In children at high risk for development of asthma, HRV-induced wheezing in infancy resulted to be the strongest predictor of doctor diagnosed asthma at age 6 years 28 , In addition to viral causes, some studies suggested that infections by atypical bacterial, such as Mycoplasma pneumoniae and Chlamydia pneumonia , may play a role in inducing and exacerbating asthma 30 , The increased asthma prevalence in metropolitan areas with respect to rural ones and, overall, in industrialized countries, highlighted the role of air pollution in asthma inception Exposure to both outdoor and indoor pollutants has been associated with increased asthma exacerbations, rates of hospitalization and reduced lung function 32 — Even though a cross-sectional study on 5 European birth cohorts recently showed no associations between air pollutants exposure and asthma prevalence 35 , a European population-based birth cohort study on more than 14, children found that increasing exposure to nitric dioxide NO 2 and particulate matter with a diameter of less than 2.
Further evidence comes from a meta-analyses of birth cohort studies showing that increased childhood exposure to PM 2.
Pediatric Asthma Treatment at National Jewish Health
The most dangerous environmental exposure in children derives from Environmental Tobacco Smoke ETS , which is universally recognized as a major risk factor for asthma. Exposure to prenatal and early postnatal passive smoke may have adverse effect on both the immune system and the structural and functional development of the lung; this may explain the subsequent increased risk of incident asthma Exposure to ETS at school age is associated with an increased risk of severity and exacerbations and may be considered a risk factor for asthma persistence in later life In recent years increasing interest raised the novel concept of Third-Hand Smoke THS , the combination of tobacco smoke pollutants which remain in an indoor environment after tobacco has been smoked.
Since infants and children are prone to the risks related to THS exposure, investigations are warranted to study the health effects of THS relevant to different exposure pathways and profiles occurring also in pre-natal life Lastly, a new threat to the respiratory health of children and adolescents has been raised from the spread of electronic cigarettes, the most commonly used tobacco product among adolescents Recent studies have shown an association with asthma symptoms in adolescents 42 , Further research on the health effects of electronic cigarettes is advised.
Asthma can appear at any stage throughout life, but it generally develops in childhood Therefore, asthma can be considered a lifelong disease with a major burden especially in subjects suffering from severe asthma.
This health gap measure can be considered as the sum of two components: years of life lost plus years lived with disability YLDs The latter measure is calculated as the prevalence of each disease sequela multiplied by the disability weight for that sequela. Asthma was the 14th highest ranked cause of global YLDs at all ages, but specific data for children were not available In the GBD , it accounted for 1.
Mortality for asthma is relatively low at all ages. In Europe, asthma is responsible for 0. In the GDB , a decrease of The decrease in age-standardized death rates was The greatest decrease was observed in HICs, reflecting a better access to health services as well as better treatment options following international guidance 1. Asthma mortality in children is low and is significantly associated with symptoms prevalence and hospital admissions Hence, when comparing childhood asthma mortality between countries, any reduction in prevalence has to be taken into account. Over recent years, asthma mortality in children decreased across Europe, with little difference between countries.
This would be attributable to a better control of symptoms due to improvements in treatment of asthma attacks together with the more widespread use of inhaled corticosteroids which have been shown to reduce mortality at all ages Asthma is a chronic condition that can assume different severity degrees throughout patient's life, with significant social impact and economic burden.
Treating Asthma in the Pediatric Population
In fact, this disease can be associated with limitations on physical and social aspects of daily life of children and their caregivers, especially when symptoms are not controlled 3. Overall, global asthma-related costs are high and significantly vary across countries, depending on several factors, such as the type of health system, financial resources on Public Health and methods of data collection Usually, asthma-related costs are classified into direct, indirect and intangible costs Figure 2.
In children and adolescents with asthma the number of outpatient visits as well as the number of visits to emergency services is higher than in non-asthmatics, increasing according to the disease severity degree Asthma is one of the main causes of hospitalization in children which are usually at least twice than in adults. Medications account for variable costs, which differ across countries depending on health system and public or private insurance coverage Greater use of asthma drugs, particularly inhaled steroids, occurred in recent years globally increased costs related to asthma medications Figure 2.
Socio-economic cost of childhood asthma: direct, indirect, and intangible costs. Indirect costs include work-related losses and early mortality. Although loss of working days is not directly applicable in children, absenteeism from school is a comparable consequence. Intangible costs are unquantifiable, since they are related to impairment of quality of life, limitation of physical activities, and study performance, with consequent psychological effects such as depression and anxiety. Nonetheless, the social burden of asthma is considerable, not only for the child but also for parents.
Therefore, when assessing quality of life in asthmatic children, it is important also to assess the quality of life of the caregivers During last decades, asthma prevalence has been increasing worldwide.
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As a chronic condition that usually starts in early childhood, it imposes a high lifetime burden on individuals, their caregivers and the community. Despite significant progress in health care reached in last decades, there are still consistent disparities between countries. Children from LMICs particularly suffer a disproportionately higher burden in terms of morbidity and mortality The implementation of strategies aimed at early detect asthma thus providing access to the proper treatment has been shown to effectively reduce the burden of the disease The Global Asthma Network GAN was established in as a collaboration between individuals from ISAAC and the International Union Against Tubercolosis and Lung Disease in order to globally improve asthma care through enhanced surveillance, research collaboration, funding and capacity building, access to medical care and quality-assured essential medicines, and education of health professionals and public In countries with a high prevalence of current wheeze, adopting an asthma strategy was significantly more common than what occurred in low prevalence countries.
This may be due to lack of interest or to difficulties in engaging in world-wide epidemiological studies.
However, extension of asthma strategies in all countries is strongly recommended, since such an approach could have a big impact on the burden of the disease, by decreasing severity and improving symptoms control In this perspective, asthma, as other non-communicable chronic respiratory diseases, must be included in the agenda of each national authority. It is therefore important that monitoring of prevalence and severity continue globally. Further studies focusing on estimates of asthma costs are warranted, especially in LMICs. Moreover, standard methods of data collection are desirable in order to obtain comparable information from different countries 2.
Finally, future asthma research should integrate both pediatric and adult populations in longitudinal studies, with the aim of better understand the role of risk and protective factors on disease onset and severity throughout life 1 , 62 , GF and SL provided substantial contributions to the conception or design of the work, revised the manuscript for important intellectual content, approved the final version, and agreed to be accountable for all aspects of the work.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, — a systematic analysis for the Global Burden of Disease Study Lancet Respir Med.
Asher I, Pearce N.
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Global burden of asthma among children. Int J Tuberc Lung Dis. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention Available online at: www. Douwes J, Pearce N. Epidemiology of respiratory allergies and asthma.
In: Ahrens W, Pigeot I, editors. Handjournal of Epidemiology. New York, NY: Springer Uniform and conclusive definitions of pediatric asthma and pediatric asthma control are needed. Findings may also facilitate label modifications of certain therapies to include use in younger patients. Emerging therapies with novel targets and mechanisms of action also need to be studied in the pediatric patient population to ensure that therapy can be optimized for individual patients, regardless of age, disease severity, or endotype.
Studies that demonstrate efficacy of omalizumab in younger patients are needed and are planned. This unmet need may be addressed in part by the PARK study.
Earlier intervention with omalizumab in appropriate patients may reduce or prevent the use of corticosteroids, inhaled or systemic, to maintain control in a patient population that is particularly vulnerable to adverse events associated with ICS or OCS. Finally, it is widely acknowledged that there are many unmet needs which remain to be addressed in the management of pediatric asthma patients.
The authors acknowledge Pascal Pfister for his support during the development of this manuscript. David B. Michael D. Cabana reports personal fees from Novartis, Genentech, and ThermoFisher. Paulo M. Sharon D. Paolo M. Matricardi reports personal fees and grants from Novartis. All international expert clinicians and scientists received honoraria from Novartis for participation at the advisory board which led to the development of this manuscript.
All authors were involved in the conception, drafting, and critical review of this article. All authors approved the final version to be published and agree to be accountable for all aspects of this work. Volume 30 , Issue 1. The full text of this article hosted at iucr.
If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username. Pediatric Allergy and Immunology Volume 30, Issue 1. Papadopoulos Corresponding Author E-mail address: nikolaos.
Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access. Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Abstract Background Despite remarkable advances in our understanding of asthma, there are still several unmet needs associated with the management of pediatric asthma. Conclusions There is a need for a uniform definition of pediatric asthma, clearly distinguishable from adult asthma. Figure 1 Open in figure viewer PowerPoint.
GPs, general practitioners; PCPs, primary care physicians.
National and regional asthma programmes in Europe. Eur Respir Rev.
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