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Unmet needs in the treatment of asthmatic children and adolescents: 1
1School of Medicine, Allergy & Inflammation Sciences Division, Southampton General Hospital, UK.
Insights
Current pediatric asthma guidelines need patient input and better subgroup definition. Future research should focus on early life origins and predictive factors for asthma to enable prevention.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
Background:
- Paediatric asthma guidelines offer a uniform approach but lack patient input and sufficient subgroup definition.
- This has led to overtreatment of some infants with wheezing and undertreatment of severe asthma.
- Asthma is a heterogeneous condition with early inflammation and remodeling, even before symptoms appear.
Purpose of the Study:
- To highlight limitations in current paediatric asthma guidelines.
- To emphasize the need for patient-centered care and better disease phenotyping.
- To explore future research directions for asthma prevention and targeted therapies.
Main Methods:
- Review of existing paediatric asthma guidelines.
- Analysis of current treatment approaches and their limitations.
- Discussion of emerging evidence on early asthma development and potential interventions.
Main Results:
- Recent guideline revisions classify asthma into infrequent episodic, frequent episodic, and chronic persistent types with defined treatments.
- Current treatments manage symptoms but do not alter the natural history of asthma.
- Early life factors predicting asthma development and the drivers of inflammation/remodeling remain key research areas.
Conclusions:
- Paediatric asthma guidelines require revision to incorporate patient preferences and better define patient subgroups.
- Understanding early life origins and predictive factors is crucial for developing preventative strategies.
- Targeting inflammation and remodeling in early life may offer new therapeutic avenues and prevention methods.
Abstract:
The paediatric asthma guidelines have been successful in providing a uniform approach to the management of asthma for the medical profession as a whole. Unfortunately, the guidelines were generated without input from patients themselves and consequently do not consider issues that are important to patients such as a preference for oral treatment. Asthma is a heterogeneous group of conditions and the guidelines do not sufficiently define subgroups of patients and their particular needs. As a result, there has been a tendency to assume that all wheezing in infancy is asthma and this had led to gross overtreatment in certain patients. In contrast, severe asthma often remains underdiagnosed and undertreated. The most recent revision of the guidelines has classified asthma in terms of the patterns of disease; infrequent episodic, frequent episodic and chronic persistent. The treatment required for each of these groups is clearly defined and there is no need for stepwise therapy. Other changes to the guidelines will occur and are needed. None of the treatments available can modify the natural history of asthma; they control the symptoms not the disease process. Evidence from bronchial biopsies suggests that both inflammation and remodelling occur early, even before the first symptoms appear. We need to look for the factors in early life that predict which children will go on to develop asthma and intervene at that stage. Anti-histamines and leukotriene receptor antagonists may be interesting as interventions in that respect. Two important unresolved issues are to understand what drives remodelling and inflammation, and to look at early life origins of asthma. These approaches may provide effective therapeutic targets and, ultimately, a means of prevention.