Severe pediatric asthma endotypes: current limits and future perspectives.

IF 2.9 3区 医学 Q2 RESPIRATORY SYSTEM Expert Review of Respiratory Medicine Pub Date : 2023-07-01 Epub Date: 2023-09-05 DOI:10.1080/17476348.2023.2254234
Beatrice Andrenacci, Maria De Filippo, Martina Votto, Maria Sole Prevedoni Gorone, Mara De Amici, Stefania La Grutta, Gian Luigi Marseglia, Amelia Licari
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Abstract

Introduction: Although rare, pediatric severe therapy-resistant asthma (STRA) is a highly heterogeneous, resource-demanding disease that differs significantly from severe adult asthma and whose pathogenesis is still poorly understood.

Areas covered: This review summarizes the latest 10 years of English-written studies defining pediatric STRA endotypes using lung-specific techniques such as bronchoalveolar lavage and endobronchial biopsy. Results of the studies and limits on the field are discussed, together with some future perspectives.

Expert opinion: Over the years, it has become increasingly clear that 'one size does not fit all" in asthma. However, "Does an extremely tailored size fit more than one?'. Only using multicentric, longitudinal pediatric studies, will we be able to answer. Three issues could be particularly critical for future research. First, to provide, if existing, a distinction between prepuberal STRA and puberal STRA endotypes to understand the transition from pediatric to adult STRA and to design effective, tailored therapies in adolescents, usually suffering from poorer asthma control. Second, design early treatments for pediatric airway remodeling to preserve lifelong good lung function. Finally, to better characterize inflammation before and during biological therapies, to provide clues on whether to stop or change treatments.

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严重儿童哮喘内型:当前限制和未来展望。
引言:尽管罕见,但儿童重症治疗抵抗性哮喘(STRA)是一种高度异质性、资源需求高的疾病,与成人重症哮喘有很大不同,其发病机制仍知之甚少。所涵盖的领域:这篇综述总结了最近10年来使用支气管肺泡灌洗和支气管内膜活检等肺部特异性技术定义儿科STRA内型的英文书面研究。讨论了该领域的研究结果和局限性,以及一些未来的展望。专家意见:多年来,越来越清楚的是,哮喘患者“一个尺码不适合所有人”。然而,“一个非常定制的尺码适合不止一个吗?”。只有使用多中心、纵向的儿科研究,我们才能回答。有三个问题对未来的研究可能特别关键。首先,如果存在,提供青春期前STRA和青春期STRA内型之间的区别,以了解从儿童到成人STRA的过渡,并为通常哮喘控制较差的青少年设计有效的、量身定制的治疗方法。其次,设计儿童气道重塑的早期治疗方法,以保持终身良好的肺功能。最后,在生物治疗之前和期间更好地描述炎症,为是否停止或改变治疗提供线索。
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来源期刊
CiteScore
6.80
自引率
2.60%
发文量
90
期刊介绍: Coverage will include the following key areas: - Prospects for new and emerging therapeutics - Epidemiology of disease - Preventive strategies - All aspects of COPD, from patient self-management to systemic effects of the disease and comorbidities - Improved diagnostic methods, including imaging techniques, biomarkers and physiological tests. - Advances in the treatment of respiratory infections and drug resistance issues - Occupational and environmental factors - Progress in smoking intervention and cessation methods - Disease and treatment issues for defined populations, such as children and the elderly - Respiratory intensive and critical care - Updates on the status and advances of specific disease areas, including asthma, HIV/AIDS-related disease, cystic fibrosis, COPD and sleep-disordered breathing morbidity
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