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Recent Advances in Long-Term Management of Asthma
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India. drkanaram@gmail.com.
Insights
Recent asthma management guidelines emphasize personalized therapy over short-acting beta-2 agonist (SABA) alone. Single maintenance and reliever therapy (MART) and tailored treatments based on asthma phenotype and endotype are recommended for improved childhood asthma control.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Pharmacotherapy
Background:
- Asthma is a prevalent chronic childhood respiratory disease causing significant morbidity.
- Current asthma management has shifted towards personalized therapeutic approaches.
- Traditional assessment of asthma severity relies on retrospective treatment needs.
Purpose of the Study:
- To summarize recent advancements in pediatric asthma management.
- To highlight evolving treatment strategies and recommendations.
- To provide an overview of personalized asthma care.
Main Methods:
- Review of current literature and clinical guidelines on asthma management.
- Analysis of recent changes in therapeutic recommendations, including SABA use and MART.
- Discussion of personalized treatment strategies based on phenotype and endotype.
Main Results:
- Emphasis on avoiding short-acting beta-2 agonist (SABA) monotherapy, even in mild asthma.
- Increasing recommendation for Single Maintenance and Reliever Therapy (MART).
- Personalized asthma management involves continuous assessment, treatment, and review cycles.
Conclusions:
- Asthma therapy should be individualized using phenotype and endotype data.
- Add-on therapies, including tiotropium and biologics, are available for severe pediatric asthma.
- Optimizing diagnosis, adherence, inhaler technique, and comorbidity management is crucial before initiating advanced therapies.
Abstract:
Asthma is one of the most common chronic diseases of childhood with significant morbidity. Management of asthma has evolved from inhaled corticosteroids to personalized therapy in recent years. This article summarizes the recent advances in the management of asthma. The severity of asthma is assessed retrospectively by the level of treatment required to control asthma symptoms.Recently, there has been an emphasis on not to use short-acting beta-2 agonist (SABA) alone, even for intermittent or mild asthma. Single maintenance and reliever therapy (MART) is increasingly being recommended. Asthma therapy should be personalized based on phenotype (clinical presentations) and endotypes (distinct mechanistic pathways) of asthma and by a continuous cycle of assessment of asthma control and risk assessment, treatment, and reviewing the response in children on treatment. Various add-on therapy like tiotropium and biological monoclonal antibodies have been approved for use in a subset of children with severe asthma. Before considering biologicals, it is vital to have a proper diagnosis, good compliance and inhaler technique, and treatment of comorbidities.
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