Recent advances in the treatment of childhood asthma: a clinical pharmacology perspective

Figures & data

Figure 1. Stepwise approach of asthma treatment based on the GINA 2021 recommendations. ICS: Inhaled corticosteroid; LABA: Long-acting beta-agonists; LTRA: leukotriene receptor antagonists; SLIT: Sublingual immunotherapy; Med: medium; LAMA: Long-acting muscarinic antagonists; SABA: Short-acting beta 2 agonist. Created with BioRender.com.

Figure 2. Biologics target type 2 airway inflammation in childhood asthma. External triggers (e.g. allergens) trigger the inflammatory cascade in previously sensitized children. Biologics target specific inflammatory compounds to reduce airway inflammation. Th0: naïve T helper cell; Th2: T helper 2; Th17: T helper 17; NKT cells: natural killer T cells; IL: interleukin; ILC2: innate lymphoid cell type 2; B cell: Basophil cell; TSLP: thymic stromal lymphopoietin; IgE: Immunoglobulin E; DC: dendritic cell. Created with BioRender.com.

Figure 3. The concept of precision medicine in pediatric asthma. Subgroups of patients might benefit from different treatment strategies. Created with BioRender.com.

Table 1. Potential predictors of biologics response in children.

Biologic	Target	Predictors	Age group studied	Reference
Omalizumab	IgE	Blood eosinophils,	≥12 years	[80]
		FeNO,
		Childhood asthma onset,
		Allergens-driven symptoms
Reslizumab*	IL-5	Blood eosinophil,	≥12 years	[83]
		Lower BMI,
		Greater baseline
		asthma control,
		Nasal polyposis,
		Older age of onset
Benralizumab	IL-5 receptor	Blood eosinophils,	≥12 years	[84,88]
		OCS use,
		Nasal polyposis,
		Lung function
Mepolizumab	IL-5	Blood eosinophils	≥12 years	[86]
Dupilumab	IL-4 receptor/IL-13	Blood eosinophils,	≥12 years	[89]
		FeNO

FeNO = fraction of exhaled Nitric Oxide

IL = interleukin

OCS = Oral corticosteroids

Figure 4. Pediatric asthma is a heterogeneous disease consisting of various asthma phenotypes and asthma endotypes.

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