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Clinical phenotypes in asthma during childhood

J Just1,2, M Bourgoin-Heck1,2, F Amat1,2

  • 1Service d'Allergologie, Centre de l'Asthme et des Allergies, AP-HP, Groupe hospitalier Trousseau-La Roche Guyon, Paris, France.

Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology
|April 20, 2017
PubMed

Insights

Asthma presents diverse phenotypes, with early-onset allergic asthma indicating a poor prognosis. Future research aims to classify asthma by endotypes and biomarkers for targeted treatments.

Area of Science:

  • Pulmonology
  • Allergy and Immunology
  • Pediatric Respiratory Medicine

Background:

  • Asthma is a complex respiratory disease with varied phenotypes based on onset, triggers, comorbidities, and inflammation.
  • Early-onset asthma with multiple allergies and comorbidities is associated with persistent and severe disease in childhood.
  • Phenotypic variation can occur over time due to evolving etiological triggers.

Purpose of the Study:

  • To explore the heterogeneity of asthma phenotypes and their prognostic implications.
  • To highlight the role of inflammatory cells and endotypes in asthma severity and prognosis.
  • To discuss the potential link between severe asthma phenotypes and the development of chronic obstructive pulmonary disease (COPD).

Main Methods:

  • Review of current understanding of asthma heterogeneity and phenotypes.
  • Analysis of inflammatory pathways (eosinophilic and neutrophilic) and associated biomarkers.
  • Discussion of prognostic factors, including age of onset, comorbidities, and specific inflammatory profiles.

Main Results:

  • Asthma phenotypes are diverse, impacting disease severity and progression.
  • Early-onset allergic asthma with multiple sensitizations predicts a poorer prognosis.
  • Severe asthma is linked to distinct inflammatory endotypes: neutrophilic (often in younger children/teenagers, associated with obesity/microbiota) and eosinophilic (often in teenagers, linked to atopy).

Conclusions:

  • Classifying asthma by endotypes and biomarkers is crucial for predicting prognosis and developing targeted therapies.
  • Neutrophil and eosinophil-driven inflammation represent key endotypes in severe asthma.
  • Severe asthma phenotypes may contribute to the development of adult COPD.

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