Advances in the pathogenesis and personalised treatment of paediatric asthma

Abstract

The diversity of pathology of severe paediatric asthma demonstrates that the one-size-fits-all approach characterising many guidelines is inappropriate. The term “asthma” is best used to describe a clinical syndrome of wheeze, chest tightness, breathlessness, and sometimes cough, making no assumptions about underlying pathology. Before personalising treatment, it is essential to make the diagnosis correctly and optimise basic management. Clinicians must determine exactly what type of asthma each child has. We are moving from describing symptom patterns in preschool wheeze to describing multiple underlying phenotypes with implications for targeting treatment. Many new treatment options are available for school age asthma, including biological medicines targeting type 2 inflammation, but a paucity of options are available for non-type 2 disease. The traditional reliever treatment, shortacting β2 agonists, is being replaced by combination inhalers containing inhaled corticosteroids and fast, longacting β2 agonists to treat the underlying inflammation in even mild asthma and reduce the risk of asthma attacks. However, much decision making is still based on adult data extrapolated to children. Better inclusion of children in future research studies is essential, if children are to benefit from these new advances in asthma treatment.

Errors in Metered Dose Inhaler Use Amongst Pediatric Asthma Patients

“…Further, unlike DPIs, MDI's can be used even during exacerbations (acute asthma attacks) and are available in a wider range of bronchodilators. 4 Although technical aspects of inhaler device design have improved, correct inhalation technique plays a crucial role in effective asthma treatment. 4 Sub-optimal usage leads to insufficient medical delivery, poor clinical outcomes, increased asthma attacks, decreased quality of life and increased expenditure associated with the management of asthma.…”

“…4 Although technical aspects of inhaler device design have improved, correct inhalation technique plays a crucial role in effective asthma treatment. 4 Sub-optimal usage leads to insufficient medical delivery, poor clinical outcomes, increased asthma attacks, decreased quality of life and increased expenditure associated with the management of asthma. 3 Despite a steady increase in cases, there is a severe lack of research conducted in pediatric populations concerning their ability to use MDIs especially in an Indian setting.…”

“…Most studies conducted are qualitative in nature, classifying usage errors according to steps described in the manufacturer inserts. 4 Hence, there is a need for quantitative assessment of patient technique. Further, there is a lack of standardization amongst studies evaluating the efficacy of training programs for patients and healthcare professionals.…”