Endotypes of Asthma in Children

Asthma is a syndrome that includes several disease variants. Definition of asthma is a chronic disorder of the lung with variable airway obstruction, wheeze/cough, and an underlying inflammatory process with remodeling. It appears that atopic genes are not necessarily directly related to childhood asthma. Airway epithelial cells express genes that encode proteins directly related to asthma. Maternal asthma and child's sex are also a significant risk factors for asthma development. Hygiene hypothesis applies with regards to the atopic status but not to asthma symptoms. Early-life respiratory syncytical virus (RSV) infection or human rhinovirus infection is correlated to maternal atopic predisposition and to decreased lung function at age 8 years in the high-risk birth cohort, both conditions indirectly linked with asthma development. Airway responsiveness may be more strongly associated with asthma in infancy and early childhood than in school age and adolescence. Endotypes of asthma need to base in their cause or pathogenic mechanism. In childhood asthma three endotypes were proposed. Type 1: Mild to intermittent asthma In this group, asthma was more often controlled with low doses of ICS than in the other groups. Type 2: Asthma with severe exacerbations and multiple allergens. This type is associated with inflammation that is predominantly ＂allergic＂ (with eosinophil and basophil cells) in combination with multiple allergic sensitisations and elevated total serum IgE. Type 3: Severe obstructive asthma with neutrophilia This phenotype is characterized by a significant decrease in FEV1 even if it remains within the accepted limits of normal, as in other studies in severe asthmatic children. Different guideline need to address the management of endotype of childhood asthma. (J Pediatr Resp Dis 2014;10:51-58)

並列關鍵字

asthma ； endotype ； epigenetics ； remodeling

國際替代計量

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