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Approaches to reduce the risk of severe asthma in children with preschool wheeze
1National Heart and Lung Institute, Imperial College, Imperial Centre for Paediatrics and Child Health, Consultant Paediatric Chest Physician, Royal Brompton Hospital, London, UK.
Insights
Severe asthma lacks specific prevention strategies. Research explores early life factors and environmental influences to reduce risk and understand disease progression for better severe asthma management.
Area of Science:
- Pediatric Respiratory Medicine
- Environmental Health
- Public Health
Background:
- Asthma is a common respiratory condition, with mild-moderate symptoms treatable, but severe asthma remains life-threatening.
- Current treatments do not cure asthma or offer specific preventive strategies for severe disease.
- Understanding risk factors and disease progression is crucial for managing severe asthma.
Purpose of the Study:
- To review current knowledge on severe asthma prevention.
- To identify risk factors for pre-school wheeze and progression to school-age asthma.
- To explore factors contributing to different types of severe asthma.
Main Methods:
- Conducted a PubMed search for 'Severe asthma', 'Prevention', and 'Preschool wheeze' in children.
- Reviewed bibliographies of relevant studies and personal archives.
- Synthesized information on transgenerational, antenatal, and early life risk factors.
Main Results:
- No current pharmacological preventive strategies exist for severe asthma.
- Public health measures like reducing smoking and pollution can mitigate risk.
- Environmental modulation and understanding disease pathways may offer personalized strategies.
Conclusions:
- Effective prevention and treatment of severe asthma require a deeper understanding of disease progression.
- Biomarkers of risk and personalized environmental strategies are needed.
- New RSV prevention strategies' impact on asthma development is anticipated.
Introduction:
Asthma is a common, serious condition. We can treat the symptoms of mild-moderate disease, but severe asthma is life-threatening despite treatment. We cannot cure asthma and have no specific preventive strategies.
Areas Covered:
We performed a PubMed search using the terms 'Severe asthma' and 'Prevention' and 'Preschool wheeze' limited to children, humans and English language over the previous five years. We searched the bibliographies of relevant references and also our personal archives. We cover transgenerational, antenatal and early life factors which increase the risk of pre-school wheeze; the factors promoting or protecting the pre-school wheezer from developing school age asthma; and the factors leading to one of the three types of severe asthma defined by WHO (untreated, difficult to treat, and treatment resistant).
Expert Opinion:
Currently we have no pharmacological preventive strategies. Risk can be reduced by public health measures such as reduction in smoking and environmental pollution, and there are tantalizing hints from comparison of farming to other environments that exploring how environmental modulation may lead to more specific, personalized strategies. The effects of the new RSV prevention strategies are awaited. We need a better understanding of the pathways driving disease progression, and biomarkers of risk.
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