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Defining pediatric asthma: phenotypes to endotypes and beyond
Laura A Conrad1, Michael D Cabana1, Deepa Rastogi2
1Department of Pediatrics, Albert Einstein College of Medicine, New York, NY, USA.
Insights
Asthma is a complex pediatric lung disease. Recent advances in pathobiology reveal distinct childhood asthma subtypes, moving beyond traditional definitions for personalized medicine.
Area of Science:
- Pediatric Pulmonology
- Immunology
- Genetics
Background:
- Asthma is the most common chronic pediatric lung disease, traditionally defined by airway inflammation and symptoms like cough and wheeze.
- Existing definitions of asthma have limitations due to the complex and heterogeneous nature of the disease.
- Recent research highlights the need for a more nuanced understanding of asthma classification based on underlying pathobiology.
Purpose of the Study:
- To summarize recent advances in asthma classification based on pathobiology.
- To contrast clinical and mechanistic features of adult and childhood asthma.
- To identify key biomarkers distinguishing childhood asthma subtypes and propose an approach for endotyping asthma.
Main Methods:
- Review of current literature on asthma pathobiology, phenotypes, and endotypes.
- Comparison of clinical and mechanistic features between adult and childhood asthma.
- Analysis of biomarkers associated with childhood asthma subtypes, including atopic and non-atopic endotypes.
Main Results:
- Evidence supports a distinct childhood asthma endotype beyond atopy.
- Biomarkers for non-atopic asthma require further research.
- A clinical approach integrating atopy measures, comorbidities, and disease control can help define childhood asthma burden.
Conclusions:
- Asthma is a complex, heterogeneous disease requiring nuanced definitions.
- Advances in understanding asthma pathobiology support the development of distinct endotypes.
- Further research into non-atopic asthma biomarkers, genetics, and epigenetics is crucial for precision medicine in pediatric asthma.
Abstract:
Asthma is the most common chronic pediatric lung disease that has traditionally been defined as a syndrome of airway inflammation characterized by clinical symptoms of cough and wheeze. Highlighting the complex and heterogeneous nature of asthma, this review summarizes recent advances in asthma classification that are based on pathobiology, and thereby directly addresses limitations of existent definitions of asthma. By reviewing and contrasting clinical and mechanistic features of adult and childhood asthma, the review summarizes key biomarkers that distinguish childhood asthma subtypes. While atopy and its severity are important features of childhood asthma, there is evidence to support the existence of a childhood asthma endotype distinct from the atopic endotype. Although biomarkers of non-atopic asthma are an area of future research, we summarize a clinical approach that includes existing measures of airway-specific and systemic measures of atopy, co-existing morbidities, and disease severity and control, in the definition of childhood asthma, to empower health care providers to better characterize asthma disease burden in children. Identification of biomarkers of non-atopic asthma and the contribution of genetics and epigenetics to pediatric asthma burden remains a research need, which can potentially allow delivery of precision medicine to pediatric asthma. IMPACT: This review highlights asthma as a complex and heterogeneous disease and discusses recent advances in the understanding of the pathobiology of asthma to demonstrate the need for a more nuanced definitions of asthma. We review current knowledge of asthma phenotypes and endotypes and put forth an approach to endotyping asthma that may be useful for defining asthma for clinical care as well as for future research studies in the realm of personalized medicine for asthma.
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