Pediatric problematic severe asthma: Recent advances in management

Abstract

Asthma is a chronic airways disease with both immediate and longterm health implications, including death and permanent disability.The burden of asthma, both clinical and financial, is considerable, with more than 100,000 annual hospital admissions in the United Kingdom and an overall cost of more than £1 billion per annum to the NHS. 1 A significant proportion of these costs can be attributed to children with asthma, in particular, those with severe asthma, who utilize up to 50% of healthcare resources for asthma. In addition, pediatric severe asthma has long-term health consequences into adulthood, with longitudinal studies suggesting it predisposes for adult chronic obstructive pulmonary disease. 2 If management of pediatric severe asthma can be optimized, then some of these health burdens may be mitigated.Problematic severe asthma (PSA) is an all-encompassing definition used for children aged 6-16 years with a confirmed diagnosis of asthma who have persistent symptoms despite maximal conventional therapy. 3 In order to optimize the management of children with PSA, a thorough assessment must be undertaken by the multidisciplinary team (MDT)

Proline metabolism reprogramming of trained macrophages induced by early respiratory infection combined with allergen sensitization contributes to development of allergic asthma in childhood of mice

“…Non-Th2 asthma (i.e., neutrophilic asthma), by contrast, is characterized by high levels of IFN-γ and IL-17, along with airway neutrophilic infiltrate ( 36 ). Recent studies have increasingly shown that severe childhood asthma is associated with neutrophils ( 37 , 38 ). In this study, the asthma mice showed increased Th1- and Th17-type responses and neutrophils in lungs, and no detectable IgE in sera, which is similar to the no-Th2 asthma.…”

From phenotype to biological treatment of severe asthma

“…Rezultati pretraga induciranog sputuma, BAL-a i endobronhalne biopsije pokazuju najčešće eozinofi lnu, a u neke djece paucigranulocitnu (nema porasta broja ni eozinofi la, ni neutrofi la) upalu uz patološke naznake remodelacije bronha. Međutim, nalaz stanica u induciranom sputumu, BAL-u i u sluznici bronha nije ujednačen u svih bolesnika (11). S obzirom na dominaciju eozinofi la u bioptatu bronha, očekivani nalaz citokina upale tipa 2 -IL-4, IL-5 i IL-13 nije potvrđen u sluznici bronha kod djece, za razliku od odraslih bolesnika (12,13).…”

Nasal Polyps in Children: The Early Origins of a Challenging Adulthood Condition

“…In particular, dupilumab, a fully human mAb directed toward the alpha chain of the IL-4 receptor used by both IL-4 and IL-13, is the first and only biological agent approved for the treatment of CRSwNP in adults with type 2 inflammation, regardless of the presence of asthma as a comorbidity, due to its effectiveness in reducing polyp size, sinus opacification, and symptom severity [45,64,88]. Dupilumab is also approved for the treatment of severe type 2 asthma, starting from 12 years of age [89]. There is still limited evidence on the efficacy of omalizumab (an anti-IgE) and mepolizumab (anti-IL-5) in CRSwNP, mainly in adult patients with comorbid asthma [90,91]; both of these drugs are currently approved for children aged ≥6 years with severe asthma.…”