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Childhood asthma--advances in pathogenesis
N Somu1, N C Gowrishankar, L Subramaniam
1Department of Pediatric Respiratory Diseases, Institute of Child Health & Hospital for Children, Madras.
Insights
Asthma may stem from a specific infection in genetically susceptible individuals, leading to bronchial hyperactivity. This hypothesis explains recurrent asthma symptoms like wheezing and cough.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Infectious Disease Epidemiology
Background:
- Global asthma morbidity and mortality rates are increasing, necessitating a deeper understanding of its origins.
- Existing research has illuminated various facets of asthma's etiopathogenesis.
- Extensive clinical experience with pediatric asthma patients provides a foundation for new hypotheses.
Purpose of the Study:
- To propose a novel hypothesis on the etiopathogenesis of asthma.
- To elucidate the role of infective agents and genetic predisposition in asthma development.
- To categorize wheezing illnesses in children that manifest as asthma.
Main Methods:
- Longitudinal clinical observation of approximately 300,000 asthmatic children over 25 years.
- Studies conducted at the Asthma clinic of ICH & HC, Madras.
- Development of a hypothesis based on clinical experience and existing literature.
Main Results:
- A hypothesis proposing asthma as a disease initiated by a specific infective agent in a genetically predisposed individual.
- Identification of altered cellular response leading to bronchial hyperreactivity.
- Correlation of bronchial hyperreactivity with clinical manifestations (cough, dyspnea, wheeze) upon exposure to aggravating factors.
- Discussion on the classification of wheezing illnesses presenting as asthma.
Conclusions:
- Asthma etiopathogenesis may involve a specific infection interacting with genetic susceptibility.
- This interaction leads to bronchial hyperresponsiveness, manifesting as asthma symptoms.
- Further research is warranted to validate the proposed infective agent hypothesis and refine asthma classification.
Abstract:
Increase in morbidity and mortality of asthmatics in the world is a cause of concern. Many researchers have described various aspects of etiopathogenesis which has thrown light on the better understanding of asthma. Our experience with nearly 3 lakhs of asthmatic children, over a period of twenty-five years and our studies in Asthma clinic of ICH & HC, Madras generated new ideas to propose a hypothesis on etiopathogenesis of asthma. "Asthma is a disease caused by a specific infective agent in a genetically predisposed individual resulting in altered cellular response initially leading to hyperactive bronchial tree which on exposure to various aggravating factors manifest clinically as recurrent cough, dyspnoea and wheeze". Category of wheezers who manifest asthma is also discussed.