Childhood asthma: pathogenesis and phenotypes

Abstract

In the pathogenesis of asthma in children there is a pivotal role for a type 2 inflammatory response to early life exposures or events. Interactions between infections, atopy, genetic susceptibility, and environmental exposures (such as farmyard environment, air pollution, tobacco smoke exposure) influence the development of wheezing illness and the risk for progression to asthma. The immune system, lung function and the microbiome in gut and airways develop in parallel and dysbiosis of the microbiome may be a critical factor in asthma development. Increased infant weight gain and preterm birth are other risk factors for development of asthma and reduced lung function. The complex interplay between these factors explains the heterogeneity of asthma in children. Subgroups of patients can be identified as phenotypes based on clinical parameters, or endotypes, based on a specific pathophysiological mechanism. Paediatric asthma phenotypes and endotypes may ultimately help to improve diagnosis of asthma, prediction of asthma development and treatment of individual children, based on clinical, temporal, developmental or inflammatory characteristics. Unbiased, data-driven clustering, using a multidimensional or systems biology approach may be needed to better define phenotypes. The present knowledge on inflammatory phenotypes of childhood asthma has now been successfully applied in the treatment with biologicals of children with severe therapy resistant asthma, and it is to be expected that more personalized treatment options may become available.

Associations between Paternal Co-residence and Child Health among African American Children

“…Past research has suggested several reasons to explain the association between paternal co-residence and decreased risk of asthma. Some have suggested that environmental factors such as home allergens, community air pollution and air quality, and viral respiratory infections may be the main drivers of childhood asthma (Buteau et al, 2019; Pijnenburg et al, 2021). Paternal co-residence may improve child health through various mechanisms, including fewer living spaces and improved housing conditions, lowering the risk for additional exposures to environmental asthma triggers (Allport et al, 2018).…”

Factors associated with asthma exacerbations in schoolchildren: an experience in clinical practice

“…In childhood, the acute upper airway infections, mainly of viral origin, represent the leading cause of asthma attacks requiring medical aid (10). Viral infections implicate bronchial inflammation that triggers airway hyperresponsiveness and further narrows the bronchial lumen (11). These phenomena depend on the overexpression of type-2 immune response usually involved in pediatric asthma.…”

What's new in pediatric asthma and rhinitis phenotypes and endotypes?

“…The former is attributed to changeable factors like inadequate adherence, while the latter persists despite addressing these factors. STRA, more common in males with atopy, exhibits eosinophilic airway inflammation and associated airway obstruction [7,8]. Severe asthma with fungal sensitization (SAFS), a sub-phenotype of STRA, is clinically more severe and resistant to steroids, often requiring maintenance oral steroid therapy [9].…”