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Pediatric asthma: natural history, assessment, and treatment
Ronit Herzog1, Susanna Cunningham-Rundles
1Department of Pediatrics, Division of Allergy, Immunology and Pulmonology, Weill Medical College of Cornell University, New York, NY, USA. roh9033@med.cornell.edu
Insights
Infant wheezing is often temporary and not linked to later asthma. Persistent childhood wheezing, however, presents a significant challenge, highlighting the need to understand asthma phenotypes.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Respiratory Medicine
Background:
- Wheezing in infants and childhood asthma are distinct conditions with varied prognoses.
- Most infant wheezing is transient, with no increased risk of developing asthma.
- Persistent wheezing throughout childhood, marked by frequent exacerbations, poses a major clinical challenge.
Purpose of the Study:
- To review current understanding of childhood asthma phenotypes.
- To discuss the natural history and clinical course prediction of different asthma phenotypes.
- To summarize recent advancements in understanding and treating childhood asthma phenotypes.
Main Methods:
- Review of recent scientific literature on childhood asthma phenotypes.
- Analysis of studies on the natural history of asthma.
- Examination of current treatment guidelines and their impact.
Main Results:
- Childhood asthma is a heterogeneous condition, not synonymous with wheezing.
- Transient infant wheezing typically resolves without leading to persistent asthma.
- Persistent wheezing phenotypes in children remain a challenge despite treatment advances.
Conclusions:
- Understanding asthma phenotypes is crucial for accurate clinical course prediction.
- Current treatments and environmental modifications do not halt the progression of persistent childhood asthma.
- Further research into asthma phenotypes is needed for improved management strategies.
Abstract:
Wheezing and childhood asthma are not synonymous but rather comprise a heterogeneous group of conditions that have different outcomes over the course of childhood. Most infants who wheeze have a transient condition associated with diminished airway function at birth and have no increased risk of asthma later in life. However, children with persistent wheezing throughout childhood and frequent exacerbations represent the main challenge today. Studying the natural history of asthma is important for the understanding and accurate prediction of the clinical course of different phenotypes. To date, a great improvement has been achieved in reducing the frequency of asthma symptoms. However, neither decreased environmental exposure nor controller treatment, as recommended by the recent National Asthma Education And Prevention Program, can halt the progression of asthma in childhood or the development of persistent wheezing phenotype. This review focuses on the recent studies that led to the current understanding of asthma phenotypes in childhood and the recommended treatments.
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