In this genome-wide association study, we used a two-stage design to identify novel and significant genome-wide associations that confer susceptibility to moderate-to-severe asthma. We used a two-stage case-control design, with variants that showed suggestive association (p<1 × 10−6) in stage 1 tested in stage 2 and then meta-analysed across the two stages to maximise power.
For stage 1, we selected individuals of European ancestry with moderate-to-severe asthma who had been recruited from primary and secondary care settings across the UK as part of the Genetics of Asthma Severity and Phenotypes (GASP) initiative, with additional cases included from the U-BIOPRED asthma cohort26 (link) and the UK Biobank May, 2015,27 , 28 (link) genetic data release (appendix ). Genotyped data were assessed for quality control (details are in the appendix ). From GASP and U-BIOPRED, we identified patients with moderate-to-severe asthma by assessing clinical records that indicated that a patient was taking medication required for patients defined as having moderate-to-severe asthma according to the British Thoracic Society (BTS) 2014 guidelines.29 From the UK Biobank, cases of moderate-to-severe asthma were defined as having asthma diagnosed by a doctor, taking medication for asthma, no diagnosis of emphysema or chronic bronchitis by a doctor, and meeting the definition of moderate-to-severe asthma by BTS criteria. Therefore, cases were selected from individuals for whom medication information was available and who met BTS stage 3–5 criteria—ie, for stage 3, taking a long-acting β2 agonist plus inhaled corticosteroid; stage 4, taking higher dose inhaled corticosteroids than stage 3 patients, and addition of a fourth drug (eg, leukotriene receptor antagonist, theophylline); and stage 5, taking oral corticosteroid or omalizumab, or both. A complete list of medications used to identify patients with moderate-to-severe asthma is in the appendix . Controls for stage 1 were identified from the UK Biobank by taking the remaining subjects for whom genotyped data were available that passed quality control and excluding individuals with asthma, rhinitis, eczema, allergy, emphysema, or chronic bronchitis as diagnosed by a doctor, or if medication data were not available to assign to either the mild-moderate or moderate-severe asthma group. Additional controls for stage 1 were included from U-BIOPRED to ensure we had controls from each cohort. Patients in the U-BIOPRED cohort had not been screened for rhinitis or eczema, and so this information was not available for these controls at time of selection. For stage 2, both cases and controls were selected from the UK Biobank May, 2017, release using the same criteria to define cases and controls as in stage 1. There was no overlap in the patients included in stage 1 and stage 2. A case-control ratio of 1:5 was chosen for both stages to balance power and computational time. Cases and controls were matched across age and sex strata, and in stage 1 across genotyping arrays. All cohorts included individuals with self-reported European ancestry; individuals of non-European ancestry were excluded to reduce confounding of the study by ancestry.
UK Biobank has ethical approval from the UK National Health Service (NHS) National Research Ethics Service (Ref 11/NW/0382). All other studies were approved by an appropriate ethics committee. Informed consent was obtained from all participants.
For stage 1, we selected individuals of European ancestry with moderate-to-severe asthma who had been recruited from primary and secondary care settings across the UK as part of the Genetics of Asthma Severity and Phenotypes (GASP) initiative, with additional cases included from the U-BIOPRED asthma cohort26 (link) and the UK Biobank May, 2015,27 , 28 (link) genetic data release (
UK Biobank has ethical approval from the UK National Health Service (NHS) National Research Ethics Service (Ref 11/NW/0382). All other studies were approved by an appropriate ethics committee. Informed consent was obtained from all participants.
Full text: Click here