Long-term treatment in pediatric asthma: an update on chemical pharmacotherapy

ABSTRACT

Introduction: Asthma is the most common chronic disease in childhood, affecting approximately 10% of all children, and is the leading cause of hospitalization in developed countries.

In this paper we aimed to review the evidence on chemical pharmacotherapy for long-term treatment of pediatric asthma, according to the latest updates.

Area covered: Long-term treatment, essential for controlling symptoms and reducing future risks including exacerbations and decline in lung function, includes control agents such as inhaled corticosteroids, long-acting beta2-adrenergic agonists, and leukotriene modifiers. More recent strategies based on the use of a biological drug such as omalizumab, which is a monoclonal antibody directed against immunoglobulin E (IgE), can be considered in selected patients with severe asthma.

Expert opinion: In the near future, the challenge of childhood asthma treatment will be to improve the chemical drugs that already exist as well as to carefully characterize the several different asthma subtypes, with special regard to children with severe disease. A better definition of patient features, made possible by the current advanced knowledge of the pathobiology of severe asthma, can ultimately allow the identification of specific phenotypes and endotypes of severe asthma, aimed to personalize pharmacological treatment.

KEYWORDS:

• Childhood asthma
• pharmacotherapy
• long term treatment of asthma

Article highlights

• Treatment recommendations of asthma guidelines are based on age-groups: preschoolers (defined as children up to five years of age) are different from older children in terms of diagnostic and therapeutic procedures.

• ICSs are the first-line recommended therapy in all age groups.

• LTRAs are recommended to be used as an alternative adjunctive treatment to ICSs in moderate or severe asthma. As monotherapy, LTRAs display inferior efficacy to inhaled corticosteroids in adults and children with persistent asthma.

• LABAs should not be used as monotherapy.

• LABAs have been recommended as adjunctive therapy in children of more than 5 years of age who have asthma that is not controlled on step 2 therapy.

• Increasing the dose of ICSs is the preferred step-up therapy compared to add-on therapy with other agents in children <12 years of age.

• ICS+LABA is the preferred step-up therapy in children ≥ 12 years of age.

• Omalizumab is available as an add-on therapy for adults and children aged ≥ 12 years, with uncontrolled moderate-to-severe persistent allergic asthma. Only the European Medicines Agency authorized omalizumab in children under 12 years of age (at least 6 years old) and above, when having allergic asthma with frequent severe exacerbations, not controlled by the combination of ICSs and LABAs.

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Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.