Phenotype-driven Asthma Treatment in Children

Abstract

Asthma is a clinical syndrome characterized by recurrent episodes of wheezing, breathlessness, chest tightness and coughing, due to variable airflow obstruction. Chronic inflammation of the airway wall has been shown in asthma, mostly in adults, also between symptom episodes. One of the pathophysiological consequences of airway inflammation in asthma is airway hyperresponsiveness (AHR).Although inflammation is a consistent feature in asthma, at least in adults, the clinical spectrum of asthma is highly variable. Different symptom patterns have been demonstrated, various types of airway inflammation, and a large number of other clinical features that make asthma a heterogeneous disease. The goal of asthma treatment is good asthma control: control of clinical manifestations and of future risks such as exacerbations, rapid decline in lung function and side effects of medication.4 Despite the availability of appropriate asthma medication and asthma management plans the burden of asthma symptoms in our population is still high and there is reason to try to develop better management strategies. Better understanding ofthe pathophysiology of the various childhood asthma phenotypes is likely to improve asthma management and may enable us to individualize a patient's therapy. Lack of phenotype-based rather than disease-based approaches in the management of asthma may contribute substantially to the burden of asthma. Most studies of asthma treatment do not take phenotype into account. If a given treatment would be active for one phenotype but not for another, not taking separate phenotypes into account will lead to underestimation of treatment benefits. It is likely that one treatment does not fit all asthma patients.