Childhood factors that predict persistence of severe asthma from late adolescence through early adulthood

Growing, Growing, Gone: The Double Whammy of Early Deprivation and Impaired Evolution of Lung Function

“…Hence, the present study ( 2 ) turns the spotlight firmly onto lung growth as the root of deteriorating asthma and, yet again, the importance of early life deprivation. Although type 2 inflammation is very important in the pathophysiology of childhood asthma, and antiinflammatory treatment with ICS has revolutionized asthma outcomes, there was no association between biomarkers and associations of type 2 inflammation (peripheral blood eosinophil count, total IgE, sensitization, and exposure to aeroallergens) and outcome (their Figure 3).…”

“…In this issue of the Journal , Izadi and colleagues (pp. 776–787 ) have studied the CAMP trial participants in adolescence and young adulthood to determine the factors that predict evolution from relatively mild to severe asthma ( 2 ). The huge strengths of the study include the longitudinal, prospective design and an amazing 65% retention rate of their subjects.…”

“…Therefore, although ICS treatment is clearly the cornerstone therapy for reducing asthma attacks and controlling symptoms, it seems highly unlikely that treating inflammation is going to impact lung growth, and new approaches are needed. Although of course biologicals such as omalizumab and mepolizumab were suggested by Izadi and colleagues ( 2 ) as therapies that might modulate remodeling, the studies of inflammation and remodeling in early life do not suggest that inflammation is the root cause of change in airway caliber but rather that inflammation and remodeling are parallel processes ( 11 ). Furthermore, the logistics of getting agreement from families and funders for the preventive treatment of a child with perhaps only mild asthma with long-term injections of an expensive biologic are not trivial.…”

Predicting the course of asthma from childhood until early adulthood

“…However, as puberty progresses, asthma prevalence and severity increase in the female population while the opposite is seen in males [4,20]. Other risk factors for asthma persistence include allergic sensitization during childhood, more severe asthma and a more obstructive lung function between the age of 5 and 12 [21,22]. Allergic sensitization plays an important role in the course of asthma, as suggested by investigations in the EGEA cohort, that reported that polysensitization was associated with asthma, allergic comorbidity and lower lung function outcomes [23].…”

Asthma and Chronic Obstructive Pulmonary Disease: Just Old Friends or Relatives?

“…By further analyzing the Childhood Asthma Management Program, an initial drug trial turned to a well-defined, long-term, ongoing cohort study. Izadi and colleagues unravel some knowledge gaps in the nature of childhood factors associated with persistent severe asthma in adult life ( 3 ). These authors reported that only two determinants among more than 22 explored, namely, reduced lung growth in childhood and maternal smoking during pregnancy, were predictors of persistent severe asthma later in life.…”