Preschool wheeze and asthma endotypes- implications for future therapy
File(s)
Author(s)
Hillson, Kushalinii
Saglani, Sejal
Custovic, Adnan
Type
Journal Article
Abstract
Introduction
Preschool wheeze and school-aged asthma present a large healthcare burden. Both conditions are now recognized to be heterogeneous, with similar symptom presentation but likely different underlying lung pathology.
Areas Covered
Current treatment options for preschool wheeze are constrained by extrapolations from the management of school-aged children with asthma. While most cases of asthma at school age are caused by classical atopic, eosinophilic, Type-2 driven asthma, only a quarter of preschool children with wheeze fall into this category. Targeting treatment to specific underlying mechanisms resulting in preschool wheeze may alter the progression to school age asthma. Novel biologics have revolutionized the management of severe, treatment-resistant school age asthma, but a limited evidence base limits their use in young children. There are several potential future non-steroid-based treatment options in development, of which bacterial lysates show the most promise.
Expert opinion
Effective treatment of preschool wheeze may preserve lung function into later life, which may alter the progression trajectory toward school age asthma. Endotype-driven management will enable more effective treatment of both preschool wheeze and school age asthma.
Preschool wheeze and school-aged asthma present a large healthcare burden. Both conditions are now recognized to be heterogeneous, with similar symptom presentation but likely different underlying lung pathology.
Areas Covered
Current treatment options for preschool wheeze are constrained by extrapolations from the management of school-aged children with asthma. While most cases of asthma at school age are caused by classical atopic, eosinophilic, Type-2 driven asthma, only a quarter of preschool children with wheeze fall into this category. Targeting treatment to specific underlying mechanisms resulting in preschool wheeze may alter the progression to school age asthma. Novel biologics have revolutionized the management of severe, treatment-resistant school age asthma, but a limited evidence base limits their use in young children. There are several potential future non-steroid-based treatment options in development, of which bacterial lysates show the most promise.
Expert opinion
Effective treatment of preschool wheeze may preserve lung function into later life, which may alter the progression trajectory toward school age asthma. Endotype-driven management will enable more effective treatment of both preschool wheeze and school age asthma.
Date Issued
2024-12-01
Date Acceptance
2024-12-06
Citation
Expert Review of Respiratory Medicine, 2024, 18 (12), pp.1025-1039
ISSN
1747-6348
Publisher
Taylor and Francis Group
Start Page
1025
End Page
1039
Journal / Book Title
Expert Review of Respiratory Medicine
Volume
18
Issue
12
Copyright Statement
© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
Identifier
10.1080/17476348.2024.2440468
Subjects
ALLERGIC SENSITIZATION
Asthma
atopy
CAUSAL RELATIONSHIP
CHILDHOOD ASTHMA
CHILDREN
endotype
EOSINOPHILIC INFLAMMATION
EXHALED NITRIC-OXIDE
HIGH-RISK
INHALED CORTICOSTEROIDS
Life Sciences & Biomedicine
LUNG-FUNCTION
machine learning
OUTDOOR AIR-POLLUTION
phenotype
preschool wheeze
Respiratory System
Science & Technology
Publication Status
Published
Date Publish Online
2024-12-13