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Severe Asthma in Children: Insights from the National Heart, Lung, and Blood Institute's Severe Asthma Research
Anne M Fitzpatrick1, William Gerald Teague
1Emory University Department of Pediatrics, Atlanta, Georgia.
Insights
Severe asthma in children, though debated, has a distinct subgroup with high morbidity. This subgroup differs from adults, often showing early signs of atopy and reversible airflow obstruction.
Area of Science:
- Pediatric Pulmonology
- Asthma Pathophysiology
- Clinical Immunology
Background:
- Severe asthma in children presents complex challenges, with persistent symptoms and inflammation despite high-dose corticosteroid treatment.
- Gaps persist in understanding the determinants and lifespan progression of severe pediatric asthma.
Purpose of the Study:
- To review recent findings on severe asthma in children from the National Heart, Lung, and Blood Institute's Severe Asthma Research Program (SARP).
- To emphasize age-specific insights and compare pediatric severe asthma with adult phenotypes.
Main Methods:
- Review of data from the Severe Asthma Research Program (SARP).
- Analysis of clinical features and age-specific findings in pediatric severe asthma.
Main Results:
- A subgroup of children with severe asthma exhibits extreme morbidity and identifiable clinical features early in life.
- Unlike adults, children with severe asthma often present with marked atopy and reversible airflow obstruction.
- The existence of a distinct severe asthma phenotype in children is supported by SARP findings.
Conclusions:
- Severe asthma in children is a distinct clinical entity with specific characteristics.
- Further research is needed to address remaining knowledge gaps in severe pediatric asthma.
Abstract:
Severe asthma in children is a complicated disorder characterized by ongoing symptoms and persistent airway inflammation despite treatment with high doses of inhaled and oral corticosteroids. Although knowledge of asthma and its associated mechanisms has increased substantially over the past decade, significant gaps remain about the determinants of severe asthma in children and the progression of the disorder across the lifespan. This review highlights recent insights into severe asthma in children derived from the National Heart, Lung, and Blood Institute's Severe Asthma Research Program (SARP), with an emphasis on age-specific findings and differences from severe asthma in adults. While the existence of a true severe asthma phenotype in children is subject to some debate, given the results of SARP and other investigators, we conclude that there is indeed a subgroup of children with severe asthma who have extreme morbidity and differentiating clinical features that are identifiable very early in life. However, unlike adults with severe asthma, children with severe asthma are more likely to fall in a more narrow cluster that is characterized by marked atopy and reversible airflow obstruction. While SARP has advanced knowledge of severe asthma in children, considerable gaps remain for which additional studies are needed.
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