Severe asthma in children: Evaluation and management

Abul, Mehtap Haktanır; Phipatanakul, Wanda

doi:10.1016/j.alit.2018.11.007

“…Children that do not seem to respond to standard treatment are referred to as severe or difficult to control asthma, and these children experience substantial morbidity from asthma symptoms. To classify a child into this phenotype, the first step is to exclude an incorrect diagnosis, poor adherence to treatment, or incorrect technique with an inhaler and spacer (46, 47). Supervised asthma therapy programs can be extremely useful in managing asthma symptoms and reducing healthcare utilization for children with poor medication adherence and inhaler and spacer technique (48, 49).…”

Section: Childhood Asthma Clinical Phenotypesmentioning

confidence: 99%

Asthma in Children and Adults—What Are the Differences and What Can They Tell us About Asthma?

Trivedi

¹

,

Denton

²

2019

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Asthma varies considerably across the life course. Childhood asthma is known for its overall high prevalence with a male predominance prior to puberty, common remission, and rare mortality. Adult asthma is known for its female predominance, uncommon remission, and unusual mortality. Both childhood and adult asthma have variable presentations, which are described herein. Childhood asthma severity is associated with duration of asthma symptoms, medication use, lung function, low socioeconomic status, racial/ethnic minorities, and a neutrophilic phenotype. Adult asthma severity is associated with increased IgE, elevated FeNO, eosinophilia, obesity, smoking, and low socioeconomic status. Adult onset disease is associated with more respiratory symptoms and asthma medication use despite higher prebronchodilator FEV1/FVC. There is less quiescent disease in adult onset asthma and it appears to be less stable than childhood-onset disease with more relapses and less remissions.

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“…Total IgE and allergen-specific IgE have been strongly associated with asthma in >80% of children [42]. In infants with viral-induced wheezing, a raised level of total IgE is considered a risk factor for asthma development [43], while high levels of allergen-specific IgE correlate well with asthma severity, mainly in children [42,44].…”

Section: Serum Igementioning

confidence: 99%

“…Total IgE and allergen-specific IgE have been strongly associated with asthma in >80% of children [42]. In infants with viral-induced wheezing, a raised level of total IgE is considered a risk factor for asthma development [43], while high levels of allergen-specific IgE correlate well with asthma severity, mainly in children [42,44]. Consequently, IgE measurements should be routinely performed in patients with asthma, and total IgE should be checked in every child diagnosed with severe asthma, for the consideration of add-on therapies such as omalizumab [42].…”

Section: Serum Igementioning

confidence: 99%

Measuring inflammation in paediatric severe asthma: biomarkers in clinical practice

Licari

¹

,

Manti

²

,

Leonardi

³

2020

Breathe

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Severe asthma in children is a highly heterogeneous disorder, encompassing different clinical characteristics (phenotypes) and immunopathological pathways (endotypes). Research is focusing on the identification of noninvasive biomarkers able to predict treatment response and assist in designing personalised therapies for severe asthma. Blood and sputum eosinophils, serum IgE and exhaled nitric oxide fraction mostly reflect type 2 airway inflammation in children. However, in the absence of available point-of-care biomarkers, the diagnosis of non-type 2 asthma is still reached by exclusion. In this review, we present the most recent evidence on biomarkers for severe asthma and discuss their implementation in clinical practice. We address the methods for guiding treatment decisions and patient identification, focusing on the paediatric age group.Key pointsSevere asthma in children is a highly heterogeneous disorder, encompassing different clinical characteristics (phenotypes) and immunopathological pathways (endotypes).Research is focusing on the identification of noninvasive biomarkers able to predict treatment response and assist in designing personalised therapies for severe asthma.Blood and sputum eosinophils, serum IgE and exhaled nitric oxide fraction mostly reflect type 2 airway inflammation in children. However, knowledge regarding non-type 2 inflammation and related biomarkers is still lacking.Educational aimsTo summarise the most recent evidence on biomarkers for severe asthma in children.To discuss their implementation in clinical practice through guiding patient identification and treatment decisions.

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“…Home visiting programs and assessment of the school environment are important features of the evaluation for children with concern for chronic exposure to asthma triggers (50)(51)(52). Children with persistent symptoms and exacerbations despite correct inhaler technique and good medical adherence to standard asthma therapy (steroid-resistant or therapy resistant asthma) should be referred to an asthma specialist to consider more potent biologic therapies such as anti-IgE, anti-IL-5, or anti-IL-13 therapies and further evaluation (47).…”

Section: Severe Difficult To Control Asthma Steroid-resistant Asthmamentioning

confidence: 99%

Asthma in Children and Adults – What are The Differences and What Can They Tell us About Asthma?

2020

Frontiers Research Topics

0

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Asthma varies considerably across the life course. Childhood asthma is known for its overall high prevalence with a male predominance prior to puberty, common remission, and rare mortality. Adult asthma is known for its female predominance, uncommon remission, and unusual mortality. Both childhood and adult asthma have variable presentations, which are described herein. Childhood asthma severity is associated with duration of asthma symptoms, medication use, lung function, low socioeconomic status, racial/ethnic minorities, and a neutrophilic phenotype. Adult asthma severity is associated with increased IgE, elevated FeNO, eosinophilia, obesity, smoking, and low socioeconomic status. Adult onset disease is associated with more respiratory symptoms and asthma medication use despite higher prebronchodilator FEV1/FVC. There is less quiescent disease in adult onset asthma and it appears to be less stable than childhood-onset disease with more relapses and less remissions.

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Severe asthma in children: Evaluation and management

Cited by 84 publications

References 97 publications

Asthma in Children and Adults—What Are the Differences and What Can They Tell us About Asthma?

Asthma in Children and Adults—What Are the Differences and What Can They Tell us About Asthma?

Measuring inflammation in paediatric severe asthma: biomarkers in clinical practice

Asthma in Children and Adults – What are The Differences and What Can They Tell us About Asthma?

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