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Update in paediatric asthma
1National Heart and Lung Institute, Imperial College, and Imperial Centre for Paediatrics and Child Health, Consultant Paediatric Chest Physician, Royal Brompton Hospital, London, UK.
Insights
New biologics show promise for severe paediatric asthma and preschool wheeze. Personalized, biomarker-driven treatments are advancing, focusing on airway remodeling and environmental factors for better asthma management.
Area of Science:
- Pediatric respiratory medicine
- Immunology
- Environmental health
Background:
- Paediatric asthma management is evolving with new biological therapies and a deeper understanding of preschool wheeze.
- Current research highlights advancements in treating severe asthma and early childhood respiratory symptoms.
Purpose of the Study:
- To review recent developments in paediatric asthma and preschool wheeze.
- To discuss the role of biologics, biomarkers, and environmental factors in respiratory health.
Main Methods:
- Review of current scientific literature on paediatric asthma and wheeze.
- Analysis of emerging treatment strategies, including biologics and personalized medicine approaches.
Main Results:
- Biologics like mepolizumab, dupilumab, and Tezepelumab show efficacy in children with Type 2 and Type 2 low asthma phenotypes.
- Airway remodeling and infection are key in preschool wheeze pathophysiology; treatment is shifting towards biomarker-driven therapies.
- Environmental factors, climate change, and inhaler emissions are critical considerations in pediatric respiratory care.
Conclusions:
- Personalized medicine and biomarker-guided treatments are crucial for all ages, requiring a move towards assessing cell function over counts.
- Airway structural changes, not just inflammation, may be the primary driver of preschool wheeze progression to school-age asthma.
Purpose Of Review:
The field of paediatric asthma is rapidly moving, with the advent of new biologicals for severe asthma and increased understanding of preschool wheeze amongst other developments and insights.
Recent Findings:
There is increasing evidence of efficacy in children for biologics directed against Type 2 inflammation (especially mepolizumab and dupilumab) as well encouraging evidence that Tezepelumab may be effective against Type 2 low phenotypes. The importance of airway remodelling and infection in the pathophysiology of preschool wheeze is increasingly appreciated. The treatment of preschool wheeze is moving from symptom-based to biomarker driven therapies. Other important areas are prediction of risk of asthma attacks, the SMART regime, the importance of climate change and reducing greenhouse gas emissions from inhalers while ensuring adequate therapy for young children, the association of early adverse environmental factors including childhood poverty and deprivation and the switch to race-neutral lung function equations.
Summary:
We are increasingly moving towards personalized medicine and the use of biomarkers to guide treatment of wheeze at all ages, but we need to move from counting cells to determining their functional status. Airway wall structural changes rather than inflammation may drive the progression of preschool wheeze to school age asthma.
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