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Miculinić A, Mrkić Kobal I, Kušan T, Turkalj M, Plavec D. Current Challenges in Pediatric Asthma. CHILDREN (BASEL, SWITZERLAND) 2024; 11:632. [PMID: 38929213 PMCID: PMC11201822 DOI: 10.3390/children11060632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024]
Abstract
Asthma is a chronic lung disease characterized by reversible bronchoconstriction and inflammation of the bronchi. Its increasing prevalence in childhood as well as different triggers make asthma a challenging disease in several ways: defining its phenotype/endotype, the diagnostic approach (especially in younger children), therapeutic options, and systematic follow-up. Considering these problems, this review approaches the current status and limitations of guidelines used for asthma management in children. It also emphasizes the key points which could lead to a better understanding and the direction to take in future studies.
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Affiliation(s)
- Andrija Miculinić
- Children’s Hospital Srebrnjak, Srebrnjak 100, 10000 Zagreb, Croatia (M.T.)
| | - Iva Mrkić Kobal
- Clinic for Pediatric Medicine Helena, Ulica Kneza Branimira 71, 10000 Zagreb, Croatia;
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
| | - Tin Kušan
- Children’s Hospital Srebrnjak, Srebrnjak 100, 10000 Zagreb, Croatia (M.T.)
| | - Mirjana Turkalj
- Children’s Hospital Srebrnjak, Srebrnjak 100, 10000 Zagreb, Croatia (M.T.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
- Faculty of Medicine, Catholic University of Croatia, 10000 Zagreb, Croatia
| | - Davor Plavec
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
- Prima Nova, Healthcare Institution, Zagrebačka Cesta 132A, 10000 Zagreb, Croatia
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2
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Al-Ahmad M, Nurkic J, Othman Y, Jusufovic E, Maher A. Severe asthma in Kuwait population: Phenotype-based approach. Respir Med 2021; 187:106586. [PMID: 34474336 DOI: 10.1016/j.rmed.2021.106586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is increasing recognition of marked phenotypic heterogeneity within severe asthma patients. METHODS Severe asthma patients on GINA step 4 or 5 treatment, followed up at Al-Rashed Allergy center Kuwait, were evaluated for: demographics (gender, age, age of asthma onset), comorbidities (allergic rhinitis (AR), chronic rhinosinusitis (CRS), chronic rhinosinusitis with nasal polyposis (CRSwNP), obesity), blood biomarkers (total serum Immunoglobulin E (IgE), peripheral eosinophils), and sensitization to inhalants allergens. RESULTS A total of 169 patients were candidates for biological treatment. Patients were divided in two groups based on level of total IgE as a "low" group with IgE<160 IU/ml (n = 55) and "high" group with IgE≥ 160 IU/ml (n = 114). Both groups were further divided in subgroups, "low" and "high", based on absolute number of eosinophils (Eos) in peripheral blood with <300 cells/μl or ≥ 300 cells/μl. Only 10% of patients were in low IgE/low Eos while majority (46%) were in the high IgE/high Eos group. Mean age of patients was 44.1 year with domination of females (n = 123). Majority of patients were obese. AR, CRS and CRSwNP were more common in group with IgE ≥160 IU/ml, while CRS and CRSwNP in group with Eos ≥300 cells/μl. CONCLUSION The majority of severe asthma patients in Kuwait are obese females with adult-onset asthma (>18 years of age) who were allergic with comorbid conditions including AR, CRS and CRSwNP, which correlates well with the level of Eos.
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Affiliation(s)
- Mona Al-Ahmad
- Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait; Al-Rashed Allergy Center, Ministry of Health, Kuwait.
| | | | | | - Edin Jusufovic
- Medical Faculty, University of Tuzla, Tuzla, Bosnia and Herzegovina.
| | - Ahmed Maher
- Al-Rashed Allergy Center, Ministry of Health, Kuwait.
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3
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Kotecha SJ, Lowe J, Granell R, Watkins WJ, Henderson AJ, Kotecha S. The effect of catch-up growth in the first year of life on later wheezing phenotypes. Eur Respir J 2020; 56:13993003.00884-2020. [PMID: 32586886 PMCID: PMC7758542 DOI: 10.1183/13993003.00884-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/14/2020] [Indexed: 11/05/2022]
Abstract
Although wheezing phenotypes have previously been accurately described using well-defined cohorts reporting longitudinal wheezing, early-life factors which lead to development of each wheezing phenotype remain uncertain [1, 2]. Birth weight and catch-up growth affect later respiratory outcomes [3], but the influence of weight gain on specific wheezing phenotypes in term-born children has not been described. Rapid weight gain in early-life is associated with increased rates of childhood wheeze and lower lung function [4, 5]. In one meta-analysis rapid infant weight gain was linked to pre-school wheeze and school-aged asthma; and to increased childhood respiratory symptoms in another meta-analysis [6, 7]. Effect of weight gain in early-life in term-born children on wheezing in early-life is less well reported [8]. In contrast, rapid increase in body mass index in infancy is associated with increased risk of asthma at school-age in preterm-born infants [9]. This study shows that catch-up growth in infancy is associated with increased early wheeze in childhood, so care is needed to not to excessively feed in early infancyhttps://bit.ly/2YPxtBw
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Affiliation(s)
- Sarah J Kotecha
- Dept of Child Health, Cardiff University School of Medicine, Cardiff, UK.,Joint first authors
| | - John Lowe
- Dept of Child Health, Cardiff University School of Medicine, Cardiff, UK.,Joint first authors
| | - Raquel Granell
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - W John Watkins
- Dept of Child Health, Cardiff University School of Medicine, Cardiff, UK
| | - A John Henderson
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sailesh Kotecha
- Dept of Child Health, Cardiff University School of Medicine, Cardiff, UK
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Withers ALI, Green R. Transition for Adolescents and Young Adults With Asthma. Front Pediatr 2019; 7:301. [PMID: 31396495 PMCID: PMC6664046 DOI: 10.3389/fped.2019.00301] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/08/2019] [Indexed: 11/13/2022] Open
Abstract
Asthma is a complex, heterogenous medical condition which is very common in children and adults. The transition process from pediatric to adult health care services can be a challenge for young people with chronic medical conditions. The significant changes in physical and mental health during this time, as well as the many unique developmental and psychosocial challenges that occur during adolescence can complicate and impede transition if not adequately addressed and managed. The transition period can also be a challenging time for health professionals to assess readiness for transition and manage some of the complications which are particularly common during this time, including poor adherence to therapy, smoking, drug use, and emerging mental health conditions. The natural history, presentation, symptoms, and management of asthma is often significantly different when comparing pediatric and adult practice. In addition, management in infants, toddlers, school aged children, and adolescents differs significantly, offering an additional challenge to pediatric physicians managing asthmatic children and young people. Despite these challenges, if the transition process for young people with asthma is planned and performed in a formalized manner, many of these issues can be addressed, allowing the transition to occur smoothly despite changes that may occur in medical and psychosocial domains.
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Affiliation(s)
| | - Ruth Green
- Glenfield Hospital, Leicester, United Kingdom
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5
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Tan HTT, Hagner S, Ruchti F, Radzikowska U, Tan G, Altunbulakli C, Eljaszewicz A, Moniuszko M, Akdis M, Akdis CA, Garn H, Sokolowska M. Tight junction, mucin, and inflammasome-related molecules are differentially expressed in eosinophilic, mixed, and neutrophilic experimental asthma in mice. Allergy 2019; 74:294-307. [PMID: 30267575 DOI: 10.1111/all.13619] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/16/2018] [Accepted: 08/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Asthma is a chronic respiratory disease with marked clinical and pathophysiological heterogeneity. Specific pathways are thought to be involved in the pathomechanisms of different inflammatory phenotypes of asthma; however, direct in vivo comparison has not been performed. METHODS We developed mouse models representing three different phenotypes of allergic airway inflammation-eosinophilic, mixed, and neutrophilic asthma via different methods of house dust mite sensitization and challenge. Transcriptomic analysis of the lungs, followed by the RT-PCR, western blot, and confocal microscopy, was performed. Primary human bronchial epithelial cells cultured in air-liquid interface were used to study the mechanisms revealed in the in vivo models. RESULTS By whole-genome transcriptome profiling of the lung, we found that airway tight junction (TJ), mucin, and inflammasome-related genes are differentially expressed in these distinct phenotypes. Further analysis of proteins from these families revealed that Zo-1 and Cldn18 were downregulated in all phenotypes, while increased Cldn4 expression was characteristic for neutrophilic airway inflammation. Mucins Clca1 (Gob5) and Muc5ac were upregulated in eosinophilic and even more in neutrophilic phenotype. Increased expression of inflammasome-related molecules such as Nlrp3, Nlrc4, Casp-1, and IL-1β was characteristic for neutrophilic asthma. In addition, we showed that inflammasome/Th17/neutrophilic axis cytokine-IL-1β-may transiently impair epithelial barrier function, while IL-1β and IL-17 increase mucin expressions in primary human bronchial epithelial cells. CONCLUSION Our findings suggest that differential expression of TJ, mucin, and inflammasome-related molecules in distinct inflammatory phenotypes of asthma may be linked to pathophysiology and might reflect the differences observed in the clinic.
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Affiliation(s)
- Hern-Tze Tina Tan
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
- Christine Kühne-Center for Allergy Research and Education; Davos Switzerland
- Department of Immunology; School of Medical Sciences; Universiti Sains Malaysia; Kubang Kerian Malaysia
| | - Stefanie Hagner
- Institute of Laboratory Medicine and Pathobiochemistry; Molecular Diagnostics; Marburg Germany
- Member of the German Center for Lung Research; Marburg Germany
| | - Fiorella Ruchti
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
- Christine Kühne-Center for Allergy Research and Education; Davos Switzerland
| | - Urszula Radzikowska
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
- Christine Kühne-Center for Allergy Research and Education; Davos Switzerland
- Department of Regenerative Medicine and Immune Regulation; Medical University of Bialystok; Bialystok Poland
| | - Ge Tan
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
- Christine Kühne-Center for Allergy Research and Education; Davos Switzerland
- Functional Genomics Center Zurich; ETH Zurich/University of Zurich; Zurich Switzerland
| | - Can Altunbulakli
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
- Christine Kühne-Center for Allergy Research and Education; Davos Switzerland
| | - Andrzej Eljaszewicz
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
- Christine Kühne-Center for Allergy Research and Education; Davos Switzerland
- Department of Regenerative Medicine and Immune Regulation; Medical University of Bialystok; Bialystok Poland
| | - Marcin Moniuszko
- Department of Regenerative Medicine and Immune Regulation; Medical University of Bialystok; Bialystok Poland
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
- Christine Kühne-Center for Allergy Research and Education; Davos Switzerland
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
- Christine Kühne-Center for Allergy Research and Education; Davos Switzerland
| | - Holger Garn
- Institute of Laboratory Medicine and Pathobiochemistry; Molecular Diagnostics; Marburg Germany
- Member of the German Center for Lung Research; Marburg Germany
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
- Christine Kühne-Center for Allergy Research and Education; Davos Switzerland
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Pedersen ESL, de Jong CCM, Ardura-Garcia C, Barben J, Casaulta C, Frey U, Jochmann A, Latzin P, Moeller A, Regamey N, Singer F, Spycher B, Sutter O, Goutaki M, Kuehni CE. The Swiss Paediatric Airway Cohort (SPAC). ERJ Open Res 2018; 4:00050-2018. [PMID: 30474037 PMCID: PMC6243078 DOI: 10.1183/23120541.00050-2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/27/2018] [Indexed: 11/20/2022] Open
Abstract
Chronic respiratory symptoms, such as cough, wheeze and dyspnoea, are common in children; however, most research has, with the exception of a few large-scale clinical cohort studies, been performed in the general population or in small, highly-selected samples. The Swiss Paediatric Airway Cohort (SPAC) is a national, prospective clinical cohort of children and adolescents who visit physicians for recurrent conditions, such as wheeze and cough, and exercise-related respiratory problems. The SPAC is an observational study and baseline assessment includes standardised questionnaires for families and data extracted from hospital records, including results of clinically indicated investigations, diagnoses and treatments. Outcomes are assessed through annual questionnaires, monthly symptom reporting via mobile phone and follow-up visits. The SPAC will address important questions about clinical phenotypes, diagnosis, treatment, and the short- and long-term prognosis of common respiratory problems in children. The cohort currently consists of 347 patients from four major hospitals (Bern, Zurich, Basel and Lucerne), with 70–80 additional patients joining each month. More centres will join and the target sample size is a minimum of 3000 patients. The SPAC will provide real-life data on children visiting the Swiss healthcare system for common respiratory problems and will provide a research platform for health services research and nested clinical and translational studies. The Swiss Paediatric Airway Cohort (SPAC) is a unique research platform for common respiratory problems in childrenhttp://ow.ly/Y1v030lDnji
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Affiliation(s)
- Eva S L Pedersen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,These authors contributed equally
| | - Carmen C M de Jong
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,These authors contributed equally
| | | | - Juerg Barben
- Division of Paediatric Pulmonology, Children's Hospital, St Gallen, Switzerland
| | - Carmen Casaulta
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Urs Frey
- Dept of Paediatrics, University Children's Hospital, University of Basel, Basel, Switzerland
| | - Anja Jochmann
- Dept of Paediatrics, University Children's Hospital, University of Basel, Basel, Switzerland
| | - Philipp Latzin
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Alexander Moeller
- Division of Paediatric Pulmonology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolas Regamey
- Division of Paediatric Pulmonology, Children's Hospital, Lucerne, Switzerland
| | - Florian Singer
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland.,Division of Paediatric Pulmonology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ben Spycher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
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7
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Ater D, Amirav I, Attias M, Nakash E, Newhouse MT, Mandelberg A. Evaluation of clinically and physiologically atypical asthma: If it doesn't wheeze it may still be asthma. J Asthma 2018; 56:21-26. [PMID: 29393720 DOI: 10.1080/02770903.2018.1424194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Children with asthma-like symptoms may not clinically wheeze. The objectives of this study were to evaluate if children, without physician-documented wheeze, wheeze during bronchial-challenge-testing (BCT), and if measurements of O2Sat and respiratory rate during BCT improve the BCT sensitivity? METHODS Seven hundred and twenty-four children, who were referred for suspicion of asthma, performed a BCT. Positive BCT was determined by the provocation concentration (PC) which resulted in a 20% decrease in FEV1 (PC20), (in those who were able to perform spirometry, group B), or (in those unable to perform spirometry, group A) a 50% increase in respiratory rate (PCRR), or a 5% decrease in oxygen-saturation (PCO2-Sat) or appearance of wheezing (PCwheeze). RESULTS Five hundred and seven BCTs were positive: group A n = 89 age, median (IQR), 3 (2.5-3.7) years (17.6%), were unable to perform spirometry, and group B n = 418 age 10.7 (6.8-15.6) years (82.4%), were able to perform spirometry. Children, without physician-documented wheeze in the total population (groups A plus B), were more likely (65.5%) to have a positive BCT without wheeze compared with those with physician-documented wheeze (41.0%, P < 0.001). In group A, adding PCRR and PCO2-Sat increased BCT sensitivity by 23.6%. CONCLUSIONS Many children in both groups did not wheeze despite reaching BCT endpoints. Children without physician-documented wheeze tended not to wheeze at BCT. This may result in clinical under-diagnosis of asthma if depending on the presence of wheeze. In young children, adding PCRR and PCO2-Sat substantially increases BCT sensitivity and may improve asthma diagnosis.
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Affiliation(s)
- Dorit Ater
- a Pediatric Pulmonary Unit , Department of pediatrics, Wolfson Medical Centre , Holon , Israel.,b Sackler School of Medicine, Tel Aviv University , Israel
| | - Israel Amirav
- c Department of Pediatrics , University of Alberta , Edmonton , Canada
| | - Matan Attias
- a Pediatric Pulmonary Unit , Department of pediatrics, Wolfson Medical Centre , Holon , Israel
| | - Eyal Nakash
- a Pediatric Pulmonary Unit , Department of pediatrics, Wolfson Medical Centre , Holon , Israel
| | - Michael T Newhouse
- d Firestone Institute for Respiratory Health, St. Joseph's Hospital , McMaster University , Hamilton , Ontario , Canada
| | - Avigdor Mandelberg
- a Pediatric Pulmonary Unit , Department of pediatrics, Wolfson Medical Centre , Holon , Israel.,b Sackler School of Medicine, Tel Aviv University , Israel
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Atkins D, Furuta GT, Liacouras CA, Spergel JM. Eosinophilic esophagitis phenotypes: Ready for prime time? Pediatr Allergy Immunol 2017; 28:312-319. [PMID: 28339136 PMCID: PMC5479411 DOI: 10.1111/pai.12715] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 12/11/2022]
Abstract
Eosinophilic esophagitis (EoE) is one of the most common causes of reflux-like symptoms and feeding problems in children and food impaction and dysphagia in adults with a prevalence of 1:2500. Therapeutic options include diet, use of swallowed corticosteroids, or dilation. In the last several years, recent clinical and translational researches have identified some common and distinctive features, for example, the varying response to diet and medications. As EoE shares some characteristics with both asthma and inflammatory bowel disease, the advances in these fields suggest that various phenotypes may also exist in patients with EoE. Here, we provide a rationale for EoE phenotypes and provide some suggestions for potential phenotypes based on histology, molecular signature, response to therapy or dietary therapy.
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Affiliation(s)
- Dan Atkins
- Gastrointestinal Eosinophilic Diseases Program, Children's Hospital Colorado, Aurora, CO, USA.,Section of Allergy-Immunology, Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | - Glenn T Furuta
- Gastrointestinal Eosinophilic Diseases Program, Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA.,Section of Pediatric Gastroenterology, Hepatology and Nutrition, Digestive Health Institute, Children's Hospital Colorado, Aurora, CO, USA
| | - Chris A Liacouras
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan M Spergel
- Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA.,Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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9
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Belgrave D, Henderson J, Simpson A, Buchan I, Bishop C, Custovic A. Disaggregating asthma: Big investigation versus big data. J Allergy Clin Immunol 2017; 139:400-407. [PMID: 27871876 PMCID: PMC5292995 DOI: 10.1016/j.jaci.2016.11.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/07/2016] [Accepted: 11/09/2016] [Indexed: 12/21/2022]
Abstract
We are facing a major challenge in bridging the gap between identifying subtypes of asthma to understand causal mechanisms and translating this knowledge into personalized prevention and management strategies. In recent years, "big data" has been sold as a panacea for generating hypotheses and driving new frontiers of health care; the idea that the data must and will speak for themselves is fast becoming a new dogma. One of the dangers of ready accessibility of health care data and computational tools for data analysis is that the process of data mining can become uncoupled from the scientific process of clinical interpretation, understanding the provenance of the data, and external validation. Although advances in computational methods can be valuable for using unexpected structure in data to generate hypotheses, there remains a need for testing hypotheses and interpreting results with scientific rigor. We argue for combining data- and hypothesis-driven methods in a careful synergy, and the importance of carefully characterized birth and patient cohorts with genetic, phenotypic, biological, and molecular data in this process cannot be overemphasized. The main challenge on the road ahead is to harness bigger health care data in ways that produce meaningful clinical interpretation and to translate this into better diagnoses and properly personalized prevention and treatment plans. There is a pressing need for cross-disciplinary research with an integrative approach to data science, whereby basic scientists, clinicians, data analysts, and epidemiologists work together to understand the heterogeneity of asthma.
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Affiliation(s)
| | - John Henderson
- School of Social and Community Medicine, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Angela Simpson
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Iain Buchan
- Health Informatics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | | | - Adnan Custovic
- Department of Paediatrics, Imperial College, London, United Kingdom.
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10
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Iordanidou M, Loukides S, Paraskakis E. Asthma phenotypes in children and stratified pharmacological treatment regimens. Expert Rev Clin Pharmacol 2016; 10:293-303. [PMID: 27936975 DOI: 10.1080/17512433.2017.1271322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Asthma is the most common inflammatory disease in childhood. The interaction of genetic, environmental and host factors may contribute to the development of childhood asthma and defines its progress, including persistence and severity. Until now, various classifications of childhood asthma phenotypes have been suggested based on patient's age during onset of symptoms, type of inflammatory cells, response to treatment and disease severity. Many efforts have been carried out to identify childhood asthma phenotypes and to clarify which are the risk factors that define asthma prediction and the response to therapy. The identification of asthma phenotypes has not only prognostic but also therapeutic role. However, the classification of asthma phenotypes is complex due to the heterogeneity of the disease. Areas covered: The current childhood asthma phenotypes and the new therapeutic strategies for each phenotype are reviewed. Expert commentary: There are multiple phenotypes in childhood asthma and it is crucial to define them before the initiation of personalized treatment. Both the therapeutic strategy and monitoring should follow the recent guidelines.
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Affiliation(s)
- Maria Iordanidou
- a Paediatric Respiratory Unit, Department of Pediatrics , University Hospital of Alexandroupolis , Alexandroupolis , Greece
| | - Stelios Loukides
- b 2nd Respiratory Medicine Department , National and Kapodistrian University of Athens Medical School, Attiko University Hospital , Athens , Greece
| | - Emmanouil Paraskakis
- a Paediatric Respiratory Unit, Department of Pediatrics , University Hospital of Alexandroupolis , Alexandroupolis , Greece
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11
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Landgraf-Rauf K, Anselm B, Schaub B. The puzzle of immune phenotypes of childhood asthma. Mol Cell Pediatr 2016; 3:27. [PMID: 27468754 PMCID: PMC4965363 DOI: 10.1186/s40348-016-0057-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 07/19/2016] [Indexed: 02/07/2023] Open
Abstract
Asthma represents the most common chronic childhood disease worldwide. Whereas preschool children present with wheezing triggered by different factors (multitrigger and viral wheeze), clinical asthma manifestation in school children has previously been classified as allergic and non-allergic asthma. For both, the underlying immunological mechanisms are not yet understood in depth in children. Treatment is still prescribed regardless of underlying mechanisms, and children are not always treated successfully. This review summarizes recent key findings on the complex mechanisms of the development and manifestation of childhood asthma. Whereas traditional classification of childhood asthma is primarily based on clinical symptoms like wheezing and atopy, novel approaches to specify asthma phenotypes are under way and face challenges such as including the stability of phenotypes over time and transition into adulthood. Epidemiological studies enclose more information on the patient’s disease history and environmental influences. Latest studies define endotypes based on molecular and cellular mechanisms, for example defining risk and protective single nucleotide polymorphisms (SNPs) and new immune phenotypes, showing promising results. Also, regulatory T cells and recently discovered T helper cell subtypes such as Th9 and Th17 cells were shown to be important for the development of asthma. Innate lymphoid cells (ILC) could play a critical role in asthma patients as they produce different cytokines associated with asthma. Epigenetic findings showed different acetylation and methylation patterns for children with allergic and non-allergic asthma. On a posttranscriptional level, miRNAs are regulating factors identified to differ between asthma patients and healthy controls and also indicate differences within asthma phenotypes. Metabolomics is another exciting chapter important for endotyping asthmatic children. Despite the development of new biomarkers and the discovery of new immunological molecules, the complex puzzle of childhood asthma is still far from being completed. Addressing the current challenges of distinct clinical asthma and wheeze phenotypes, including their stability and underlying endotypes, involves addressing the interplay of innate and adaptive immune regulatory mechanisms in large, interdisciplinary cohorts.
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Affiliation(s)
- Katja Landgraf-Rauf
- Department of Pulmonary and Allergy, Dr. von Hauner Children's Hospital, LMU, Lindwurmstraße 4, 80337, Munich, Germany.,Member of German Lung Centre (DZL), CPC, Munich, Germany
| | - Bettina Anselm
- Department of Pulmonary and Allergy, Dr. von Hauner Children's Hospital, LMU, Lindwurmstraße 4, 80337, Munich, Germany
| | - Bianca Schaub
- Department of Pulmonary and Allergy, Dr. von Hauner Children's Hospital, LMU, Lindwurmstraße 4, 80337, Munich, Germany. .,Member of German Lung Centre (DZL), CPC, Munich, Germany.
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