Severe asthma in children: what have we learned?

Published Online: January 2016

Severe asthma in children is a complicated disorder that is challenging to treat.  Most children with asthma achieve symptom control with low doses of inhaled corticosteroids, however,  children with “severe” or “refractory” asthma have ongoing symptoms and airway inflammation despite high-dose corticosteroid treatment. Children with severe asthma are therefore ultimately at increased risk for severe adverse outcomes, including asthma-related death, but these children have not been well studied.

In a recently published issue of The Journal of Allergy and Clinical Immunology: In Practice, Fitzpatrick reviews key findings on severe asthma in school-age children from the National Heart, Lung and Blood Institute’s Severe Asthma Research Program (SARP).  SARP is a multi-center program created in 2001 that is focused on the clinical and biological attributes of severe asthma in adults and children.  SARP studies have shown that children with severe asthma do have distinct and differentiating features, but they are different from those of older adult populations. More importantly, SARP studies also suggest that severe asthma in children is a heterogeneous disorder with diverse clinical, molecular, and cellular inflammatory characteristics. Many of the phenotypes and biological endotypes of severe asthma in children have not yet been fully elucidated.  

Although SARP has advanced knowledge of unique attributes of severe asthma in children, considerable gaps remain for which additional studies are needed.  Current SARP efforts are focused on longitudinal studies to better understand the natural history of severe asthma as well as its phenotypic heterogeneity and related endotypes over time.  Ultimately, this clinical, biological, molecular and genetic knowledge may be useful for the development of phenotypic-directed treatments and personalized medicine for affected children.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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