Severe asthma in children: therapeutic considerations
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Supporting information
Supporting information
Author(s)
Selby, Louise
Saglani, Sejal
Type
Journal Article
Abstract
Purpose of review Children with poor asthma control despite maximal maintenance therapy have problematic severe asthma(PSA). A step-wise approach including objective adherence monitoring and a detailed multidisciplinaryteam assessment to identify modifiable factors contributing to poor control is needed prior to consideringtherapy escalation. Pathophysiological phenotyping in those with true severe therapy-resistant asthma(STRA) and the current array of add-on therapies will be discussed.Recent findingsAdherence monitoring using electronic devices has shown that only 20–30% of children with PSA haveSTRA and need additional therapies. Omalizumab and mepolizumab are licensed for children with STRAaged 6 years and older. Although robust safety and efficacy data, with reduced exacerbations, areavailable for omalizumab, biomarkers predicting response to treatment are lacking. Paediatric safety dataare available for mepolizumab, but efficacy data are unknown for those aged 6–11 years and minimal forthose 12 years and older. A sub-group of children with STRA have neutrophilia, but the clinicalsignificance and contribution to disease severity remains uncertain.SummaryMost children with PSA have steroid sensitive disease which improves with adherence to maintenanceinhaled corticosteroids. Add-on therapies are only needed for the minority with STRA. Paediatric efficacydata of novel biologics and biomarkers that identify the optimal add-on for each child are lacking. If weare to progress toward individualized therapy for STRA, pragmatic clinical trials of biologics in accuratelyphenotyped children are needed.
Date Issued
2019-04
Date Acceptance
2019-01-21
Citation
Current Opinion in Allergy and Clinical Immunology, 2019, 19 (2), pp.132-140
ISSN
1473-6322
Publisher
Lippincott, Williams & Wilkins
Start Page
132
End Page
140
Journal / Book Title
Current Opinion in Allergy and Clinical Immunology
Volume
19
Issue
2
Copyright Statement
© 2019 Wolters Kluwer Health, Inc. All rights reserved.
Identifier
https://journals.lww.com/co-allergy/fulltext/2019/04000/Severe_asthma_in_children__therapeutic.10.aspx
Subjects
Science & Technology
Life Sciences & Biomedicine
Allergy
Immunology
adherence
immunomodulatory drugs
problematic severe asthma
severe therapy resistant asthma
DOUBLE-BLIND
MONOCLONAL-ANTIBODY
AIRWAY INFLAMMATION
BENRALIZUMAB
OMALIZUMAB
EFFICACY
SAFETY
LIFE
RECEPTOR
1107 Immunology
Allergy
Publication Status
Published
Date Publish Online
2019-04-01