Severe asthma in childhood: assessed in 10 year olds in a birth cohort study*

Lång, Anna; Carlsen, Kai Håkon; Haaland, Gry; Devulapalli, Chandra Sekhar; Munthe‐Kaas, Monica Cheng; Mowinckel, Petter

doi:10.1111/j.1398-9995.2008.01672.x

Cited by 150 publications

(130 citation statements)

References 31 publications

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“…Around 5% of children with asthma suffer from chronic symptoms and/or severe exacerbations despite treatment with a variety of drugs, including high doses of inhaled corticosteroids [1]. The term ''problematic severe asthma'' has been proposed to classify these children, of whom a subgroup suffers from severe, therapy-resistant asthma that probably requires novel therapeutic approaches [2].…”

Section: Introductionmentioning

confidence: 99%

Transcriptome analysis reveals upregulation of bitter taste receptors in severe asthmatics

et al. 2012

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The causes of severe childhood asthma are poorly understood. Our aim was to define global patterns of gene expression in children with severe therapy-resistant and controlled asthma.White blood cells were isolated and the global transcriptome profile was characterised using the Affymetrix Human Gene ST 1.0 chip in children with severe, therapy-resistant asthma (n517), controlled asthma (n519) and healthy controls (n518). Receptor expression was studied in separated leukocyte fractions from asthmatic adults (n512).Overall, 1378 genes were differentially expressed between children with severe/controlled asthma and controls. Three significantly enriched Kyoto Encyclopedia of Genes and Genomes pathways were represented: natural killer cell-mediated cytotoxicity (upregulated in controlled asthma); N-glycan biosynthesis (downregulated in severe asthma); and bitter taste transduction receptors (TAS2Rs) (upregulated in severe asthma). Quantitative PCR experiments confirmed upregulation of TAS2Rs in severe asthmatics. TAS2R expression was replicated in leukocytes from adult asthmatics, in which TAS2R agonists also inhibited LPS-induced cytokine release. Significant correlations between expression of TAS2Rs and clinical markers of asthma severity were found in both adults and children.In conclusion, specific gene expression patterns were observed in children with severe, therapy-resistant asthma. The increased expression of bronchodilatory TAS2Rs suggests a new target for the treatment of asthma. @ERSpublications Bitter taste receptors are up-regulated in children with severe asthma, suggesting a new therapeutic target

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Section: Introductionmentioning

confidence: 99%

Transcriptome analysis reveals upregulation of bitter taste receptors in severe asthmatics

et al. 2012

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“…Children with persistent symptoms and/or severe exacerbations despite high-dose treatment, especially inhaled corticosteroids (ICS), are diagnosed with PSA and may represent ∼5% of children with asthma and 0.5% in a general population-based cohort [22,23]. Clinically, it is essential to distinguish between children with PSA who present with truly severe therapy-resistant disease and those with difficult-to-treat asthma because of underlying modifiable factors such as ongoing allergen exposure, poor adherence to treatment, poor inhaler technique, smoking and comorbidities [22].…”

Section: Asthma Severitymentioning

confidence: 99%

Monitoring asthma in children

et al. 2015

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The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. To reach this goal in children with asthma, ongoing monitoring is essential. While all components of asthma, such as symptoms, lung function, bronchial hyperresponsiveness and inflammation, may exist in various combinations in different individuals, to date there is limited evidence on how to integrate these for optimal monitoring of children with asthma. The aims of this ERS Task Force were to describe the current practise and give an overview of the best available evidence on how to monitor children with asthma.22 clinical and research experts reviewed the literature. A modified Delphi method and four Task Force meetings were used to reach a consensus.This statement summarises the literature on monitoring children with asthma. Available tools for monitoring children with asthma, such as clinical tools, lung function, bronchial responsiveness and inflammatory markers, are described as are the ways in which they may be used in children with asthma. Management-related issues, comorbidities and environmental factors are summarised.Despite considerable interest in monitoring asthma in children, for many aspects of monitoring asthma in children there is a substantial lack of evidence. @ERSpublications ERS statement summarising and discussing the available literature on monitoring children with asthma

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“…The prevalence of severe asthma in childhood is largely unknown, since there is no general consensus regarding the definition, and severe childhood asthma has rarely been studied in a general population. One birth cohort study reported the prevalence of severe asthma in a general population of 10-yr-old children to be 0.5%, and 4.5 % among children with asthma [2], using a definition of poor asthma control despite prescription of 800 mg budesonide equivalent and at least a long-acting b-agonist and/or a leukotriene antagonist. However, there may be disparate underlying problems, including wrong diagnosis, poor adherence to therapy, adverse environmental conditions and comorbid conditions, such as gastro-oesophageal reflux and rhinosinusitis, as well as various forms of genuine therapy-resistant asthma.…”

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confidence: 99%

Problematic severe asthma in children, not one problem but many: a GA²LEN initiative

Hedlin

Bush²,

Carlsen³

et al. 2010

Eur Respir J

146

130

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Although most children with asthma are easy to treat with low doses of safe medications, many remain symptomatic despite every therapeutic effort. The nomenclature regarding this group is confusing, and studies are difficult to compare due to the proliferation of terms describing poorly defined clinical entities.In this review of severe asthma in children, the term problematic severe asthma is used to describe children with any combination of chronic symptoms, acute severe exacerbations and persistent airflow limitation despite the prescription of multiple therapies.The approach to problematic severe asthma may vary with the age of the child, but, in general, three steps need to be taken in order to separate difficult-to-treat from severe therapy-resistant asthma. First, confirmation that the problem is really due to asthma requires a complete diagnostic re-evaluation. Secondly, the paediatrician needs to systematically exclude comorbidity, as well as personal or family psychosocial disorders. The third step is to re-evaluate medication adherence, inhaler technique and the child's environment.There is a clear need for a common international approach, since there is currently no uniform agreement regarding how best to approach children with problematic severe asthma. An essential first step is proper attention to basic care.

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Severe asthma in childhood: assessed in 10 year olds in a birth cohort study*

Abstract: The prevalence of severe asthma was 0.5% in all 10-year olds, and 4.5% among current asthmatics. The severe asthma definition applied in this study is supported by results of clinical investigations.

Cited by 150 publications

References 31 publications

Transcriptome analysis reveals upregulation of bitter taste receptors in severe asthmatics

Transcriptome analysis reveals upregulation of bitter taste receptors in severe asthmatics

Monitoring asthma in children

Problematic severe asthma in children, not one problem but many: a GA²LEN initiative

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Severe asthma in childhood: assessed in 10 year olds in a birth cohort study*

Abstract: The prevalence of severe asthma was 0.5% in all 10-year olds, and 4.5% among current asthmatics. The severe asthma definition applied in this study is supported by results of clinical investigations.

Cited by 150 publications

References 31 publications

Transcriptome analysis reveals upregulation of bitter taste receptors in severe asthmatics

Transcriptome analysis reveals upregulation of bitter taste receptors in severe asthmatics

Monitoring asthma in children

Problematic severe asthma in children, not one problem but many: a GA2LEN initiative

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Product

Resources

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Problematic severe asthma in children, not one problem but many: a GA²LEN initiative