New and future strategies to improve asthma control in children

Abstract

Symptomatic asthma in childhood has lifelong effects on lung function and disease severity, emphasizing the need for improved pediatric asthma control. Control of pediatric risk and impairment domains can be achieved through increased medication adherence or new therapeutic strategies. Developing electronic monitoring device technology with reminders might be a key noninvasive resource to address poor adherence in children and adolescents in a clinical setting. In patients who have persistently poor control despite optimal medication compliance, newly emerging pharmaceuticals, including inhaled therapies and biologics, might be key to their treatment. However, barriers exist to their development in the pediatric population, and insights must be drawn from adult studies, which has its own unique limitations. Biomarkers to direct the use of such potentially expensive therapies to those patients most likely to benefit are imperative. In this review the current literature regarding strategies to improve pediatric asthma control is addressed with the goal of exploring the potential and pitfalls of strategies that might be available in the near future.

Severe asthma in pediatrics: Outcomes of the implementation of a special health care protocol

“…15 In this study, access was warranted because both the drugs and metered dose inhalers were provided by the hospital at no charge so as to control a major cause of lack of treatment adherence, especially in a population with limited financial resources. 25 Another major factor associated with inadequate control was poor treatment adherence. Multiple reasons lie behind the lack of treatment adherence, including costs, complex treatment regimens, risk for side effects, and lack of parental monitoring, among others.…”

“…Multiple reasons lie behind the lack of treatment adherence, including costs, complex treatment regimens, risk for side effects, and lack of parental monitoring, among others. 25,26 Although there is no completely reliable method to verify adherence, the recommendation is to monitor and promote compliance with therapeutic indications using any method available at the time of consult. Successful adherence is defined as the administration of at least 80% of prescribed doses.…”

Examining causes of the urban (inner city) asthma epidemic: Implementing new management strategies

“…New medications are being developed, but there are financial limits to their application. 2 In managing asthma in the present times, we are focused on achieving asthma control through an effort to minimize asthma impairment and minimize risk for future asthma exacerbations, progression, and adverse effects to medications. 3,4 Some key observations have been made to help design strategies for future asthma management.…”

“…New medications have been developed that can improve pulmonary function, e.g., tiotropium, a long-acting anticholinergic, and new immunomodulators that improve pulmonary function and prevent asthma exacerbations. 2,[5][6][7] There is emerging concern regarding the potential for poorly controlled asthma to lead to chronic obstructive pulmonary disease, including the "asthma-chronic obstructive pulmonary disease overlap syndrome." 3 There is also growing emphasis to address the special needs of children, and, therefore, asthma management must be viewed across the ages, including strategies to prevent asthma.…”

“…On the horizon is the imminent approval of a set of new medications that are directed toward blocking key cytokines related to asthma. 2 Of interest, biomarkers have been identified that are linked to a high level of response to these medications. 2,8 -10 These observations brought attention to the use of biomarkers to predict response to asthma therapy.…”