What is Asthma? And If So, How Many? Roughly quoting a popular book title, this could also be the definition of the research question of the ALL Age Asthma Cohort (ALLIANCE). In fact, physicians are aware of not only one type of asthma but a multitude of typical courses of the disease. Wheezing occurs in around one quarter of all children at least once during early childhood. A wheeze is a typical sound produced when breathing out, which is caused by narrowed airways. Even though it can be a sign of developing asthma at a later stage, only 3–5% of all children showing wheezes or other early symptoms suffer from asthma through to adulthood. In other cases, asthma is not developed until adulthood; then, however, it is often a severe form.

In order to predict the course and treatment of a disease, the DZL has brought the ALLIANCE cohort into being in the first funding period. The cohort now comprises more than 1,000 patients and healthy subjects aged between six months and 84 years. Following a comprehensive baseline examination, the asthmatic patients generally visit their study sites once a year. Healthy subjects, who serve as the control group, are only examined once.

As part of the examinations, the ALLIANCE study team measures lung function and airway inflammation of the subjects and checks to what extent they are sensitized to specific allergens. Biomaterial such as blood, nasal swabs, sputum, and exhaled air are collected and analyzed. Structured interviews based on questionnaires and data from the patients’ medical records document symptoms, disease progression, living conditions, and environmental factors. To directly compare the results in children and adults, the range of examinations is as similar as possible, and the processes are standardized.

A broad range of profound analytical methods of molecular biology (“deep phenotyping”) is used to elucidate the mechanisms of the different courses. Databases and biobanks of the ALLIANCE cohort now include hundreds of thousands of data points and patient samples. Researchers have already started to analyze the information. The study aims to identify biomarkers allowing us to detect the respective subtype of the disease as early as possible in the future. This way, therapies could also be adapted more individually to the requirements of each single patient.

ALLIANCE is a major clinical flagship project of the DZL. It involves the ARCN (Kiel/Lübeck/Borstel/Grosshansdorf), BREATH (Hannover), UGMLC (Giessen/Marburg/Bad Nauheim), and CPC-M (Munich) sites as well as the University Hospital of Cologne (external DZL partner). Regarding the pediatric part, there is a collaboration between the University Medical Center Schleswig-Holstein (Lübeck Campus), Hannover Medical School, the University Hospital of Giessen and Marburg, the Medical Center of the University of Munich, and the University Hospital of Cologne. Adult patients participate in the study at the LungenClinic Grosshansdorf and the Research Center Borstel.

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