Advances in adult and pediatric asthma

This year we present updates on the management and therapeutics of asthma and research on the relationship of airway remodeling to clinically irreversible disease and continue a discussion about the origins of asthma. Significant advances are occurring in our understanding of the natural history of asthma, including the application of biomarkers and genetics. These tools should assist the clinician in defining patients at risk for significant morbidity related to asthma. Incorporating this knowledge will help prompt the development of more effective management techniques and new medications. Meanwhile, more effective health care strategies must be developed to reduce the reported disparities in asthma care noted in our patient populations.     

Advances in pediatric and adult asthma

Last year's review on adult and pediatric asthma highlighted reports related to asthma genetics, the importance of upper airway management, the costs of asthma, and the importance of early recognition and intervention. This year we will organize our discussion to review recent reports related to the origins and persistence of asthma in both adults and children. We highlight Journal publications from 2004, along with recent key publications from other medical journals, to provide a perspective on the rapidly developing areas of genetics, including pharmacogenetics, respiratory infection, biomarker measurements, and asthma pharmacotherapy. This new understanding of the pathogenesis of asthma combined with clinical applications of genetics and biomarkers should lead to new management strategies. Asthma management is likely to change in the coming years from a strategy directed to the best outcome in groups of patients to an individualized approach to assessment and management.     

Advances in pediatric asthma 2006

Because the outcomes experienced in adult asthma often result from pathophysiology that begins in early childhood, this year's summary focuses on recent advances in pediatric asthma. This past year, we have learned that early intervention with inhaled corticosteroids in childhood asthma reduces morbidity but does not alter the natural history of asthma. Theme issues over the last year focused attention on severe asthma and black box warnings. Both of these themes significantly affect the management of childhood asthma. Responsiveness to asthma treatment is heterogeneous even among patients with asthma of similar severity. This heterogeneity calls attention to the importance of assessing control and adjusting treatment accordingly. We are now moving toward an individualized approach to asthma therapy and searching for biomarkers and genetics as a resource to guide treatment. To improve asthma control, we must continue to obtain information on early asthma, severe asthma, asthma exacerbations, and methods to improve asthma control. Evaluation and management of severe asthma in children include verification of the diagnosis, assessment for coexisting illnesses, and identification of effective treatment strategies directed to adherence, medication delivery, and combination therapy. Application of biomarkers and genetics could be useful tools in individualizing our approach to the management of childhood asthma.     

Advances in pediatric asthma in 2007

This year's summary focuses on recent advances in pediatric asthma as reported in 2007 publications in the Journal. This past year, new National Asthma Education and Prevention Program asthma guidelines were released with a special emphasis on new information in pediatric asthma. Journal theme issues in 2007 included the revised National Asthma Education and Prevention Program asthma guidelines, the accomplishments of the National Institutes of Health asthma networks, and focused discussions on environmental allergens, neutrophils, eosinophils, T cells, and epithelial cells, all of which affect pediatric asthma. The new asthma guidelines emphasize several key terms including severity, control, impairment, risk, and responsiveness that are relevant for advancing the care of children with asthma. This review highlights journal articles that relate to these guideline topics.     

Advances in pediatric asthma in 2011: moving forward

Last year's "Advances in pediatric asthma" concluded with the following statement: "Perhaps new directions in personalized medicine and improved health care access and communication will help maintain steady progress in alleviating the burden of this disease in children, especially young children." This year's summary will focus on recent advances in pediatric asthma that show significant accomplishments in reducing asthma morbidity and mortality over the last 10 years and discuss some pathways to further reduce asthma burden, as indicated in Journal of Allergy and Clinical Immunology publications in 2011. Some of the recent reports continue to shed light on methods to improve asthma management through steps to reduce asthma exacerbations, identify features of the disease in early childhood, alter asthma progression, intervene with nutrition, and more effectively implement the asthma guidelines. As new information evolves, it is also time to consider a revision of the asthma guidelines based on key studies that affect our management of the disease since the last revision in 2007. Now is also the time to use information recorded in electronic medical records to develop innovative disease management plans that will track asthma over time and enable timely decisions on interventions to maintain control that can lead to disease remission and prevention.     

Advances in adult asthma diagnosis and treatment and HEDQ in 2010

This summary reviews research published over the past year on asthma and through the prism of health care delivery and quality. Special attention is given to management, therapeutics, and the role of environmental exposures and their interactions with genetics. The discussion is framed around the 3 stages of translational research: from bench to first studies in human subjects, then to larger efficacy studies in well-defined patient populations, and finally into practice through effectiveness research in real-world settings.     

Advances in pediatric asthma in 2010: addressing the major issues

Last year's "Advances in pediatric asthma" concluded with the following statement: "If we can close these [remaining] gaps through better communication, improvements in the health care system and new insights into treatment, we will move closer to better methods to intervene early in the course of the disease and induce clinical remission as quickly as possible in most children." This year's summary will focus on recent advances in pediatric asthma that take steps moving forward as reported in Journal of Allergy and Clinical Immunology publications in 2010. Some of these recent reports show us how to improve asthma management through steps to better understand the natural history of asthma, individualize asthma care, reduce asthma exacerbations, and manage inner-city asthma and some potential new ways to use available medications to improve asthma control. It is clear that we have made many significant gains in managing asthma in children, but we have a ways to go to prevent asthma exacerbations, alter the natural history of the disease, and reduce health disparities in asthma care. Perhaps new directions in personalized medicine and improved health care access and communication will help maintain steady progress in alleviating the burden of this disease in children, especially young children.     

Levalbuterol: pharmacologic properties and use in the treatment of pediatric and adult asthma.

LEARNING OBJECTIVES: To review the rationale supporting the use of levalbuterol [(R)-albuterol] for the treatment of pediatric and adult asthma. DATA SOURCES: Peer-reviewed articles, selected abstracts from studies presented at recent professional meetings, and the Xopenex [levalbuterol, (R)-albuterol; Sepracor, Marlborough, MA] Summary Basis of Approval and package insert. STUDY SELECTION: Institutional review board-approved clinical study protocols. RESULTS: Levalbuterol is a single isomer beta2-agonist that differs from racemic albuterol by elimination of (S)-albuterol. Levalbuterol is an effective bronchodilator whose primary mechanism of action is unimpeded by (S)-albuterol. Thus, when compared with racemic albuterol, clinically comparable bronchodilation can be achieved with doses that substantially lessen beta-mediated side effects. In chronic or acute treatment of asthma, this favorable therapeutic profile cannot apparently be duplicated by increasing or decreasing the dose of racemic albuterol or by the addition of anticholinergic agents such as ipratropium bromide. CONCLUSIONS: Levalbuterol seems to provide efficacy and safety advantages in pediatric and adult patients suffering from asthma. Its use may afford a cost benefit as well. More clinical studies are required to extend these observations for use in the treatment of other pulmonary diseases in both adults and children and to determine levalbuterol's impact on long-term therapy of respiratory diseases.     

Advances in adult asthma 2006: its risk factors, course, and management

This Advances article updates our understanding of risk factors for asthma and its course and management. Studies relevant to clinical practice are discussed, with special attention to their clinical research methods.     

Rhinosinusitis and pediatric asthma

Rhinosinusitis is a common disease in patients of all age groups. Rhinosinusitis arises from a variety of infectious and inflammatory mechanisms. There is ample evidence that rhinosinusitis can directly influence asthma. There is also growing evidence that rhinosinusitis may be associated with asthma as different manifestations of the same disorder. A great deal of future research is required to fully elucidate the different mechanisms whereby rhinosinusitis influences or associates with asthma, but it is clear that rhinosinusitis needs to be considered in patients with severe or refractory asthma.     

Bacterial infections and pediatric asthma

Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis seem to have no role in asthma in children. Mycoplasma pneumoniae and Chlamydophila pneumoniae can induce wheezing and cause asthma exacerbations in children, and chronic Chlamydophila infections may even participate in asthma pathogenesis. However, studies have failed to show any benefits from antibiotics for incipient or stable pediatric asthma, as well as for asthma exacerbations in children. Exposure to antibiotics in infancy has been an independent risk factor of later asthma in many studies. A recent study applying molecular biology methods to lower airway samples provided preliminary evidence that lower airways are not sterile but have their own protective microbiota, which can be disturbed in lung diseases like asthma.     

Advances and highlights in asthma in 2021

Last year brought a significant advance in asthma management, unyielding to the pressure of the pandemics. Novel key findings in asthma pathogenesis focus on the resident cell compartment, epigenetics and the innate immune system. The precision immunology unbiased approach was supplemented with novel tools and greatly facilitated by the use of artificial intelligence. Several randomised clinical trials and good quality real-world evidence shed new light on asthma treatment and supported the revision of several asthma guidelines (GINA, Expert Panel Report 3, ERS/ATS guidelines on severe asthma) and the conception of new ones (EAACI Guidelines for the use of biologicals in severe asthma). Integrating asthma management within the broader context of Planetary Health has been put forward. In this review, recently published articles and clinical trials are summarised and discussed with the goal to provide clinicians and researchers with a concise update on asthma research from a translational perspective.     

Unmet needs in adult asthma

Guidelines have been developed to provide an objective framework for the effective management of asthma. They are based on a mix of sound clinical practice and evidence-based medicine. The aims of asthma management are to ensure that the patient is symptom free and living an unrestricted life with normal physical activity, lung function normalized as much as possible, using minimum therapy, that exacerbations are kept to a minimum and mortality is reduced or abolished. In practice, however, these aims are not being met. Thus, unmet needs exist in asthma and need to be addressed. One particular unmet need is poor delivery of asthma care. Undertreatment of asthma is common, especially in severe asthma. However, studies suggest that some patients with severe asthma do not respond to any available treatments. Many outcome measures have been used in asthma and different outcomes will ensue according to which outcome measure is chosen, which in turn depends on the population studied. Asthma is a heterogeneous disease and there is heterogeneity in the response to treatment. However, at present there are no means to determine which patients will be a responder or non-responder to a particular treatment. In clinical trials of potential new asthma treatment we need to target the patient population more carefully according to the selected outcome measure, which should reflect the patient's perspective.     

Dietary antioxidants and adult asthma

The triggers and causes of asthma have long been topics of investigation by epidemiologists. The current concept of asthma and atopy is that the onset of the disease and its clinical course are determined by gene environment interactions; that is, those individuals who develop asthma are both genetically susceptible and receive appropriate environmental stimuli. One potential environmental factor that may relate to disease etiology is diet. This article will review the published evidence for the effects of dietary antioxidants on asthma incidence and disease control.     

Passive smoking and adult asthma

Asthma is a common chronic health condition, affecting 5% of the United States adult population. In most developed countries, the prevalence of asthma and its severity continues to increase. Understanding the factors contributing to asthma morbidity and mortality has important clinical and public health implications. This article evaluates the evidence that secondhand smoke exposure is a risk factor for new-onset asthma among adults and exacerbates pre-existing adult asthma, resulting in greater symptom burden and morbidity.     

Occupational exposures and adult asthma

Occupational exposures can cause a new onset of asthma in a subset of susceptible workers on the basis of sensitization to a specific work agent or a high-level irritant exposure. Epidemiologic studies give insight into the natural history of occupational asthma, including host factors and environmental factors leading to the development of occupational asthma, the progression, and the potential role of preventive measures. Work-exacerbated asthma has been a focus of studies only recently but is recognized as common among asthmatic workers and is a potential cause of significant morbidity and socioeconomic impact.