory levels of sphingolipids to steroids predicts asthma,” the study, authored by Yulu Chen, Pei Zhang, Mengna Huang, and others, was published in Nature Communications on January 19, 2026.
Collaboration and Future Directions
This study was a collaborative effort between Karolinska Institutet in Sweden and Mass General Brigham in the USA, supported by funding from the National Heart, Lung, and Blood Institute (NHLBI), the Swedish Research Council, and the Swedish Heart-Lung Foundation.
As the research community continues to explore the potential of this method, the implications for asthma patients worldwide are profound. The ability to predict and prevent severe asthma attacks could transform patient outcomes and reduce the burden on healthcare systems globally.
Conflicts of interest were disclosed, with researchers having applied for a patent for the method. Jessica Lasky-Su serves as a scientific advisor to Precion Inc. and TruDiagnostic Inc., while co-author Scott T. Weiss receives royalties from UpToDate and sits on the board of Histolix. Other authors reported no relevant competing interests.
