A new study suggests that measuring the balance of certain blood molecules could predict who is likely to have an asthma attack years before it happens, potentially transforming how doctors prevent severe flare-ups.
For millions of people living with asthma, severe attacks can seem to come out of nowhere. A new international study suggests that may soon change.
Researchers from Mass General Brigham in the United States and Karolinska Institutet in Sweden have identified a blood-based method that can predict a person’s risk of future asthma attacks with high accuracy, in some cases up to five years in advance. The work, published in Nature Communications, points to a simple laboratory test that could help doctors step in before an attack happens.
Asthma is one of the most common chronic diseases worldwide, affecting more than 500 million people. Sudden worsening of symptoms, known as asthma exacerbations or attacks, are a leading cause of emergency visits, hospitalizations and health care costs. Yet doctors have had few reliable tools to tell which patients who seem stable today are actually at high risk for a serious flare-up.
This gap has long frustrated clinicians, according to co-corresponding author Jessica Lasky-Su, an associate professor in the Channing Division of Network Medicine at Mass General Brigham and Harvard Medical School.
“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,” she said in a news release.
To tackle that problem, the research team turned to metabolomics, a high-throughput technology that measures small molecules, or metabolites, circulating in the blood. These molecules reflect the body’s ongoing biology and can sometimes reveal disease risks that are not obvious from standard tests or symptoms.
The scientists analyzed data from three large asthma cohorts with a total of more than 2,500 participants, supported by decades of electronic medical records. They focused on two major classes of metabolites: sphingolipids, which are fat-like molecules involved in cell membranes and inflammation, and steroids, which include many of the drugs commonly used to treat asthma.
Individually, levels of these metabolites offered some clues about asthma control. But the key insight came when the team looked at the ratio between sphingolipids and steroids in the blood.
They found that this ratio could predict the risk of future asthma exacerbations over a five-year period. In some cases, the model could separate high-risk and low-risk groups so clearly that the average time to a first attack differed by nearly a full year.
“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% accuracy, allowing clinicians to intervene before an attack occurs,” Lasky-Su added.
That level of accuracy, if confirmed in further studies, could mark a major step toward precision medicine in asthma care. Instead of relying mainly on symptoms and lung function tests, doctors could use a blood test to uncover hidden vulnerability in patients who otherwise appear stable.
Co-corresponding author Craig E. Wheelock, a principal researcher in the Institute of Environmental Medicine at Karolinska Institutet, emphasized that it is not just the presence of these molecules, but how they interact, that matters most.
“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 said in the news release.
Because the test is based on measuring common types of blood metabolites and then calculating a ratio, the researchers say it could be implemented in standard clinical laboratories. That raises the possibility of adding a predictive asthma risk panel to routine care for people with the disease.
If such a test becomes available, it could change how asthma is managed. Patients flagged as high risk might receive closer monitoring, earlier adjustments to their medications, or targeted education and support to avoid triggers. Health systems could also use the information to better allocate resources and reduce costly emergency visits.
At the same time, the team cautions that more work is needed before the method can be used in everyday practice. The results must be validated in additional groups of patients, including through direct clinical trials. Researchers also need to study how best to act on the test results and whether doing so is cost-effective in real-world health care settings.
The researchers have applied for a patent on the method, and some team members report industry relationships, including advisory roles and royalties, which were disclosed as potential conflicts of interest.
For now, the work offers a hopeful glimpse of a future in which asthma attacks are not just treated after they strike, but anticipated and prevented. By reading the body’s own chemical signals, clinicians may one day be able to give patients years of warning — and a better chance to breathe easier.
Source: Mass General Brigham