Elise M Slob1,2, Anke-Hilse Maitland-Van der Zee1,2, Gerard H Koppelman3,4, Mariëlle W Pijnenburg5. 1. Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam. 2. Pediatric Respiratory Medicine, Emma Children's Hospital, Amsterdam UMC, Amsterdam. 3. Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital. 4. Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen. 5. Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC - Sophia, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Abstract
PURPOSE OF REVIEW: Childhood asthma is a heterogeneous disease and many children have uncontrolled disease. Therefore an individualized approach is needed to improve asthma outcomes in children. Precision medicine using clinical characteristics, biomarkers, and the rapidly involving field of genomics and pharmacogenomics aims to achieve asthma control and reduce future risks with less side-effects in individual children with asthma. RECENT FINDINGS: It is not yet possible to select treatment options on clinical characteristics. Novel monoclonal antibodies are efficacious in patients with severe, eosinophilic asthma. Reduced lung function growth and early decline is a prevalent finding in children with persistent asthma. Pharmacogenetic studies have identified children at risk for cortisol suppression when using inhaled corticosteroids. SUMMARY: Clinical characteristics and simple biomarkers like eosinophils, IgE, and the fraction of exhaled nitric oxide may be used in clinical practice for a basic precision medicine approach, deciding which children will have the best chance to respond to inhaled corticosteroids and to the biologicals omalizumab and mepolizumab.Further application of pharmacogenomics and breathomics needs additional studies before they can be applied as tools for precision medicine in individual children with asthma.
PURPOSE OF REVIEW: Childhood asthma is a heterogeneous disease and many children have uncontrolled disease. Therefore an individualized approach is needed to improve asthma outcomes in children. Precision medicine using clinical characteristics, biomarkers, and the rapidly involving field of genomics and pharmacogenomics aims to achieve asthma control and reduce future risks with less side-effects in individual children with asthma. RECENT FINDINGS: It is not yet possible to select treatment options on clinical characteristics. Novel monoclonal antibodies are efficacious in patients with severe, eosinophilic asthma. Reduced lung function growth and early decline is a prevalent finding in children with persistent asthma. Pharmacogenetic studies have identified children at risk for cortisol suppression when using inhaled corticosteroids. SUMMARY: Clinical characteristics and simple biomarkers like eosinophils, IgE, and the fraction of exhaled nitric oxide may be used in clinical practice for a basic precision medicine approach, deciding which children will have the best chance to respond to inhaled corticosteroids and to the biologicals omalizumab and mepolizumab.Further application of pharmacogenomics and breathomics needs additional studies before they can be applied as tools for precision medicine in individual children with asthma.
Authors: William J Sheehan; Rebecca Z Krouse; Agustin Calatroni; Peter J Gergen; James E Gern; Michelle A Gill; Rebecca S Gruchalla; Gurjit K Khurana Hershey; Meyer Kattan; Carolyn M Kercsmar; Carin I Lamm; Frederic F Little; Melanie M Makhija; Daniel A Searing; Edward Zoratti; William W Busse; Stephen J Teach Journal: J Allergy Clin Immunol Pract Date: 2020-05-04