Management of severe asthma in children: current insights and future directions

Area of Science:

• Pediatric Respiratory Medicine
• Immunology
• Precision Medicine

Background:

• Severe pediatric asthma affects a subset of children, causing significant morbidity and healthcare costs.
• Disease complexity stems from diverse phenotypes, endotypes, and inflammatory pathways, complicating diagnosis and management.
• Advances in precision medicine, including biologic therapies for Type 2 inflammation, offer new therapeutic avenues.

Purpose of the Study:

• To review current knowledge on severe pediatric asthma, covering pathophysiology, phenotypes, and treatments.
• To explore the role of biomarkers and endotypes in personalized therapy for pediatric asthma.
• To examine challenges in severe pediatric asthma management, including non-Type 2 inflammation and biologic therapy access.

Main Methods:

• Comprehensive literature search focused on biologic therapies, diagnostic innovations, and care models.
• Synthesis of current knowledge on severe pediatric asthma pathophysiology and clinical phenotypes.
• Critical examination of challenges and emerging care models in pediatric asthma.

Main Results:

• Biologic therapies targeting Type 2 inflammation represent a significant advancement in treating severe pediatric asthma.
• Biomarkers and endotypes are crucial for guiding personalized treatment strategies.
• Challenges persist, including defining treatment response, validating biomarkers, and overcoming cost barriers to biologic access.

Conclusions:

• Early initiation of biologic therapies in high-risk children and multidisciplinary care are vital for improving outcomes.
• Future research should focus on predictive algorithms, novel therapies, and equitable access.
• The paradigm may shift towards disease prevention, redefining pediatric asthma care.