Natural history of asthma in childhood

Asthma is the most common chronic respiratory disease, affecting up to 10% of adults and 30% of children (JACI, 2011).

Here are some facts about pediatric asthma:

- A high proportion of cases of chronic asthma begin during the preschool years.

- Structural and functional changes in the asthmatic airway are often detected after age 3 years.

- In patients with chronic persistent asthma, the first clinical manifestations of the disease are triggered by viruses, most often rhinovirus, and are associated with early aeroallergen sensitization (e.g. dust mite, etc).

- Single-allergen environmental avoidance (e.g. dust mite) is not effective in preventing asthma onset.

- Current inhaled anti-inflammatory therapy (ICS) does not change the natural course of asthma.

Childhood asthma phenotypes (click to enlarge the image):



A 2012 study described 2 "new" phenotypes for young children with wheezing: "boys atopic multiple-trigger" and "girls nonatopic uncontrolled wheeze". JACI, 2012.

Algorithm for the diagnosis and management of early childhood asthma, JACI, 2012:



References:

New insights into the natural history of asthma: Primary prevention on the horizon. Fernando D. Martinez. The Journal of Allergy and Clinical Immunology, Volume 128, Issue 5 , Pages 939-945, November 2011.

Treatment of Pediatric Asthma