Strategies to control the risk domain of NHLBI EPR-3 (National Heart, Lung, and Blood Institute Expert Panel Report-3)
asthma guidelines, which includes exacerbations requiring systemic
corticosteroids, reduction in lung growth, and progressive loss of lung function, and treatment-related adverse effects, are evolving in children and adolescents. Increasing evidence demonstrates that children and adolescents with
asthma are at risk of a reduction in lung growth, leading to lower lung function and potentially
chronic obstructive pulmonary disease as adults. Readily available clinical
biomarkers for atopy, including aeroallergen testing, total serum
IgE, blood
eosinophilia, and spirometry, are being utilized to phenotype difficult-to-treat pediatric patients, to assess risk for seasonal exacerbations, and to predict response to controller
therapies. The Composite
Asthma Severity Index is a novel, freely available scoring system to define
asthma control, incorporating NHLBI EPR-3 risk and impairment domains. As new
asthma controller
therapies, such as
tiotropium, are introduced for pediatric use, the safety of established controller
therapies including inhaled
corticosteroid and long-acting beta-agonist are being reexamined.
Macrolide antibiotics may be an oral
corticosteroid sparing alternative for the treatment of severe
respiratory tract infection in preschool-aged children. Seasonally directed courses of
omalizumab may provide an alternative approach to prevent fall
asthma exacerbations in children. Combining these pharmaceuticals and
biomarker-directed
therapies provide potential new options and personalized approaches to gain
asthma control in pediatric patients failing current management.