30 Apr 26
As a chronic lung disease with increasing prevalence in childhood, asthma represents a significant challenge when it comes to early diagnosis and monitoring. The main issues can be divided into four categories:
In this article, we explore the current status and limitations of guidelines used for asthma management in children, with a focus on different asthma phenotypes and current diagnostic and therapeutic approaches.
Asthma is a chronic respiratory disease characterized by reversible bronchoconstriction and inflammation of the bronchi. Narrowing of the airways, along with increased mucus production, obstructs normal airflow, trapping air and preventing adequate ventilation of the alveoli. This leads to an increased work of breathing, with symptoms such as wheezing, chest tightness, and shortness of breath.
Asthma presents with a wide range of phenotypic features influenced by genetic factors, environmental triggers, and comorbidities. Although the underlying mechanisms of asthma are relatively well understood, its development remains difficult to predict and classify.
Different phenotypes and endotypes are associated with different triggers, but they do not consistently predict prognosis, and airway inflammation may vary over time. This variability represents a major obstacle, particularly for early diagnosis.
Today, the most common clinical phenotype in children is allergic asthma, in which inflammation is triggered by airborne allergens. When particles such as dust, pollen, pet dander, or mold are inhaled, they activate a complex immune response in the airway mucosa.
Other triggers include viral infections, physical exercise, certain medications, cigarette smoke, and changes in humidity, although these are more commonly associated with asthma onset later in life.
Asthma diagnosis in both children and adults primarily relies on lung function tests, such as spirometry, which measure parameters like FVC and FEV1 to detect reversible bronchoconstriction.
However, diagnosing asthma in children can be particularly challenging, as these tests require patient cooperation. Younger children may have difficulty understanding instructions or may feel anxious and unwilling to perform the tests properly.
To address this limitation, alternative methods such as forced oscillation techniques are being explored. These assess airway resistance rather than airflow and require less active cooperation. However, standardized cutoff values for children are still lacking. Other emerging diagnostic tools, such as light plethysmography, show promise but are not yet widely available. Additional approaches include assessing airway inflammation and hypersensitivity.
Despite these advances, the need for reliable biomarkers and child-friendly diagnostic methods remains, making pediatric asthma diagnosis an ongoing challenge.
Treating asthma in children is challenging because it requires both long-term control and rapid symptom relief. Current strategies focus on two main types of medication:
International guidelines (GINA) recommend a stepwise approach, adjusting treatment according to symptom severity and frequency.
However, treatment is often complicated by poor adherence. This may be due to parental concerns about medication safety or inconsistent use among adolescents. While advanced therapies, including combination treatments and biologic drugs, are available for severe cases, their effectiveness varies and requires careful patient selection.
Overall, managing childhood asthma requires a personalized approach that considers symptom variability, adherence, and the limitations of current evidence.
Once asthma is diagnosed, regular follow-up is essential for long-term disease management. This includes periodic clinical assessments and monitoring for partially controlled or uncontrolled asthma.
Follow-up typically involves annual specialist visits, with more frequent evaluations in cases of difficult-to-control asthma. If treatment is ineffective, potential comorbidities or misdiagnoses should also be considered.
In addition to lung function testing, tools such as asthma control questionnaires, educational programs, and digital health solutions can support disease management. E-diaries and mobile applications, in particular, can help patients and caregivers monitor symptoms more consistently.
