Meaning of Endotype-Phenotype in Pediatric Respiratory Pathology

Abstract

Respiratory processes that take place in childhood (preschool and adolescence) have a predominant frequency, especially rhinitis and asthma. Family predisposition and the environment define the characteristics of the endotype and the phenotype. Heritage, both of the genes related to bronchial hyperresponsiveness and those related to atopy (production of specific IgE against allergens and hypereosinophilia) are the fundamental basis of those processes that begin at preschool age and continue into adulthood if they do not receive early and etiological treatment. The physiological vagal hyperresponsiveness of the infant; the environment in which it develops, even from the prenatal phase (pregnant smoker); and viral infections are responsible for frequent bronchial processes in the early years that, sometimes, also extend into adolescence. In summary, the coordination of the endotype and the phenotype has led to the acknowledgement and acceptance of these three tracheobronchial processes: transient early wheezing, non-atopic wheezing, and atopic wheezing/asthma.

Asma: endotipos y fenotipos en la edad pediátrica

“…Es por ello que la definición de asma puede parecer compleja, sobre todo desde que el concepto de asma se ha modificado al tener en cuenta distintos factores, incluidos en lo que actualmente se denomina fenotipo y endotipo. 2 En cuanto a la genética, en 70 a 80 % de los pacientes se confirma el factor hereditario, a veces de ambos progenitores, de ahí que el inicio del asma tenga lugar incluso a partir de los dos años de edad. Son diversos los genes implicados (poligenia).…”

Asthma at Pediatric Age

“…The physiological vagal hyperresponsiveness of the infant; the environment in which it develops, even from the prenatal phase (pregnant smoker); and viral infections are responsible for frequent bronchial processes in the early years that, sometimes, also extend into adolescence. In summary, the coordination of the endotype and the phenotype has led to the acknowledgement and acceptance of these three tracheobronchial processes: transient early wheezing, non-atopic wheezing, and atopic wheezing/asthma" [9].…”

“…In asthma crisis there is a first phase due to constriction of the bronchial smooth muscle caused by the action of mediators that are released from mast cells; an intermediate phase that is maintained by constriction; and a later phase in which, by intervention of different cells, an inflammatory reaction is consolidated. The variable influence of these factors determines the differences at different ages at which the disease begins, as well as its evolution and the beginning in adulthood [9]. No doubt there are differences in early onset asthma and when it appears at a later stage, especially in adults (heterogeneity) in which the basic treatment is anti-inflammatory drugs, although in younger children, immunotherapy is essential, although not always mentioned [10,11].…”