Asthma across the ages: knowledge gaps in childhood asthma

Abstract

The Eunice Kennedy Shriver National Institute of Child Health and Human Development convened an Asthma Group in response to the Best Pharmaceuticals for Children Act. The overall goal of the Best Pharmaceuticals for Children Act Program is to improve pediatric therapeutics through preclinical and clinical drug trials that lead to drug-labeling changes. Although significant advances have been made in the understanding and management of asthma in adults with appropriately labeled medications, less information is available on the management of asthma in children. Indeed, many medications are inadequately labeled for use in children. In general, the younger the child, the less information there is available to guide clinicians. Because asthma often begins in early childhood, it is incumbent on us to continue to address the primary questions raised in this review and carefully evaluate the medications used to manage asthma in children. Meanwhile, continued efforts should be made in defining effective strategies that reduce the risk of exacerbations. If the areas of defined need are addressed in the coming years, namely prevention of exacerbations and progression of disease, as well as primary intervention, we will see continuing reduction in asthma mortality and morbidity along with improved quality of life for children with asthma.

Keywords: Asthma; CO; Carbon monoxide; EBC; Exhaled breath condensate; Feno; Fraction of exhaled nitric oxide; HRV; Human rhinovirus; RBM; RSV; Respiratory syncytial virus; Reticular basement membrane; SARP; Severe Asthma Research Program; asthma biomarkers; asthma natural history; asthma pharmacotherapy; asthma progression; childhood asthma.

Figure 1

Airway inflammation in asthma. The orange box represents activities in the lymph node. The DC processes antigens, migrates to the lymph node, and associates with TH0, which then differentiates and migrates back to the airway. Figure A demonstrates non-eosinophilic/neutrophilic asthma, and Figure B demonstrates eosinophilic asthma. Remodeling occurs in all forms of asthma, but is only shown in Figure B.