Airway reactivity, atopy, cytokine production by stimulated PBMCs, and the number of dendritic cells contribute to the risk of recurrent wheezing and airway hyperreactivity in early life (24).
Allergic rhinitis in preschool children is a predictor for subsequent wheezing onset, but the association is not attributable to the type of sensitization, the severity of sensitization or atopic dermatitis in early life (26).
Remission of childhood asthma in adolescence is infrequent and not affected by long-term anti-inflammatory controller therapy. Factors such as sensitization and exposure, low lung function, and airway greater hyperresponsiveness decrease the likelihood of remitting asthma (29).
Previously reported effects of acetaminophen on asthma are confounded by increased respiratory tract infection morbidity in asthma susceptible children (34, 35). Studies are needed to assess the appropriate antipyretic therapy for managing fever in children who have established asthma.
Genes involved in the development and function of regulatory T cells, specifically IL2RA, TLR2, TGFBR2, and FOXP3, are associated with atopy and asthma by gene-gene interaction (37).
Multiple-trigger wheeze in young children is associated with pulmonary function abnormalities independent of atopic and current wheeze status (43).
Urinary LTE4/FeNO ratio predicts a better response to montelukast than fluticasone propionate in school-aged children with mild-to-moderate asthma (52).
Severe asthma includes three types of patients: 1) untreated severe asthma, 2) difficult-to-treat severe asthma and 3) treatment-resistant severe asthma (64). These terms classify patients based on their responsiveness to available medications and prompt development of new types of interventions.
Children demonstrate differential responses to Step 3 therapy, with best response more than one-and-a-half times as likely with LABA step-up. However, many children demonstrate best response to ICS or LTRA step-up, highlighting the importance of continually re-evaluating an individual child’s response to therapy (68).
Airway hyper-responsiveness to mannitol is less sensitive but more specific than methacholine in diagnosing asthma and is more closely associated with ongoing airway inflammation (99). Therefore, mannitol complements but does not substitute for the methacholine challenge.
Tiotropium bromide when added to an inhaled glucocorticoid, improves symptoms and lung function in adult patients with inadequately controlled asthma (106). Its effects appear to be equivalent to those with the addition of salmeterol. However, further studies in adults and children are needed to establish its position in the treatment of asthma.
Corticosteroid use and worsening airflow limitation are associated with lower vitamin D serum levels in asthmatic patients (109). Vitamin D enhances glucocorticoid action in PBMCs from asthmatic patients and can enhance the immunosuppressive function of dexamethasone.
OM-85 BV (Broncho-Vaxom; OM Pharma, Meyrin/Geneva, Switzerland), an immunostimulant extracted from 8 bacterial pathogens of the upper respiratory tract, reduces the rate and duration of wheezing attacks in preschool children with acute respiratory tract illnesses (112).
The number of underinsured children exceeds the number of children without insurance (115). Access to health care and the quality of health care are suboptimal for both uninsured and underinsured children.
