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Published on: March 10, 2016
Management of asthma in children
Andrew Bush1,2,3
1Section of Pediatrics, Imperial College, London, UK - a.bush@imperial.ac.uk.
Insights
Personalized medicine for childhood asthma management requires objective diagnosis of variable airflow obstruction and inflammation. Reviewing comorbidities and environmental factors is crucial before escalating treatment or considering biologics.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Respiratory Medicine
Background:
- Recent Lancet commission highlights the need for personalized medicine in airway diseases.
- Asthma management in children requires a deconstructed approach considering airflow obstruction, inflammation, and infection.
- Accurate diagnosis is paramount before initiating asthma treatment.
Purpose of the Study:
- To outline a framework for personalized asthma management in children.
- To emphasize objective diagnostic criteria for childhood asthma.
- To guide treatment escalation and the use of advanced therapies like biologics.
Main Methods:
- Diagnosis based on objective evidence: bronchodilator-sensitive variable airflow obstruction, eosinophilic airway inflammation, and atopy.
- Initial treatment with inhaled corticosteroids and potentially long-acting beta-agonists.
- Comprehensive review of non-responders, including comorbidities, adherence, and environmental factors.
- Use of peripheral blood eosinophil counts as a surrogate for eosinophilic airway inflammation in preschool children.
Main Results:
- Most children with atopic asthma respond to standard inhaled corticosteroids.
- Escalation of treatment without reassessment yields limited evidence.
- Addressing comorbidities and environmental factors is essential for treatment success.
- Biological therapies may be indicated when other measures fail or are not feasible.
Conclusions:
- Personalized medicine is essential for effective childhood asthma management.
- Objective diagnostic criteria are key to accurate asthma diagnosis.
- A thorough review of contributing factors is necessary before escalating asthma therapy.
- Peripheral blood eosinophil counts can aid in diagnosing airway inflammation in young children.
Abstract:
This manuscript takes a challenging look at the management of asthma in childhood, in particular in the light of the recent Lancet commission. One of the central pillars of the Commission is the need to deliver personalized medicine for airway disease by deconstructing the airway into components of fixed and variable airflow obstruction, inflammation and infection. Before any treatment for asthma, a diagnostic workup is essential to exclude other conditions. A diagnosis of asthma needs to be based on objective evidence of bronchodilator sensitive variable airflow obstruction, eosinophilic airway inflammation and atopy. Most children with atopic asthma respond to low dose inhaled corticosteroids, sometimes requiring a long acting β-agonist. If the response is unsatisfactory, then, rather than escalate treatment, an approach for which there is little evidence, a full review of the child should be undertaken, including extrapulmonary comorbidities, adherence and adverse environmental influences. If these cannot or will not be addressed by the family, then further treatment including biologicals may be indicated. Asthma attacks are an important warning sign and should always be taken seriously, including a focused reassessment of all aspects of the management of the child. Finally, preschool children with wheeze can also be evaluated for eosinophilic airway inflammation using peripheral blood eosinophil count as a surrogate. It is essential that we start to deliver personalized medicine to children with airway disease.
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