Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 May 20:14:525-538.
doi: 10.2147/JAA.S265657. eCollection 2021.

Precision Medicine for Paediatric Severe Asthma: Current Status and Future Direction

Manisha Ramphul  1 , David K H Lo  1   2 , Erol A Gaillard  1   2
Affiliations
Review

Precision Medicine for Paediatric Severe Asthma: Current Status and Future Direction

Manisha Ramphul et al. J Asthma Allergy. .

Erratum in

Abstract

Asthma is a heterogeneous disease, characterised by different phenotypes and endotypes. Precision medicine in asthma refers to the implementation of a targeted therapy for each individual child, based on the identification of treatable traits, including environmental, immunological and genetic factors. Severe asthma in children is associated with increased hospitalisation rates, a lower quality of life, increased healthcare costs and an increased mortality. In the era of new molecular biologics treatments, it is essential to improve deep phenotyping of children with severe asthma in order to deliver the most effective treatment to each individual child. In this review, we discuss the personalised approach to the assessment and management of severe asthma. We explore the indications and use of the currently licensed biologics, as well as the potential of other emerging treatments.

Keywords: benralizumab; child; dupilumab; mepolizumab; omalizumab; reslizumab.

PubMed Disclaimer

Conflict of interest statement

Dr Erol A Gaillard reports consultancy work for Boehringer Ingelheim with money paid to the institution (University of Leicester), investigator led research grants from Chiesi, Gilead,and Circassia, and non-financial support from Medimmune, outside the submitted work. The authors reported no other potential conflicts of interest for this work.

Figures

Figure 1
Figure 1
Eosinophilic asthma inflammatory pathways. There are two aetiologies for eosinophilic inflammation in asthma: an allergic pathway triggered by allergens and a non-allergic mechanism triggered by microbes, pollutants and glycolipids. The key mediators in the pathways are depicted below. Eosinophils release cationic proteins, which lead to bronchial epithelial tissue damage, thus causing airways hyper-responsiveness. Eosinophils also lead to airway smooth muscle cell proliferation through increased eosinophils adhesion caused by the release of cationic proteins and the eosinophilic effect on transforming growth factor-β1 and gene coding of wingless/integrase-1 signaling. IL-13 triggers mucus hyper-secretion. Figure created with BioRender.com.
Figure 2
Figure 2
Licensed mediator cascade of biologics used in eosinophilic asthma. The figure below shows the targets for the licensed biologics. Omalizumab is an IgE-blocker. Mepolizumab, reslizumab and benralizumab are anti IL-5 agents. Dupilumab is an Anti-IL-4/anti-IL-13 agent. Figure created with BioRender.com.
See this image and copyright information in PMC

References

    1. Dharmage SC, Perret JL, Custovic A. Epidemiology of asthma in children and adults. Front Pediatr. 2019;7:246. doi: 10.3389/fped.2019.00246 - DOI - PMC - PubMed
    1. Zahran H, Bailey C, Damon S, Garbe P, Breysse P Vital signs: asthma in children — United States, 2001–2016; 2018. - PMC - PubMed
    1. Gibson GJ, Loddenkemper R, Lundbäck B, Sibille Y. Respiratory health and disease in Europe: the new European Lung White Book. Eur Respir J. 2013;42(3):559. doi: 10.1183/09031936.00105513 - DOI - PubMed
    1. Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ. Asthma and wheezing in the first six years of life. N Engl J Med. 1995;332(3):133–138. doi: 10.1056/NEJM199501193320301 - DOI - PubMed
    1. Spycher BD, Silverman M, Brooke AM, Minder CE, Kuehni CE. Distinguishing phenotypes of childhood wheeze and cough using latent class analysis. Eur Respir J. 2008;31(5):974. doi: 10.1183/09031936.00153507 - DOI - PubMed

LinkOut - more resources