title: The need to differentiate between adults and children when treating severe asthma.
abstract: Severe asthma at all ages is heterogeneous incorporating several phenotypes that are distinct in children and adults, however, there are also numerous similar features including the limitation that they may not remain stable longitudinally. Severe asthma in both children and adults is characterized by eosinophilic airway inflammation and evidence of airway remodeling. In adults, targeting eosinophilia with anti-IL-5 antibody therapy is very successful, resulting in the recommendation that sputum eosinophils should be used to guide treatment. In contrast, data for the efficacy of blocking IL-5 remain unavailable in children. However, its effectiveness is uncertain since many children with severe asthma have normal blood eosinophils and the dominance of Th2-mediated inflammation is controversial. Approaches that have revealed gene signatures and biomarkers such as periostin that are specific to adult disease now need to be adopted in children to identify effective pediatric specific therapeutics and minimize the extrapolation of adult therapeutics to children.
authors.affiliation: Leukocyte Biology and Respiratory Paediatrics, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Valentina
authors.initials: V
authors.lastname: Fainardi
authors.forename: Sejal
authors.initials: S
authors.lastname: Saglani
mesh_terms: D000328:Adult; D000367:Age Factors; D056151:Airway Remodeling / Q000276:immunology; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000276:immunology; D002648:Child; D004802:Eosinophilia / Q000188:drug therapy* / Q000276:immunology; D004804:Eosinophils / Q000276:immunology; D006801:Humans
chemical_list: D018927:Anti-Asthmatic Agents
keywords: asthma phenotype; early-onset asthma; innate cytokines; lung development; severe asthma; steroid resistance