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Asthma
Recent Discoveries in Preventing and Controlling Childhood Asthma
Edward Dompeling,
1
Quirijn Jöbsis
1
and Onno van Schayck
2
1. Department of Paediatric Pulmonology; 2. Director, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre
Abstract
Asthma in children is a complex disease with different phenotypes. In spite of considerable progress in several aspects of asthma
management and treatment in the past 30 years, several problematic issues remain. The purpose of this article is to summarise some of
the recent discoveries in preventing and controlling childhood asthma and to indicate new developments and areas for improvement. The
prevalence of asthma in the past three decades has risen considerably, whereas the results of several – mostly monofaceted – prevention
studies are disappointing. Can we prevent asthma at all? Are multifaceted interventions more effective than monofaceted? Overweight and
obesity have reached epidemic proportions worldwide. They are risk factors not only for cardiovascular disease and diabetes, but also for
the development of asthma and the aggrevation of already existing disease, which increases the necessity for an effective intervention
strategy in the coming years. Globally, there are large problems with the accurate diagnosis of asthma in pre-school children because of
various wheezing phenotypes. This contributes to undertreatment of ‘true asthmatic children’ and overtreatment of pre-school children
with ‘viral wheeze’ (also called ‘transient wheeze’). Are there new diagnostic techniques that have the potential to tackle this problem?
Another huge problem is the low level of asthma control in both children and adults worldwide. One of the likely reasons for this is that
although asthma is a disease with chronic airway inflammation, we do not routinely measure airway inflammation in clinical practice. This
article discusses some of the new non-invasive techniques that may help to improve the monitoring and thereby the control of the disease.
Keywords
Prevention, asthma, children, passive smoking, exhaled breath, exhaled breath condensate, allergen reduction, obesity, immunotherapy
Disclosure: The authors have no conflicts of interest to declare.
Received: 14 January 2009 Accepted: 10 June 2009
Correspondence: Edward Dompeling, Department of Paediatric Pulmonology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
edward.dompeling@mumc.nl
Asthma is the most common occurring chronic disease in childhood, five-fold increase in the prevalence of asthma was observed during this
with a prevalence of 5–10%.
1,2
The World Health Organization (WHO) period.
8
The reasons for this increase are poorly understood, as are
estimates that 300 million people currently suffer from asthma the reasons for a recent stabilisation or even a small decrease
worldwide, which makes it a major public health problem.
2
It is widely in prevalence. Are these changes in prevalence related to changes in
recognised that asthma has a multifactorial origin, with both genetic and diagnostic labelling, treatment, air pollution or allergen load?
environmental causes and important gene–environment interactions.
3
Nowadays, proper treatment of asthma is possible and modern The results of several prevention studies are disappointing. This
pharmacotherapy exists in the form of (long-acting) β
2
agonists, holds for both early intervention studies with inhaled corticosteroids
inhaled corticosteroids and leukotriene receptor antagonists.
1,4
The and prevention studies directed towards allergen reduction.
9–13
Can
consequences of childhood asthma for daily life are huge and comprise we prevent the development of asthma at all? What are the
respiratory complaints, diminished quality of life, disturbed physical characteristics of an effective intervention? Should we use
activities, school absence or work absence of the parents, extra visits to monofaceted or multifaceted interventions?
a doctor, emergency care visits and hospital admissions.
1,5
The financial
burden on patients with asthma in different western countries ranges There are large problems with the diagnosis of asthma, particularly at
from US$300 to US$1,300 per patient per year, mainly affecting those an early age.
14
Different wheezing phenotypes exist with differences
with severe disease.
6
Proper national and international guidelines are in prognosis. The largest group of children with wheeze at an early
available that describe adequate treatment in a stepwise manner.
1,4
The age is symptom-free six years of age.
15
So far, it is very difficult to
purpose of treatment is optimal asthma control.
1
However, despite distinguish this group with ‘transient or viral-associated wheeze’
marked progress in several aspects of asthma management and from a persistent type of bronchial asthma. However, such a
treatment in the past 30–50 years, several problematic issues remain. distinction is very important for management and treatment of these
groups. What new developments do we have to discriminate
In the past 30 years, a marked increase in the prevalence of asthma was between these wheezing phenotypes and to adjust our treatment on
observed in many Western countries worldwide.
7
In The Netherlands, a an individual basis?
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