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Published on: November 4, 2010
Pathogenesis and prevention strategies of severe asthma exacerbations in children
1aDepartment of Respiratory Paediatrics, Royal Brompton Hospital bRespiratory Sciences Division, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Insights
Asthma exacerbations in children are often triggered by infections. Individualized management considering triggers, age, and clinical factors is crucial for better outcomes and preventing long-term lung damage.
Area of Science:
- Pediatric Pulmonology
- Immunology
- Microbiome Research
Background:
- Asthma exacerbations in children are frequently caused by respiratory infections with seasonal patterns.
- Current management often overlooks the specific infective or other precipitating factors.
- Understanding these triggers is vital for effective asthma control in pediatric populations.
Purpose of the Study:
- To review the key determinants of asthma exacerbations in children.
- To highlight the role of environmental triggers, airway microbiome, and innate immune responses.
- To emphasize the need for individualized management strategies.
Main Methods:
- Review of current literature on asthma exacerbations in children.
- Analysis of interactions between environmental factors, microbiome, and immune responses.
- Examination of specific molecular pathways and cytokines involved in exacerbations.
Main Results:
- Interactions between environmental triggers, airway microbiome, and innate immunity are central to exacerbations.
- Elevated cytokines (IL-33, IL-25) and interferon pathway abnormalities are linked to rhinovirus infections.
- Fungal allergens also induce IL-33, suggesting it as a therapeutic target. Bacterial and viral infections contribute equally, especially in preschoolers.
- Lung function decline is most severe in 6-11 year olds, with low FEV1 predicting COPD and mortality.
- Suboptimal education, therapy adherence, and lack of biomarkers hinder exacerbation prevention.
Conclusions:
- Asthma exacerbation management in children should be individualized, considering precipitants, predictors, age, and clinical phenotype.
- A shift from uniform approaches to personalized strategies is necessary.
- Further research into infection-related exacerbations, particularly in preschoolers, is needed.
Purpose Of Review:
Exacerbations of asthma in children are most frequently precipitated by respiratory infections with a seasonal pattern. However, management takes little account of the underlying infective or other precipitant abnormality.
Recent Findings:
Interactions between environmental triggers, the airway microbiome and innate immune responses are key determinants of exacerbations. Elevated innate cytokines interleukin (IL)-33 and IL-25, and abnormal molecular responses in the interferon pathway are associated with rhinoviral infections. Exacerbations caused by fungal allergens also induce IL-33, highlighting this as an attractive therapeutic target. An equal contribution of bacterial and viral infection during exacerbations, particularly in preschool children, has become increasingly apparent, but some organisms may be protective. Investigation of mechanisms underlying infection-related exacerbations especially in preschool children is needed.Progressive loss of lung function from exacerbations is most pronounced in children aged 6-11 years, and low FEV1 is now recognized as a key predictor for the development of chronic obstructive pulmonary disease and premature death. Although prevention of exacerbations is critical, suboptimal patient education, prescription and adherence to maintenance therapy, and a lack of predictive biomarkers, remain key unaddressed issues in children.
Summary:
Precipitants and predictors of exacerbations, together with the child's age and clinical phenotype, need to be used to achieve individualized management in preference to the current uniform approach for all.
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