An update on paediatric asthma

Abstract

In this Update we will discuss aspects of the definitions, epidemiology, diagnostics, asthma-associated comorbidities, assessment and treatment of asthma including a specific focus on severe asthma in school children. The Update will mainly cover data published during the last 3 yrs. In 2009, an expert panel was tasked to propose a World Health Organization definition of asthma severity and control. The result of this Task Force was a uniform definition of asthma severity, control and exacerbation [1]. As we will discuss later in an overview of asthma outcomes [2], symptom evaluation is the key to the diagnosis and outcome measures in clinical studies. Airway inflammation is one of the pathophysiological characteristics of asthma, which is mediated through infiltration of inflammatory cells, including mast cells, and eosinophilic and neutrophilic granulocytes in the airway wall. This cell infiltration subsequently leads to bronchial hyperresponsiveness (BHR) and, in the case of chronic inflammation, persistent changes of the airways, i.e. airway remodelling [3, 4]. Immunoglobulin (Ig)E-mediated allergy leading to allergic inflammation is common among children with persistent asthma. There are ongoing studies worldwide (the MeDALL initiative) aiming to identify allergic phenotypes [5] and understand the complexity of the IgE related phenotypes in children and adults [6]. The purpose of paediatric asthma treatment is for the child to control symptoms, to be able to lead a normal active life, to have normal lung function and to prevent asthma exacerbations [7, 8]. The care of asthmatic children does not only include the prescription of asthma medication. The families need to be convinced and educated to actually make the parents give the medication as prescribed and in a proper manner [9]. Furthermore, healthcare providers must teach the families how to avoid or …