Recent Discoveries in Preventing and Controlling Childhood Asthma

Recent Discoveries in Preventing and Controlling Childhood Asthma

Dompeling Edward, Jobsis Quirijn, Schayck Onno van
European Respiratory Disease Volume 5 Issue 1 2009
Published: September 2009
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Asthma in children is a complex disease with different phenotypes. In spite of considerable progress in several aspects of asthma management and treatment in the past 30 years, several problematic issues remain. The purpose of this article is to summarise some of the recent discoveries in preventing and controlling childhood asthma and to indicate new developments and areas for improvement. The prevalence of asthma in the past three decades has risen considerably, whereas the results of several – mostly monofaceted – prevention studies are disappointing. Can we prevent asthma at all? Are multifaceted interventions more effective than monofaceted? Overweight and obesity have reached epidemic proportions worldwide. They are risk factors not only for cardiovascular disease and diabetes, but also for the development of asthma and the aggrevation of already existing disease, which increases the necessity for an effective intervention strategy in the coming years. Globally, there are large problems with the accurate diagnosis of asthma in pre-school children because of various wheezing phenotypes. This contributes to undertreatment of ‘true asthmatic children’ and overtreatment of pre-school children with ‘viral wheeze’ (also called ‘transient wheeze’). Are there new diagnostic techniques that have the potential to tackle this problem? Another huge problem is the low level of asthma control in both children and adults worldwide. One of the likely reasons for this is that although asthma is a disease with chronic airway inflammation, we do not routinely measure airway inflammation in clinical practice. This article discusses some of the new non-invasive techniques that may help to improve the monitoring and thereby the control of the disease.

Asthma is the most common occurring chronic disease in childhood, with a prevalence of 5–10%.1,2 The World Health Organization (WHO) estimates that 300 million people currently suffer from asthma worldwide, which makes it a major public health problem.2 It is widely recognised that asthma has a multifactorial origin, with both genetic and environmental causes and important gene–environment interactions.3

Nowadays, proper treatment of asthma is possible and modern pharmacotherapy exists in the form of (long-acting) β2 agonists, inhaled corticosteroids and leukotriene receptor antagonists.1,4 The consequences of childhood asthma for daily life are huge and comprise respiratory complaints, diminished quality of life, disturbed physical activities, school absence or work absence of the parents, extra visits to a doctor, emergency care visits and hospital admissions.1,5 The financial burden on patients with asthma in different western countries ranges from US$300 to US$1,300 per patient per year, mainly affecting those with severe disease.6 Proper national and international guidelines are available that describe adequate treatment in a stepwise manner.1,4 The purpose of treatment is optimal asthma control.1 However, despite marked progress in several aspects of asthma management and treatment in the past 30–50 years, several problematic issues remain. In the past 30 years, a marked increase in the prevalence of asthma was observed in many Western countries worldwide.7 In The Netherlands, a five-fold increase in the prevalence of asthma was observed during this period.8 The reasons for this increase are poorly understood, as are the reasons for a recent stabilisation or even a small decrease in prevalence. Are these changes in prevalence related to changes in diagnostic labelling, treatment, air pollution or allergen load?

The results of several prevention studies are disappointing. This holds for both early intervention studies with inhaled corticosteroids and prevention studies directed towards allergen reduction.9–13 Can we prevent the development of asthma at all? What are the characteristics of an effective intervention? Should we use monofaceted or multifaceted interventions? There are large problems with the diagnosis of asthma, particularly at an early age.14 Different wheezing phenotypes exist with differences in prognosis. The largest group of children with wheeze at an early age is symptom-free six years of age.15 So far, it is very difficult to distinguish this group with ‘transient or viral-associated wheeze’ from a persistent type of bronchial asthma. However, such a distinction is very important for management and treatment of these groups. What new developments do we have to discriminate between these wheezing phenotypes and to adjust our treatment on an individual basis?

Keywords:
Prevention, asthma, children, passive smoking, exhaled breath, exhaled breath condensate, allergen reduction, obesity, immunotherapy

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