ADVANCEMENTS IN PAEDIATRICS ASTHMA TREATMENT: NAVIGATING A BREATH OF PROGRESS

Main Article Content

Diwan Israr khan
Jameel Ahmad

Keywords

childhood asthma, monoclonal antibodies, E-health , recent advances

Abstract

A complex and varied inflammatory illness, childhood asthma can be quite taxing on both the patient and the caregiver. A new age of tailored and focused care has been brought about by the notable breakthroughs in pediatric asthma treatment in recent years. By combining genetic and biomarker data, precision medicine has completely changed our understanding of asthma. With this method, patients can be more precisely categorized into unique phenotypes and endotypes, allowing medical professionals to customize interventions to the unique features of each patient's asthma.


The introduction of novel biologics, especially monoclonal antibodies made to target particular inflammatory pathways linked to asthma, is one significant advancement in the field. Asthma exacerbations are caused by underlying mechanisms that these biologics directly address, providing a fresh therapeutic approach. This focused strategy reduces the possibility of adverse effects from broad-spectrum drugs while also improving therapeutic efficacy.


Furthermore, the use of digital health technologies has revolutionized the treatment of pediatric asthma. Real-time monitoring of symptoms, medication adherence, and environmental triggers is made possible via telemedicine platforms, e-health technologies, and home monitoring systems. These digital tools enable preventive interventions and individualized care regimens by providing patients and healthcare practitioners with vital data.


All things considered, these advancements have ushered in a new era in the treatment of pediatric asthma, one that places an emphasis on accuracy, customized care, and the application of technology to improve outcomes and minimize exacerbations while also increasing the quality of life for young asthmatic patients.

Abstract 66 | pdf Downloads 25

References

1. A P Kaplan, Gimenez-Arnau AM, Saini SS. Mechanisms of action that contribute to efficacy of omalizumab in chronic spontaneous urticaria. Allergy. 2017;72(4):519-533.
2. Akinbami LJ, Simon AE, Rossen LM. Changing trends in asthma prevalence among children. Pediatrics. 2016 Jan;137(1):1-7.
3. Baena-Cagnani, C.E.; Teijeiro, A.; Canonica, G.W. Four-year follow-up in children with moderate/severe uncontrolled asthma after withdrawal of a 1-year omalizumab treatment. Curr. Opin. Allergy Clin. Immunol. 2015, 15, 267–271.
4. Baraldi E, de Jongste JC; European Respiratory Society/American Thoracic Society (ERS/ATS) Task Force. Measurement of exhaled nitric oxide in children, 2001. Eur Respir J 2002; 20:223–237.
5. Bjerregaard A, Laing IA, Backer V, Sverrild A, Khoo SK, Chidlow G, et al.. High fractional exhaled nitric oxide and sputum eosinophils are associated with an increased risk of future virus-induced exacerbations: a prospective cohort study. Clin Exp Allergy 2017; 47:1007–1013.
6. Bleecker, E.R.; FitzGerald, J.M.; Chanez, P.; Papi, A.; Weinstein, S.F.; Barker, P.; Sproule, S.; Gilmartin, G.; Aurivillius, M.; Werkström, V.; et al. Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β2-agonists (SIROCCO): A randomised, multicentre, placebo-controlled phase 3 trial. Lancet 2016, 388, 2115–2127.
7. Bobolea I, Barranco P, Del Pozo V, Romero D, Sanz V, López-Carrasco V, et al.. Sputum periostin in patients with different severe asthma phenotypes. Allergy 2015; 70:540–546
8. Bossley CJ, Fleming L, Gupta A, Regamey N, Frith J, Oates T, et al.. Pediatric severe asthma is characterized by eosinophilia and remodeling without T(H)2 cytokines. J Allergy Clin Immunol 2012; 129:974–982.e13
9. Brunekreef B, Smit J, de Jongste J et al. The prevention and incidence of asthma and mite allergy (PIAMA) birth cohort study: design and first results. Pediatr Allergy Immunol. 2002;13(15):55-60.
10. Brusselle GG, Maes T, Bracke KR. Eosinophils in the spotlight: eosinophilic airway inflammation in nonallergic asthma. Nat Med 2013; 19:977–979.
11. Busse W, Spector S, Rosén K, Wang Y, Alpan O. High eosinophil count: a potential biomarker for assessing successful omalizumab treatment effects. J Allergy Clin Immunol 2013; 132:485–486.
12. Bynum A, Irwin C, Burke B et al. Impact of school telehealth on access to medical care, clinical outcomes, and cost savings among children in rural Arkansas. J Educ Res. 2011; 5(2):999-117.
13. Casciano J, Krishnan JA, Small MB, Buck PO, Gopalan G, Li C, et al.. Value of peripheral blood eosinophil markers to predict severity of asthma. BMC Pulm Med 2016; 16:109.
14. Chapurlat RD, Confavreux CB. Novel biological markers of bone: from bone metabolism to bone physiology. Rheumatology (Oxford) 2016; 55:1714–1725.
15. Ciprandi G, Marseglia GL, Castagnoli R, Valsecchi C, Tagliacarne C, Caimmi S, et al.. From IgE to clinical trials of allergic rhinitis. Expert Rev Clin Immunol 2015; 11:1321–1333.
16. Cowan DC, Taylor DR, Peterson LE, Cowan JO, Palmay R, Williamson A, et al.. Biomarker-based asthma phenotypes of corticosteroid response. J Allergy Clin Immunol 2015; 135:877–883.
17. Dima AL, Hernandez G, Cunillera O, et al.. Asthma inhaler adherence determinants in adults: a systematic review of observational data. Eur Respir J 2015;45:994–1018.
18. Dweik RA, Boggs PB, Erzurum SC, Irvin CG, Leigh MW, Lundberg JO, et al.. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med 2011; 184:602–615
19. Evelim L F D Gomes et al. Active video game exercise training improves the clinical control of asthma in children: randomized Controlled Trial. PLoS One. 2015 Aug 24; 10(8): e0135433
20. Fang LC, Shyur SD, Wang JY, Kao YH, Yang CH, Yu YT. Exhaled nitric oxide helps discriminating asthmatic children with and without positive specific IgE to aeroallergens. Asian Pac J Allergy Immunol 2017; [Epub ahead of print]; DOI: 10.12932/AP-270717-0126
21. Farne HA, Wilson A, Powell C, Bax L, Milan SJ. Anti-IL5 therapies for asthma. Cochrane Database Syst Rev. 2017;9(9):CD010834.
22. FitzGerald, J.M.; Bleecker, E.R.; Nair, P.; Korn, S.; Ohta, K.; Lommatzsch, M.; Ferguson, G.T.; Busse, W.W.; Barker, P.; Sproule, S.; et al. Benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): A randomised, double-blind, placebo-controlled phase 3 trial. Lancet.2016, 388, 2128–2141.
23. Fitzpatrick AM, Jackson DJ, Mauger DT, Boehmer SJ, Phipatanakul W, Sheehan WJ, et al.. Individualized therapy for persistent asthma in young children. J Allergy Clin Immunol 2016; 138:1608–1618.e12
24. Fleming L, Tsartsali L et al. Sputum inflammatory phenotypes are not stable in children with asthma. Thorax. 2012; 67(8):675-81.
25. F-NBW G. 2016. Best (Biomarkers, EndpointS, and other tools) resource. Published. [PubMed] [GoogleScholar]
26. Formanek W, Inci D, Lauener RP, Wildhaber JH, Frey U, Hall GL. Elevated nitrite in breath condensates of children with respiratory disease. Eur Respir J 2002; 19:487–491
27. Gabriele C, Jaddoe VW, van Mastrigt E, Arends LR, Hofman A, Moll HA, et al.. Exhaled nitric oxide and the risk of wheezing in infancy: the Generation R Study. Eur Respir J 2012; 39:567–572
28. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention, 2016. Available from: www.ginathma.org
29. Glowacka E, Jedynak-Wasowicz U, Sanak M, Lis G. Exhaled eicosanoid profiles in children with atopic asthma and healthy controls. Pediatr Pulmonol 2013; 48:324–335
30. Halken S. Prevention of allergic disease in childhood: clinical and epidemiological aspects of primary and secondary allergy prevention. Pediatr Allergy Immunol. 2004: 164(5); 9-32
31. Harris HE, Raucci A. Alarmin(g) news about danger: workshop on innate danger signals and HMGB1. EMBO Rep 2006; 7:774–778
32. Hastie AT, Moore WC, Meyers DA, Vestal PL, Li H, Peters SP, et al.. Analyses of asthma severity phenotypes and inflammatory proteins in subjects stratified by sputum granulocytes. J Allergy Clin Immunol 2010; 125:1028–1036.e13
33. Hermelijn H S, Lucien EPM van der Vlugt et al. childhood allergies and asthma: New insights on environmental exposures and local immunity at the lung barrier. Current Opinion in Immunology. 2016;42:41-47.
34. Humbert M, Beasley R, Ayres J et al. Benefits of omalizumab as add-on therapy in patients with severe persistent asthma who are inadequately controlled despite best available therapy (GINA 2002 step 4 treatment): INNovate. Allergy. 2005; 60:309-316.
35. Huss K, Winkelstein ML, Crosbie K, et al. ’Backpack adventures in asthma’: interactive multimedia computer game piques childrens’ interest in asthma. J Allergy Clin Immunol. 2001;107(2):239.
36. IOM (Institute of Medicine) 2000. Cleaning the air: asthma and indoor air exposures. Washington, DC: national Academy of Press.
37. IOM (Institute of Medicine) 2004. Cleaning the air: asthma and indoor air exposures. Washington, DC: national Academy of Press.
38. James A, Hedlin G. biomarkers for the phenotyping and monitoring of asthma in children. Curr Treat Options Allergy. 2016;3:439-452.
39. Kolbeck R, Kozhich A, Koike M et al. MEDI-563, a humanized anti-IL-5 receptor alpha mAb with enhanced antibody-dependent cell-mediated cytotoxicity function. Journal of Allergy and Clinical immunology. 2010;125(6):1344-1353.
40. Kotaniemi-Syrjänen A, Malmberg LP, Malmström K, Pelkonen AS, Mäkelä MJ. Factors associated with elevated exhaled nitric oxide fraction in infants with recurrent respiratory symptoms. Eur Respir J 2013; 41:189–194
41. Lanier, B.; Bridges, T.; Kulus, M.; Taylor, A.F.; Berhane, I.; Vidaurre, C.F. Omalizumab for the treatment of exacerbations in children with inadequately controlled allergic (IgE-mediated) asthma. J. Allergy Clin. Immunol. 2009, 124, 1210–1216.
42. Lemanske RF., Jr The childhood origins of asthma (COAST) study. Pediatr Allergy Immunol 2002; 13:38–43
43. Massanari M, Holgate ST, Busse WW, Jimenez P, Kianifard F, Zeldin R. Effect of omalizumab on peripheral blood eosinophilia in allergic asthma. Respir Med 2010; 104:188–196
44. McPherson A, Forster D, Glazebrook C, et al. The asthma files: evaluation of a multimedia package for children’s asthma education. Paediatr Nurs. 2002 Mar;14(2):32–35.
45. McPherson AC, Glazebrook C, Forster D, et al. A randomized, controlled trial of an interactive educational computer package for children with asthma. Pediatrics. 2006 Apr;117(4):1046–1054.
46. Milgrom, H.; Berger, W.; Nayak, A.; Gupta, N.; Pollard, S.; McAlary, M.; Taylor, A.F.; Rohane, P. Treatment of childhood asthma with anti-immunoglobulin E antibody (Omalizumab). Pediatrics 2001, 108, e36.
47. Moschino L, Zanconato S, Bozzetto S, Baraldi E, Carraro S. Childhood asthma biomarkers: present knowledge and future steps. Paediatr Respir Rev 2015; 16:205–212
48. Neerincx AH, Vijverberg SJH, Bos LDJ, Brinkman P, van der Schee MP, de Vries R, et al.. Breathomics from exhaled volatile organic compounds in pediatric asthma. Pediatr Pulmonol 2017; 52:1616–1627
49. Ortega, H.G.; Liu, M.C.; Pavord, I.D.; Brusselle, G.G.; FitzGerald, J.M.; Chetta, A.; Humbert, M.; Katz, L.E.; Keene, O.N.; Yancey, S.W.; et al. Mepolizumab treatment in patients with severe eosinophilic asthma. N. Engl. J. Med. 2014, 371, 1198–1207.
50. Pavord, I.D.; Korn, S.; Howarth, P.; Bleecker, E.R.; Buhl, R.; Keene, O.N.; Ortega, H.; Chanez, P. Mepolizumab for severe eosinophilic asthma (DREAM): A multicentre, double-blind, placebo-controlled trial. Lancet 2012, 380, 651–659.
51. Payne DN, Adcock IM, Wilson NM, Oates T, Scallan M, Bush A. Relationship between exhaled nitric oxide and mucosal eosinophilic inflammation in children with difficult asthma, after treatment with oral prednisolone. Am J Respir Crit Care Med 2001; 164:1376–1381
52. Petsky HL, Kew KM, Chang AB. Exhaled nitric oxide levels to guide treatment for children with asthma. Cochrane Database Syst Rev 2016;11:CD011439.
53. Pham, T.H.; Damera, G.; Newbold, P.; Ranade, K. Reductions in eosinophil biomarkers by benralizumab in patients with asthma. Respir. Med. 2016. 111, 21–29.
54. Philip J. Lowe, Panayiotis Georgiou, Janice Canvin. Revision of omalizumab dosing table for dosing every 4 instead of 2 weeks for specific ranges of bodyweight and baseline IgE. Regulatory Toxicology and Pharmacology. 2015;71(1):68-77.
55. Pini A, Boccalini G, Lucarini L, et al.. Protection from cigarette smoke-induced lung dysfunction and damage by H2 relaxin (Serelaxin). J Pharmacol Exp Ther. 2016;357:451–8.
56. Platts-Mills TA, Rakes G, Heymann PW. The relevance of allergen exposure to the development of asthma in childhood. J Allergy Clin Immunol. 2000 Feb; 105(2):S503-S508.
57. Popplewell EJ, Innes VA, Llyod-Hughes S et al. the effect of high efficiency and standard vacuum cleaners on mite, cat and dog allergen levels and clinical progess. Pediatr Allergy Immunol. 2000;11:142-148
58. Portnoy JM, Waller M, De Lurgio S, Dinakar C. Telemedicine is as effective as in-person visits for patients with asthma. Ann Allergy Asthma Immunol. 2016;117(3):241–5.
59. Price D, Wilson AM, Chisholm A, Rigazio A, Burden A, Thomas M, et al.. Predicting frequent asthma exacerbations using blood eosinophil count and other patient data routinely available in clinical practice. J Asthma Allergy 2016; 9:1–12
60. Robinson D, Humbert M, Buhl R, Cruz AA, Inoue H, Korom S, et al.. Revisiting Type 2-high and Type 2-low airway inflammation in asthma: current knowledge and therapeutic implications. Clin Exp Allergy 2017; 47:161–175
61. Rufo JC, Madureira J, Fernandes EO, Moreira A. Volatile organic compounds in asthma diagnosis: a systematic review and meta-analysis. Allergy 2016; 71:175–188.
62. S B Fitzpatrick et al. A novel asthma camp intervention for childhood asthma among urban blacks. The pediatric lung committee of the American Lung Association of the district of Columbia (ALADC) Washington, DC. J Natl Med Assoc. 1992;84:233-237.
63. Shames RS, Sharek P, Mayer M, et al. Effectiveness of a multicomponent self-management program in at-risk, school-aged children with asthma. Ann Allergy Asthma Immunol. 2004 Jun;92(6):611–618.
64. Somerville M, Mackenzie I, Owen P, Miles D. housing and health: does installing heating in their homes improve the health of children with asthma? Public Health. 2000; 114:434-439.
65. Spahn JD, Malka J, Szefler SJ. Current application of exhaled nitric oxide in clinical practice. J Allergy Clin Immunol 2016; 138:1296–1298
66. Szefler SJ, Wenzel S, Brown R, Erzurum SC, Fahy JV, Hamilton RG, et al.. Asthma outcomes: biomarkers. J Allergy Clin Immunol 2012; l129:S9–S23
67. Tinschert P, Jakob R, Barata F, et al.. The potential of mobile apps for improving asthma self-management: a review of publicly available and well-adopted asthma apps. JMIR Mhealth Uhealth 2017;5:1–13.
68. Van Boven JFM, Trappenburg JCA, van der Molen T, et al.. Towards tailored and targeted adherence assessment to optimise asthma management. NPJ Prim Care Respir Med. 2015;25:1–6. 10.1038/npjpcrm.2015.46
69. Van Rensen EL, Evertse CE, Van Schadewijk WA et al. Eosinophils in bronchial mucosa of asthmatics after allergen challenge:effect of anti-IgE treatment. Allergy. 2009;64(1):72-80.
70. Vizmanos-Lamotte G, Moreno-Galdó A, Muñoz X, Gómez-Ollés S, Gartner S, Cruz MJ. Induced sputum cell count and cytokine profile in atopic and non-atopic children with asthma. Pediatr Pulmonol. 2013; 48:1062–1069
71. Wakefield M, Banham D, McCaul K, Martin J et al. effect of feedback regarding urinary cotinine and brief tailored advice on home smoking restrictions among low-income parents of children with asthma: a controlled trial. Prev Med. 2002;34:58-65.
72. Wang YH, Liu YJ. Thymic stromal lymphopoietin, OX40-ligand, and interleukin-25 in allergic responses. Clinical and Experimental Allergy. 2009; 39(6):798-806.
73. Warner JA et al. mechanical ventilation and high-eeficiency vacuum cleaning: a combined strategy of mite and mite allergen reduction in the control of mite-sensitive asthma. J Allergy Clin Immunol. 2000; 105: 75-82.
74. Wenzel, S.; Ford, L.; Pearlman, D.; Spector, S.; Sher, L.; Skobieranda, F.; Wang, L.; Kirkesseli, S.; Rocklin, R.; Busse, W.; et al. Dupilumab in persistent asthma with elevated eosinophil levels. N. Engl. J. Med. 2013. 368, 2455–2466.
75. Woodruff PG, Khashayar R, Lazarus SC, Janson S, Avila P, Boushey HA, et al.. Relationship between airway inflammation, hyperresponsiveness, and obstruction in asthma. J Allergy Clin Immunol 2001; 108:753–758
76. Wu F and Takaro T K. childhood asthma and environemtnal interventions. Environ Health perspect. 2007 Jun;115(6): 971-975
77. Zanconato S, Carraro S, Corradi M, Alinovi R, Pasquale MF, Piacentini G, et al.. Leukotrienes and 8-isoprostane in exhaled breath condensate of children with stable and unstable asthma. J Allergy Clin Immunol 2004; 113:257–263