Features of severe asthma in school-age children: Atopy and increased exhaled nitric oxide

Fitzpatrick, Anne M.; Gaston, Benjamin; Erzurum, Serpil C.; Teague, W. Gerald

doi:10.1016/j.jaci.2006.08.019

Cited by 178 publications

(169 citation statements)

References 35 publications

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“…It is important to confirm whether children with suspected asthma have variable airflow obstruction, but this is difficult in practice. Children with severe asthma often have normal lung function and no acute response to bronchodilators [135]. Children with a normal FEV1 both before and after a short-acting b-agonist may show a bronchodilator response in terms of forced expiratory flow at 25-75% of FVC (FEF25-75%) [136].…”

Section: Discussionmentioning

confidence: 99%

“…Biomarkers of atopy including elevated FeNO and serum IgE differentiate severe asthma in children but not adults with severe asthma, and support a prevalent Th2-driven pattern of airway inflammation [135]. However, a bronchoscopic study did not support a defining role for Th2 cytokines in children with severe asthma [61].…”

Section: Remarksmentioning

confidence: 92%

“…However, most large epidemiological studies are reporting that severe asthma is less associated with atopy/allergy than milder asthma, with a lower proportion of patients with positive skin testing [120,141]. The association between allergy and asthma severity is stronger in children [135,142]. In all patients, determining whether there is an association between specific IgE (as measured by skin prick testing or serum testing), on-going exposures and symptoms may help identify factors which contribute to asthma symptoms and exacerbations [143].…”

Section: Remarksmentioning

confidence: 99%

“…Early-life exposures and sensitisation to various allergens, especially to moulds, occur in children with severe asthma [135]. Evidence supporting a therapeutic response to environmental control in severe asthma is inconsistent and inadequately studied, but a decrease in environmental ozone levels following reduction in traffic congestion was associated with improvement in asthma outcomes in an urban environment [148].…”

Section: Remarksmentioning

confidence: 99%

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International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

et al. 2013

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Severe or therapy-resistant asthma is increasingly recognised as a major unmet need. A Task Force, supported by the European Respiratory Society and American Thoracic Society, reviewed the definition and provided recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults.A literature review was performed, followed by discussion by an expert committee according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach for development of specific clinical recommendations.When the diagnosis of asthma is confirmed and comorbidities addressed, severe asthma is defined as asthma that requires treatment with high dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming “uncontrolled” or that remains “uncontrolled” despite this therapy. Severe asthma is a heterogeneous condition consisting of phenotypes such as eosinophilic asthma. Specific recommendations on the use of sputum eosinophil count and exhaled nitric oxide to guide therapy, as well as treatment with anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty are provided.Coordinated research efforts for improved phenotyping will provide safe and effective biomarker-driven approaches to severe asthma therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Remarksmentioning

confidence: 92%

Section: Remarksmentioning

confidence: 99%

Section: Remarksmentioning

confidence: 99%

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International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

et al. 2013

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“…U-BIOPRED builds upon previous severe asthma cohort studies [26][27][28][29]. However, to our knowledge, this is the first study to recruit preschool wheeze cohorts on the basis of a consensus definition, which can be : predictive lung function equations from QUANJER et al [19] were used to generate z-scores.…”

Section: Discussionmentioning

confidence: 99%

The burden of severe asthma in childhood and adolescence: results from the paediatric U-BIOPRED cohorts

Fleming

Murray

Bansal³

et al. 2015

Eur Respir J

199

145

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Epigenetic regulation: The interface between prenatal and early‐life exposure and asthma susceptibility

Planell-Saguer

Lovinsky‐Desir

Miller

2013

Environ and Mol Mutagen

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Asthma is a complex disease with genetic and environmental influences and emerging evidence suggests that epigenetic regulation is also a major contributor. Here, we focus on the developing paradigm that epigenetic dysregulation in asthma and allergy may start as early as in utero following several environmental exposures. We summarize the pathways important to the allergic immune response that are epigenetically regulated, the key environmental exposures associated with epigenetic changes in asthma genes, and newly identified epigenetic bio-markers that have been linked to clinical asthma. We conclude with a brief discussion about the potential to apply newly developing technologies in epigenetics to the diagnosis and treatment of asthma and allergy. The inherent plasticity of epigenetic regulation following environmental exposures offers opportunities for prevention using environmental remediation, measuring novel biomarkers for early identification of those at risk, and applying advances in pharmaco-epigenetics to tailor medical therapies that maximize efficacy of treatment. ‘Precision Medicine’ in asthma and allergy is arriving. As the field advances this may involve an individually tailored approach to the prevention, early detection, and treatment of disease based on the knowledge of an individual’s epigenetic profile.

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Features of severe asthma in school-age children: Atopy and increased exhaled nitric oxide

Abstract: Background-Children with severe asthma have persistent symptoms despite treatment with inhaled corticosteroids (ICSs). The differentiating features of severe asthma in children are poorly defined.

Cited by 178 publications

References 35 publications

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

The burden of severe asthma in childhood and adolescence: results from the paediatric U-BIOPRED cohorts

Epigenetic regulation: The interface between prenatal and early‐life exposure and asthma susceptibility

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