‘We can’t diagnose asthma until &lt;insert arbitrary age&gt;’

Bush, Andy; Pavord, Ian

doi:10.1136/archdischild-2017-314180

Cited by 10 publications

(9 citation statements)

References 44 publications

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“…We often ask “at what age can we diagnose asthma?”, instead of asking “how do we diagnose eosinophilic airway inflammation at any age?” The INFANT study showed that two simple biomarkers—blood eosinophil count >300/μL and aeroallergen sensitization—could be used to target ICS in preschool wheeze . The group recruited 300 children, and, in a blinded three‐way cross‐over design, compared regular ICS, intermittent ICS, and regular montelukast treatment using a composite outcome of asthma control days and time to an exacerbation for which oral corticosteroids were prescribed.…”

Section: Biomarkers In the Early Diagnosis And Management Of Childhoomentioning

confidence: 99%

Addressing the risk domain in the long‐term management of pediatric asthma

Hamelmann

Bush

Szefler

2019

Pediatric Allergy Immunology

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There is growing concern regarding the long‐term outcomes of early and poorly controlled childhood asthma, either of which can potentially lead to the development of severe asthma in adults and irrecoverable loss of lung function leading to chronic obstructive pulmonary disease. These outcomes of inadequately controlled asthma should prompt a change in practice to better and/or earlier identify children at risk of adverse respiratory outcomes of asthma, to monitor disease progression, and to design intervention strategies that could either prevent or reverse asthma progression in children. The careful follow‐up of spirometry over time—in the form of lung function trajectories, the application of biomarkers to assist in the diagnosis of early asthma and medication selection for these patients, as well as methods to identify patients at risk of asthma attacks—can be used to develop individualized management strategies for children with asthma. It is now time for asthma specialists to communicate this information to patients, parents, and primary care physicians and to incorporate them into routine clinical assessments of children with asthma. In time, these concepts of risk management and prevention can be refined to provide a more comprehensive approach to asthma care so as to prevent adverse respiratory outcomes from poorly controlled childhood asthma.

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Section: Biomarkers In the Early Diagnosis And Management Of Childhoomentioning

confidence: 99%

Addressing the risk domain in the long‐term management of pediatric asthma

Hamelmann

Bush

Szefler

2019

Pediatric Allergy Immunology

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“…However, confusion arose from definitions conflating clinical symptoms, abnormal spirometry findings and assumed pathological descriptions, and meaningless questions such as "at what age can asthma be diagnosed?" [29] abounded, without thought as to what "asthma" actually meant.…”

Section: Other Wet Crackly Diseasesmentioning

confidence: 99%

Challenging the paradigm: moving from umbrella labels to treatable traits in airway disease

Bush

Pavord²

2021

Breathe

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Airway diseases were initially described by nonspecific patterns of symptoms, for example “dry and wheezy” and “wet and crackly”. The model airway disease is cystic fibrosis, which has progressed from nonspecific reactive treatments such as antibiotics for airway infection to molecular sub-endotype, proactive therapies with an unequivocal evidence base, early diagnosis, and biomarkers of treatment efficacy. Unfortunately, other airway diseases lag behind, not least because nonspecific umbrella labels such as “asthma” are considered to be diagnoses not mere descriptions.Pending the delineation of molecular sub-endotypes in other airway disease the concept of treatable traits, and consideration of airway disease in a wider context is preferable. A treatable trait is a characteristic amenable to therapy, with measurable benefits of treatment. This approach determines what pathology is actually present and treatable, rather than using umbrella labels. We determine if airway inflammation is present, and whether there is airway eosinophilia which will likely respond to inhaled corticosteroids; whether there is variable airflow obstruction due to bronchoconstriction which will respond to β2-agonists; and whether there is unsuspected underlying airway infection which should be treated with antibiotics unless there is an underlying endotype which can be addressed, as for example an immunodeficiency. The context of airway disease should also be extrapulmonary comorbidities, social and environmental factors, and a developmental perspective, particularly this last aspect if preventive strategies are being contemplated. This approach allows targeted treatment for maximal patient benefit, as well as preventing the discarding of therapies which are useful for appropriate subgroups of patients. Failure to appreciate this almost led to the discarding of valuable treatments such as prednisolone.Educational aimsTo use cystic fibrosis as a paradigm to show the benefits of the journey from nonspecific umbrella terms to specific endotypes and sub-endotypes, as a road map for other airway diseases to follow.Demonstrate that nonspecific labels to describe airway disease can and should be abandoned in favour of treatable traits to ensure diagnostic and therapeutic precision.Begin to learn to see airway disease in the context of extrapulmonary comorbidities, and social and environmental factors, as well as with a developmental perspective.

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“…The Commission contends that this is untrue. 10 The question really should be: how do we determine the presence or otherwise of the above treatable traits at any given age? Of course, this is most challenging in young children, but even then, physician diagnosis of wheeze and auscultatory response to a beta 2 -agonist is useful in determining bronchodilator responsiveness.…”

Section: Asthma Diagnosismentioning

confidence: 99%