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Published on: May 12, 2023
Precision medicine in childhood asthma
Elise M Slob1,2, Anke-Hilse Maitland-Van der Zee1,2, Gerard H Koppelman3,4
1Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam.
Insights
Precision medicine offers a tailored approach to childhood asthma management. Current strategies use clinical factors and biomarkers, with genomics and pharmacogenomics showing future potential for personalized asthma care.
Area of Science:
- Pediatric Pulmonology
- Precision Medicine
- Asthma Research
Background:
- Childhood asthma is a complex, heterogeneous condition often leading to uncontrolled disease.
- An individualized treatment approach is crucial for improving asthma outcomes in children.
- Current treatment selection based solely on clinical characteristics remains challenging.
Purpose of the Study:
- To review the role of precision medicine in managing childhood asthma.
- To explore the application of clinical characteristics, biomarkers, genomics, and pharmacogenomics for personalized asthma care.
- To identify strategies for achieving asthma control and reducing risks with minimized side effects in children.
Main Methods:
- Review of current clinical characteristics and biomarkers (eosinophils, IgE, FeNO) for asthma management.
- Evaluation of novel monoclonal antibodies for severe, eosinophilic asthma.
- Analysis of pharmacogenetic studies identifying risks associated with inhaled corticosteroids.
Main Results:
- Monoclonal antibodies demonstrate efficacy in severe, eosinophilic asthma.
- Reduced lung function growth and early decline are common in persistent childhood asthma.
- Pharmacogenetic studies highlight risks of cortisol suppression with inhaled corticosteroids.
Conclusions:
- Clinical characteristics and basic biomarkers can guide a foundational precision medicine approach.
- Inhaled corticosteroids and biologics (omalizumab, mepolizumab) can be targeted using current precision methods.
- Further research into pharmacogenomics and breathomics is needed for advanced precision medicine applications in pediatric asthma.
Purpose Of Review:
Childhood asthma is a heterogeneous disease and many children have uncontrolled disease. Therefore an individualized approach is needed to improve asthma outcomes in children. Precision medicine using clinical characteristics, biomarkers, and the rapidly involving field of genomics and pharmacogenomics aims to achieve asthma control and reduce future risks with less side-effects in individual children with asthma.
Recent Findings:
It is not yet possible to select treatment options on clinical characteristics. Novel monoclonal antibodies are efficacious in patients with severe, eosinophilic asthma. Reduced lung function growth and early decline is a prevalent finding in children with persistent asthma. Pharmacogenetic studies have identified children at risk for cortisol suppression when using inhaled corticosteroids.
Summary:
Clinical characteristics and simple biomarkers like eosinophils, IgE, and the fraction of exhaled nitric oxide may be used in clinical practice for a basic precision medicine approach, deciding which children will have the best chance to respond to inhaled corticosteroids and to the biologicals omalizumab and mepolizumab.Further application of pharmacogenomics and breathomics needs additional studies before they can be applied as tools for precision medicine in individual children with asthma.
Related Concept Videos
Asthma-I: Introduction
Asthma-III: Symptoms and Complications
Classification of Asthma
Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
Asthma: Pathogenesis and Management
Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.
Asthma-II: Pathophysiology and Classification
Additionally, environmental and genetic factors play crucial roles in determining an individual's susceptibility to asthma and the severity of their condition.
Critical processes in asthma pathophysiology include:
Uncertainty in Measurement: Accuracy and Precision

