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Presentation of new GINA guidelines for paediatrics. The Global Initiative on Asthma
1Munich University Children's Hospital, Germany.
Insights
Asthma management guidelines for children exist, but infant asthma research is limited. Identifying distinct infant wheezing phenotypes is crucial for effective, early anti-inflammatory treatment and preventing lung function decline.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
Background:
- Global Initiative on Asthma (GINA) provides step-wise management guidelines for childhood asthma, differentiating preventive and quick-relief therapies.
- Limited research exists on infant asthma management, complicated by diverse wheezing phenotypes with distinct pathogenic mechanisms.
Framework:
- Asthma is categorized by severity: intermittent, mild persistent, moderate persistent, and severe persistent.
- Wheezing phenotypes include transient wheezers (cease by age 3, no atopy link) and persistent wheezers (onset in infancy, high atopy risk, declining lung function).
Implementation:
- Current GINA guidelines offer a clear framework but lack specific infant-focused studies.
- Research is needed to determine if early anti-inflammatory therapy can prevent lung function decrements in persistent wheezers.
Implications:
- Identifying distinct infant wheezing phenotypes is essential for targeted therapeutic strategies.
- Development of disease markers, such as eosinophil counts, may aid in differentiating phenotypes and guiding treatment.
- Early intervention in persistent wheezers could potentially mitigate long-term lung function impairment.
Abstract:
The Global Initiative on Asthma (GINA) has provided guidelines for the management of children with asthma. For a step-wise approach to therapy, asthma is divided into four categories based on severity of symptoms: intermittent, mild persistent, moderate persistent, and severe persistent asthma. Long-term preventive therapy is distinguished from quick relief therapy in each group. Although these guidelines are clear and simple there have been few studies on asthma therapy for infants. Moreover, the existence of different wheezing phenotypes with varying pathogenic mechanisms hampers the interpretation of these studies. Transient wheezers have stopped wheezing by the age of 3 years and there is no relationship to atopy or a family history of asthma. In contrast, persistent wheezers continue to wheeze from the first year of life throughout school-age and have a high risk of atopy. Although they have normal lung function at birth, persistent wheezers develop significant decrements in lung function by the age of 6 years. Whether these impairments are amenable to prevention by early initiation of anti-inflammatory therapy remains to be seen. At present, there are no disease markers to identify the different wheezing phenotypes in infancy, although eosinophil counts and measurements of eosinophil cationic protein in serum may prove to be helpful in distinguishing these conditions.