Natural history of asthma from childhood to adulthood

Abstract

SummaryAsthma is a common and complex condition, with considerable heterogeneity both in phenotype and in the underlying pathophysiology. This paper aims to address some of the recent advances in the understanding of asthma, as well as indicating how these advances reveal potential new avenues for therapeutic intervention. Current drug treatments, although effective at alleviating inflammatory symptoms, do little to target the underlying causative factors. The onset of asthma is controlled by a combination of genetic and environmental factors, and a greater understanding of these has highlighted the importance of early‐life infections, allergen avoidance and fetal and postnatal nutrition. An imbalance in the expression of T‐cell phenotypes is thought to play an important role in the pathophysiology of asthma, and further elucidation of the underlying immune mechanisms has identified new ways of modulating the course of the disease. It is clear that there is also a need for new drug strategies that are aimed at the diverse factors that both trigger the disease and determine its course and severity, as well as the immune mechanisms contributing to its pathophysiology. Treatment plans that address this diversity are likely to provide a more effective means of asthma management and, combined with current knowledge of causative factors, might even act to modulate the course and severity of the disease.