Where does current and future pediatric asthma treatment stand? Remodeling and inflammation: Bird's eye view

Abstract

Airway remodeling is the chronic outcome of inflammation in asthma and a point of intervention between pediatric and adult ages. Pediatric asthma has been of great interest in the efforts to find a valuable time to interrupt remodeling. Various experimental and clinical research have assessed the effect of current therapeutic modalities on airway remodeling in asthma and many new agents are being developed with promising results. The heterogeneity in the results of these studies may lie in the heterogeneity of pathogenesis leading to asthma and remodeling; underlying the need for individualized treatment of the unique pathogenetic characteristics of each child's asthma. The aim of this review is to summarize the evidence about the influence of current and future therapeutic modalities in the concept of inflammation and remodeling in pediatric asthma. Pediatr Pulmonol. 2016;51:1422-1429. © 2016 Wiley Periodicals, Inc.

Chronic asthma and Mesenchymal stem cells: Hyaluronan and airway remodeling

“…In a recent study by Yilmaz et al provided a review of remodeling and inflammation in pediatric asthma as well as possible therapeutic agents [ 33 ]. The authors discussed remodeling of the airways and provide pathophysiologic mechanisms such as epithelial/subepithelial tissue rearrangement, sub-epithelial fibrosis, epithelial basement membrane thickening, myofibroblast hyperplasia, increased smooth muscle layer thickness, and neoangiogenesis [ 33 ]. Chronic inflammation lead to excess fibroblast response which increased ECM deposition resulting in remodeling [ 34 , 35 ].…”

Serum Clara cell protein and atopic phenotype in children up to 2 years of age

“…Pediatric asthma has been of great interest of researching efforts to find a valuable time to interrupt remodeling, but there is also the heterogeneity of pathogenesis leading to remodeling in asthma . Disturbance of airways reparation is considered as one of the possible mechanisms for development of airway remodeling in childhood that might be present early in life regardless of long‐standing inflammation .…”

“…Pediatric asthma has been of great interest of researching efforts to find a valuable time to interrupt remodeling, but there is also the heterogeneity of pathogenesis leading to remodeling in asthma. 27,28 Disturbance of airways reparation is considered as one of the possible mechanisms for development of airway remodeling in childhood 29 that might be present early in life regardless of long-standing inflammation. 5 Thinning of basal membrane of the airway epithelium (initial macroscopic sign of remodeling) was not observed in children with wheezing under the age of 1 year, 30 and the risk period for the formation of airway's remodeling could be the second year of life.…”

Pediatric usage of Omalizumab: A promising one

“…2) Airway remodeling is the chronic outcome of inflammation in asthma and a point of intervention between pediatric and adult ages. 29 IgE acts on the inflammation and smooth muscle components of the airway, which plays a role in remodeling. It is conceivable that anti-IgE therapy may have the potential to attenuate or reverse remodeling, which may help the patient to escape from the chronicity of asthma.…”