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Steroid responsiveness and wheezing phenotypes

Francine M Ducharme1, Maja Krajinovic

  • 1Departments of Pediatrics and of Social Preventive Medicine, University of Montreal, Montreal, Quebec, Canada. francine.m.ducharme@umontreal.ca

Paediatric Respiratory Reviews
|July 5, 2011
PubMed

Insights

Corticosteroid resistance in childhood asthma, particularly in preschool viral-induced cases, necessitates higher doses. Identifying factors like age, triggers, and genetics is crucial for effective asthma management.

Area of Science:

  • Pediatric Pulmonology
  • Clinical Immunology
  • Pharmacogenetics

Background:

  • Corticosteroids are essential for managing childhood asthma, with oral forms for acute exacerbations and inhaled forms for prevention.
  • Variability in patient response to corticosteroids is a recognized clinical challenge.
  • Emerging evidence suggests corticosteroid resistance in preschool children with viral-induced asthma.

Purpose of the Study:

  • To explore the determinants of corticosteroid responsiveness in children with asthma.
  • To investigate potential factors contributing to corticosteroid resistance in specific pediatric asthma phenotypes.
  • To inform phenotype-specific therapeutic strategies for childhood asthma.

Main Methods:

  • Review of published trials examining corticosteroid response in pediatric asthma populations.
  • Analysis of potential influencing factors including age, asthma triggers, phenotype, environmental exposures (e.g., tobacco smoke), and genetic variations.
  • Exploration of mechanistic pathways, including gene-environment interactions and inflammatory profiles.

Main Results:

  • Heterogeneity in study populations and asthma phenotypes complicates the identification of response determinants.
  • Key potential determinants identified include patient age, specific asthma triggers, underlying asthma phenotype, exposure to tobacco smoke, and genetic factors.
  • A proposed mechanism for corticosteroid resistance involves gene-environment interactions leading to non-eosinophilic airway inflammation.

Conclusions:

  • Accurate asthma diagnosis and precise phenotyping are critical for selecting optimal, phenotype-specific therapies.
  • Understanding determinants of corticosteroid resistance can guide personalized treatment approaches in pediatric asthma.
  • Further research is needed to elucidate the complex interplay of factors influencing corticosteroid response in children.

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