Personalized asthma management in pediatric patients based on treatment response

ABSTRACT

Introduction

Asthma is the most common chronic illness in the pediatric population and is characterized by substantial heterogeneity in phenotypes and treatment response. A precision medicine approach is required to advance asthma care and improve asthma morbidity in children.

Areas covered

We present a review of currently available biomarkers for the diagnosis and management of pediatric asthma. We discuss a core set of biomarkers recognized by the National Institute of Health Asthma Outcomes Task Force including eosinophil counts, IgE levels, and fraction of exhaled nitric oxide. We also review emerging biomarkers including periostin, thymic stromal lymphopoietin, and volatile organic compounds. These biomarkers have proven effective in differentiating asthma phenotypes and predicting and monitoring treatment response, and have led to the development of game-changing biologic therapies for pediatric asthma.

Expert opinion

Substantial progress has been made in the identification of key biomarkers to aid in the classification and management of pediatric asthma. However, for biomarkers to be used routinely in clinical practice, further investigations are needed to expand biomarker representation of additional asthma phenotypes. A systems biology approach is also required, combining the various ‘omic’ strategies, for precision medicine to reach its full potential in pediatric asthma management.

KEYWORDS:

• Asthma
• biomarkers
• type-2 phenotype
• pediatrics
• eosinophils
• fraction of exhaled nitric oxide
• ige
• periostin
• treatment response
• volatile organic compounds

Article highlights

• Asthma is a heterogeneous disease with variability in clinical phenotypes and treatment response.

• Numerous biomarkers have been identified representing the type 2 inflammatory asthma pathway and are useful in predicting and monitoring treatment response.

• Several game-changing biologic therapies have been developed targeting type 2 inflammatory cytokines and have demonstrated efficacy in reducing exacerbation rates and corticosteroid dose and improving lung function.

• There is a need for identification of more robust biomarkers, including ones that represent the non-type 2 phenotype, to provide better representation of all asthma phenotypes.

• Use of a systems biology approach, integrating combinations of biomarkers and omic techniques, will allow for advancement towards precision medicine for the treatment of childhood asthma.

Declaration of interest

S.J. Szefler has consulted for Astra Zeneca, Boehringer-Ingelheim, GlaxoSmithKline, Novartis, Propeller Health, Regeneron, and Sanofi and has received research support from the National Institutes of Health, the National Heart, Lung and Blood Institute, the National Heart, Lung and Blood Institute, Propeller Health, the Colorado Cancer, Cardiovascular and Pulmonary Disease Program.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

The authors did not receive funding for this work.