Abstract
Asthma exacerbations are associated with significant childhood morbidity and mortality. Recurrent asthma attacks contribute to progressive loss of lung function and can sometimes be fatal or near-fatal, even in mild asthma. Exacerbation prevention becomes a primary target in the management of all asthmatic patients. Our work reviews current advances on exacerbation predictive factors, focusing on the role of non-invasive biomarkers and genetics in order to identify subjects at higher risk of asthma attacks. Easy-to-perform tests are necessary in children; therefore, interest has increased on samples like exhaled breath condensate, urine and saliva. The variability of biomarker levels suggests the use of seriate measurements and composite markers. Genetic predisposition to childhood asthma onset has been largely investigated. Recent studies highlighted the influence of single nucleotide polymorphisms even on exacerbation susceptibility, through involvement of both intrinsic mechanisms and gene-environment interaction. The role of molecular and genetic aspects in exacerbation prediction supports an individual-shaped approach, in which follow-up planning and therapy optimization take into account not only the severity degree, but also the risk of recurrent exacerbations. Further efforts should be made to improve and validate the application of biomarkers and genomics in clinical settings.
Highlights
Asthma is the most common chronic disease in childhood
Our work aims to review current advances in the identification of exacerbation predictive factors, focusing on the role of non-invasive biomarkers and genetics in childhood
Studies on children population reported a significant association of ILR4A polymorphisms and asthma susceptibility [118], a more specific predisposition to asthma exacerbation risk needs to be evaluated in these patients
Summary
Asthma is the most common chronic disease in childhood. WHO surveillance highlighted a rising trend of global asthma prevalence [1]. Global Initiative for Asthma (GINA) defines exacerbations as episodes characterized by a progressive increase in symptoms of shortness of breath, cough, wheezing or chest tightness and progressive decrease in lung function, representing a change from the patient’s usual status sufficient to require a change in treatment [3]. These features are the result of chronic inflammation of the lower airways, which predisposes one to airway hyperresponsiveness and obstruction. Our work aims to review current advances in the identification of exacerbation predictive factors, focusing on the role of non-invasive biomarkers and genetics in childhood
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