Severe Asthma in Pediatric Patients. Pathophysiology and Unmet Needs.

Recent statistics have shown that asthma deaths and hospitalizations are decreasing, but there are unmet challenges in the management of severe asthma in children. Current asthma management is focused on achieving asthma control through an effort to minimize asthma impairment via specifically addressing factors that affect day-to-day symptoms, and minimizing the risk of future asthma-related events, such as asthma exacerbations, disease progression, and adverse effects to medications. New targeted medications have been developed for which therapeutic responses have been correlated with specific biomarkers; for example, sputum or blood eosinophil count with anti-IL-5 therapy and serum periostin with anti-IL-13 therapy. These drugs hold great promise, but will likely be expensive alternatives to traditional asthma therapy. There is a growing need to address the age-specific challenges in the management of subjects with asthma from the young to the very old. In the future, it will be important to develop strategies to prevent the development of asthma and, in children with the disease, to maximize the appropriate use of, and adherence to, the available medications before considering more expensive alternatives. To do this, we will need to standardize and harmonize medical care, while improving communication and setting up systems of collaboration. If executed effectively, this effort should have a marked impact on reducing the prevalence of asthma in the future and the consequent burden of asthma on society.