[Clinical pictures of bronchial asthma in children]

In the tip-to-date medical literature a topic for discussion is the variety of asthma clinical phenotypes. The knowledge of the various clinical asthma phenotypes is very important as regards the appropriate treatment approach, and the prognostic assessment of the patients with asthma. This allows a better understanding of pathophysiologic mechanisms, and of the phenotype-genotype correlation. A diagrammatic classification of clinical asthma phenotypes includes following criteria: onset age, inflammatory profile, severity pattern. According to the onset age, asthma clinical phenotypes specific for children and clinical phenotypes more frequent in adulthood are known. The main childhood asthma phenotypes are: transient infant wheezing, non atopic wheezing of the toddler and early school years, persistent IgE-mediated wheezing/asthma, late-onset childhood asthma. Other asthma phenotypes like aspirin-induced asthma, asthma related to chronic, persistent respiratory infection, are rare in childhood. It is reported a prevalence of 2-5% for the aspirin-induced asthma among pediatric patients. According to the airway inflammation pattern there are two phenotypes to distinguish: eosinophilic and non-eosinophilic asthma. The majority of the patients have an eosinophilic inflammation, but there is also a meaningful percentage of patients with noneosinophilic asthma which is neutrophil mediated. Clinical phenotypes of severe asthma are rarely described in childhood: near-fatal asthma, asthma with fixed airflow obstruction, and corticosteroid-resistant asthma.