Asthma in childhood

Abstract

Several topics on childhood asthma were addressed in the Paediatric Clinical Year in Review session at the 2015 European Respiratory Society International Congress. With regard to the relationship between lower respiratory tract infections and asthma, it emerges that is the number of respiratory episodes in the first years of life, but not the particular viral trigger, to be associated with later asthma development. Understanding which characteristics of individual patients are associated with an increased risk for asthma exacerbation is a critical step to implement strategies preventing these seasonal events. Recent data suggest the possibility that exhaled volatile organic compounds may qualify as biomarkers in detecting early signs of asthma. Adding information of exhaled volatile organic compounds and expression of inflammation genes to a clinical tool significantly improves asthma prediction in preschool wheezy children. Personal communication with children and adolescents is likely more important than the tools actually used for monitoring asthma. Systemic corticosteroids do not affect the long-term prognosis in children with first viral-induced wheezing episode and should be used cautiously during acute episodes. Finally, stress and a polymorphism upstream of a specific gene are both associated with reduced bronchodilator response in children with asthma.

FIGURE 1

Risk of asthma at age 7 years in relation to viral or bacterial respiratory tract infection in the first 3 years of life. Data are presented as crude (circles) and adjusted (triangles; adjusted for the total number of respiratory episodes from which an aspirate was taken) odd ratios with 95% confidence intervals. RV: rhinovirus; RSV: respiratory syncytial virus. Reproduced from [10] with permission from the publisher.

FIGURE 2

Time to a new physician-confirmed wheezing episode in children receiving prednisolone or placebo. The 2-month time-point, which was one of the primary outcomes, and the 12-month time-point are marked with vertical lines. Reproduced from [15] with permission from the publisher.

FIGURE 3

Receive operating characteristic curves for volatile organic compounds (VOC), expression of inflammatory genes, and the Asthma Predictive Index (API) in a combined model in the discovery set. Reproduced from [28] with permission from the publisher.