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Severe pediatric asthma endotypes: current limits and future perspectives
Beatrice Andrenacci1, Maria De Filippo1,2, Martina Votto1,2
1Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
Insights
Pediatric severe therapy-resistant asthma (STRA) is complex and poorly understood. Research needs multicentric studies to differentiate endotypes and guide tailored treatments for better lifelong lung function.
Area of Science:
- Pulmonology
- Pediatric Allergy and Immunology
- Asthma Research
Background:
- Pediatric severe therapy-resistant asthma (STRA) is a rare, heterogeneous, and resource-intensive condition distinct from adult asthma.
- The underlying pathogenesis of pediatric STRA remains incompletely understood, necessitating further investigation.
Purpose of the Study:
- To review recent advancements in defining pediatric STRA endotypes over the past decade.
- To discuss current research limitations and propose future research directions for pediatric STRA.
Main Methods:
- Systematic review of English-written studies published in the last 10 years.
- Focus on lung-specific techniques like bronchoalveolar lavage and endobronchial biopsy to define endotypes.
Main Results:
- Identified heterogeneity within pediatric STRA, highlighting the inadequacy of a 'one-size-fits-all' approach.
- Current research is limited by the lack of multicentric, longitudinal pediatric studies.
Conclusions:
- Future research must focus on multicentric, longitudinal studies to differentiate prepubertal and pubertal STRA endotypes.
- Early interventions targeting airway remodeling and precise characterization of inflammation are crucial for developing effective, tailored therapies and improving long-term lung function in pediatric STRA patients.
Introduction:
Although rare, pediatric severe therapy-resistant asthma (STRA) is a highly heterogeneous, resource-demanding disease that differs significantly from severe adult asthma and whose pathogenesis is still poorly understood.
Areas Covered:
This review summarizes the latest 10 years of English-written studies defining pediatric STRA endotypes using lung-specific techniques such as bronchoalveolar lavage and endobronchial biopsy. Results of the studies and limits on the field are discussed, together with some future perspectives.
Expert Opinion:
Over the years, it has become increasingly clear that 'one size does not fit all" in asthma. However, "Does an extremely tailored size fit more than one?'. Only using multicentric, longitudinal pediatric studies, will we be able to answer. Three issues could be particularly critical for future research. First, to provide, if existing, a distinction between prepuberal STRA and puberal STRA endotypes to understand the transition from pediatric to adult STRA and to design effective, tailored therapies in adolescents, usually suffering from poorer asthma control. Second, design early treatments for pediatric airway remodeling to preserve lifelong good lung function. Finally, to better characterize inflammation before and during biological therapies, to provide clues on whether to stop or change treatments.
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