Measuring inflammation in paediatric severe asthma: biomarkers in clinical practice

Abstract

Severe asthma in children is a highly heterogeneous disorder, encompassing different clinical characteristics (phenotypes) and immunopathological pathways (endotypes). Research is focusing on the identification of noninvasive biomarkers able to predict treatment response and assist in designing personalised therapies for severe asthma. Blood and sputum eosinophils, serum IgE and exhaled nitric oxide fraction mostly reflect type 2 airway inflammation in children. However, in the absence of available point-of-care biomarkers, the diagnosis of non-type 2 asthma is still reached by exclusion. In this review, we present the most recent evidence on biomarkers for severe asthma and discuss their implementation in clinical practice. We address the methods for guiding treatment decisions and patient identification, focusing on the paediatric age group.Key pointsSevere asthma in children is a highly heterogeneous disorder, encompassing different clinical characteristics (phenotypes) and immunopathological pathways (endotypes).Research is focusing on the identification of noninvasive biomarkers able to predict treatment response and assist in designing personalised therapies for severe asthma.Blood and sputum eosinophils, serum IgE and exhaled nitric oxide fraction mostly reflect type 2 airway inflammation in children. However, knowledge regarding non-type 2 inflammation and related biomarkers is still lacking.Educational aimsTo summarise the most recent evidence on biomarkers for severe asthma in children.To discuss their implementation in clinical practice through guiding patient identification and treatment decisions.

The Relationship Between Indicators of Nasal Respiratory Function and Spirometric Parameters in Children With Bronchial Asthma

“…Small airways may be the most vulnerable and sensitive to both the rhinobronchial reflex and cytokinemia, which are currently being considered as the main mechanisms of the pathological influence of AR/ARS on the course of BA (17). However, this assumption requires further study, which would include the identification of local and systemic biomarkers of inflammation and remodeling (6,(55)(56)(57). Nevertheless, it is worth noticing that our data are consistent with the results of studies by Iyer and Athavale (34), which showed that patients with AR are characterized by a high risk of latent damage to the small respiratory tract.…”

“…Currently, the goal of the treatment of this disease is to achieve control over the symptoms and risk factors for exacerbation of the disease (1,2). This is realized by the basic anti-inflammatory therapy since the most significant component of the pathogenesis is chronic inflammation localized in the respiratory tract and occurring in childhood mainly by the Th2-dependent mechanism (3)(4)(5)(6)(7). This approach to the BA treatment has shown significant success.…”

Asthma-Like Features and Anti-Asthmatic Drug Prescription in Children with Non-CF Bronchiectasis

“…Unfortunately, this approach is not always helpful in patients with bronchiectasis due to the confounding effect of co-administered treatments. Some authors have suggested that ICS should be reserved for children with evidence of type 2–mediated allergic airway inflammation, whose existence can be roughly determined or ruled out by the measurements of eosinophils and IgE with or without concurrent measurement of fractional exhaled nitric oxide (FeNO) [ 8 , 12 ]. However, asthma in children is a heterogeneous disorder and atopic inflammation is neither necessary nor sufficient for its development.…”

Efficacy and Safety of Pidotimod in Childhood Wheezing: A Pilot Study 

“…The shift of the immune balance to pro-/Th2/anti-Th1 direction, the increase both in the in ammatory response and Th2-related marker as well as in serum immunoglobulin (Ig)E levels and eosinophils in ltration are some of the mechanisms resulting in airway remodelling, wheezing, and asthma [1,10,11]. By acting on all these pathways [12][13][14][15], it has been hypothesized that PDT could prove to be a possible therapeutic approach in treating patients with wheezing.…”