Introduction for this Issue's Commentaries: Asthma, COVID-19, and the Future

As COVID-19 continues to ravage our planet, and our scientists rise up to the challenge with diligence and devotion, and our medical community continues to demonstrate selfless courage, generosity, and personal sacrifice, I am again reminded by Albert Camus's protagonist Dr. Bernard Rieux in The Plague: “I have no idea what is awaiting me, or what will happen when this all ends. For the moment I know this: there are sick people and they need curing.” And curing is what our mission has been and continues to be. As respirologists, we need to continue caring for our COVID-19 and non-COVID-19 patients. In this issue of the journal, we are fortunate to have three outstanding commentaries. One by Prof. Ciprandi and his colleagues from the Italian Society of Pediatric Allergy and Immunology COVID-19 Commission. As Italy was one of the first western countries to experience this scourge, we are grateful for their shared experience in which they describe the use of biologics in children with asthma and allergies, which suggests continuing biological therapy in patients with severe allergic diseases, but stopping it after contracting COVID-19. Two other commentaries are also thought-provoking, in which Prof. Andrew Bush from the Imperial College, London, and Prof. Gerry Teague from the University of Virginia, provide reflections on addressing severe asthma in pediatrics. Prof. Bush advocates moving from descriptive phenotypes to clinically relevant endotypes that allows proper and specific therapy. It calls upon our current and future generations of respirologists to keep looking for answers and not just follow the herd mentality. This commentary is an elegant analysis that has tremendous implications for our specialty. It shed so much needed light on the issue and the health care consequences of just accepting descriptive diagnosis. These children continue to have serious health care utilization, and other functional consequences from underestimation and lack of knowledge of their true pathology. Prof. Teague advises the reader to consider also endotyping by looking at lung granulocyte pattern and to rule out other disorders before committing a child with severe asthma to a biologic treatment. He encourages the readers to also consider the social determinants of health such as poverty, racial disparity, nonadherence, and insurance barriers in assessing asthma outcomes and to improve children's respiratory health: “unless the chasm separating expensive biologics and the financial priorities of the health care consumer is bridged, many deserving children will go un-treated” concludes Prof. Teague.