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What is new in the management of childhood asthma?

  • Symposium on Advances in Therapy
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Abstract

The prevalence of asthma has increased in developed countries. The efficacy of available drugs in those with severe persistent disease is limited. This has led to a renewed search for the reasons for failures of the existing treatment and for novel concepts. Treatment with inhaled corticosteroids, and to a much lesser extent theophylline, can reduce the survival of inflammatory cells including esinophils. Emerging trends in treatments for asthma could include strategies to alter the cytokine/chemokine balance. It is evident that the current ICS are already very efficient and safe, it will be difficult to introduce further improved formulations. Perhaps the most fruitful effort shall be in developing patient friendly easy to use targeted delivery systems. The newer therapies are planned for the several upstream targets and may have potential to prevent the disease. Various potential therapies are being worked upon like-targeting prevention of T cell activation, modulation of Th-1/Th-2 differentiation, inhibition of Th-2 related cytokines, Th-1/Th-2 modulation, inhibition of downstream mediators etc. The new strategy shall perhaps lie with matching the patients and their disease with the most suitable therapy.

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References

  1. Bush A. Phenotype specific treatment of asthma in childhood. Pediatric Respir Reviews 2004; 5: S93–S101.

    Article  Google Scholar 

  2. Bousquet J, Jeffery PK, Busse WW et al. Asthma. From bronchoconstriction to airways inflammation and remodeling. Am J Respir Crit Care Med 2000; 161: 1720–1745.

    PubMed  CAS  Google Scholar 

  3. Pahl A, Szelenyi I. Asthma therapy in the new millennium. Inflamm Res 2002; 51: 273–282.

    Article  PubMed  CAS  Google Scholar 

  4. Mimi LK, Collin, P. Childhood asthma as an allergic disease: rationale for the development of future treatment. Eur J Pediatr 2001; 160: 696–704.

    Google Scholar 

  5. Holt Shaun, Suder Aneta, Weatherall Mark, Cheng Soo, Shirtcliffe Philippa, Beasley Richard. Dose-response relation of inhaled fluticasone propionate in adolescents and adults with asthma: meta-analysis. BMJ 2001; 323: 1–8.

    Article  Google Scholar 

  6. Todd GR, Acerini CL, Ross-Russell R et al. Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom. Arch Dis Child 2002; 87: 457–461.

    Article  PubMed  CAS  Google Scholar 

  7. Paton J, Jardine E, McNeill E et al. Adrenal responses to low dose synthetic ACTH (Synacthen) in children receiving high dose inhaled fluticasone. Arch Dis Child 2006; 91: 808–813.

    Article  PubMed  CAS  Google Scholar 

  8. Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2007. Available from: http://www.ginasthma.org.

  9. Barnes PJ, Pedersen S, Busse WW. Efficacy and Safety of Inhaled Corticosteroids New Developments. Am J Respir Crit Care Med 1998; 157: S1–S53.

    PubMed  CAS  Google Scholar 

  10. Biggadike K, Uings Iain, Farrow Stuart N. Designing Corticosteroid Drugs for Pulmonary Selectivity. Proc Am Thorac Soc 2004; 1: 352–355.

    Article  PubMed  CAS  Google Scholar 

  11. Edsbäcker S, Brattsand R. Budesonide fatty acid esterification: a novel mechanism prolonging binding to airway tissue. Review of available data. Am Allergy Asthma Immunol 2002; 88: 609–616.

    Article  Google Scholar 

  12. Vayssie’re BM, Dupont S, Choquart A, Petit F, Garcia T, Marchandeau C et al. Synthetic glucocorticoids that dissociate transactivation and AP-1 transrepression exhibit antiinflammatory activity in vivo. Mol Endocrinol 1997; 11: 1245–1255.

    Article  CAS  Google Scholar 

  13. Coghlan MJ, Jacobson PB, Lane B, Nakane M, Lin CW, Elmore SW et al. A novel anti-inflammatory maintains glucocorticoid efficacy with reduced side effects. Mol Endocrinol 2003; 17: 860–869.

    Article  PubMed  CAS  Google Scholar 

  14. Belvisi MG, Wicks SL, Battram CH, Bottoms SEW, Redford JE, Woodman P et al. Therapeutic benefit of a dissociated glucocorticoid and the relevance of in vitro separation of transrepression from transactivation activity. J Immunol 2001; 166: 1975–1982.

    PubMed  CAS  Google Scholar 

  15. Agertoft L, Laulund LW, Harrison LI, Pedersen S. Influence of particle size on lung deposition and pharmacokinetics of beclomethasone dipropionate in children. Pediatr Pulmonol 2003; 35: 192–199.

    Article  PubMed  CAS  Google Scholar 

  16. Ederle K. Improved control of asthma symptoms with a reduced dose of HFA-BDP extrafine aerosol: an open-label, randomised study. Eur Rev Med Pharmacol Sci 2003; 7: 45–55.

    PubMed  CAS  Google Scholar 

  17. Hochhaus Günther. New Developments in Corticosteroids. Proc Am Thorac Soc 2004; 1: 269–274.

    Article  PubMed  CAS  Google Scholar 

  18. Helgo Magnussen Novolizer: How does it fit into inhalation therapy? Curr Medic Research Opinion 2005; 21, S39–46.

    Article  CAS  Google Scholar 

  19. Barnes Peter J. Theophylline New Perspectives for an Old Drug. Am J Respir Critic Care Medi 2003; 167: 813–818.

    Article  CAS  Google Scholar 

  20. Karish Sarah B, The Potential Role of Roflumilast: The New Phosphodiesterase-4 Inhibitor. Annals Pharmacotherapy 2006; 40: 1096–1104.

    Article  CAS  Google Scholar 

  21. Sankar Jhuma, Lodha Rakesh, Kabra SK. Doxofylline: The next generation methylxanthine. Ind J Pediatrics 2008; 75: 251–254.

    Article  Google Scholar 

  22. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma-Full Report, 2007 as Ndownloaded in June 2008from http://www.nhlbi.nih.gov/guidelines/asthma/index.htm

  23. The American Lung Association Clinical Research Centers. Randomized comparisons of strategies for reducing treatment in mild persistent asthma. N Engl J Med 2007; 356: 2027–2039.

    Article  Google Scholar 

  24. Mansfield Lyndon E. The future of the long-acting betaadrenergic bronchodilators in the treatment of asthma. Allergy Asthma Proc 2008; 29: 103–108.

    Article  PubMed  CAS  Google Scholar 

  25. Stirling RG, Chung KF. Future treatments of allergic diseases and asthma. Bntish Medical Bulletin 2000;56: 1037–1053

    Article  CAS  Google Scholar 

  26. Tamaoki J, Kondo M, Sakai N et al. Effect of Suplatast tosilate, a TH2 cytokine inhibitor, on steroid-dependent asthma: a double blind randomised study. Lancet 2000; 356: 273–278.

    Article  PubMed  CAS  Google Scholar 

  27. Kon OM, Sihra BS, Compton CH, Leonard TB, Kay AB, Barnes NC. Randomised, doseranging, placebo-controlled study of chimeric antibody to CD4 (keliximab) in chronic severe asthma. Lancet 1998; 352: 1109–1113.

    Article  PubMed  CAS  Google Scholar 

  28. Jaffe HA, Buhl R, Mastrangeh A et al. Organ specific cytokine therapy. Local activation of mononuclear phagocytes by delivery of an aerosol of recombinant interferon-gamma to the human lung. Clm Invest 1991; 88: 297–302.

    Article  CAS  Google Scholar 

  29. Boguniewicz M, Schneider LC, Milgrom H et al. Treatment of steroid-dependent asthma with recombinant interferongamma. Clm Exp Allergy 1993; 23: 785–790.

    Article  CAS  Google Scholar 

  30. O’Connnor B, Hansel T, Holgate S, Barnes P. Effects of recombinant human IL-12 on allergen induced airway inflammation and the late response. Am J Resptr Cnt Care Med 2000; 161: A592.

    Google Scholar 

  31. Boushey HA. New and Exploratory Therapies for Asthma Chest 2003; 123: 439S–445S.

    Article  PubMed  CAS  Google Scholar 

  32. Hill S, Herlaar E, Le Cardinal A, van Heeke G, Nicklin P. Homologous human and murine antisense oligonucleotides targeting Stat6. Functional effects on germline c-epsilon transcript. Am J Respir Cell Mol Biol 1999; 21: 728–737.

    PubMed  CAS  Google Scholar 

  33. Kips JC, O’Connor BJ, Langley SJ et al. Results of a phase I trial with SCH55700, a humanized anti-IL-5 antibody, in severe persistent asthma. Am J Respir Crit Care Med 2000; 161: A505.

    Google Scholar 

  34. Gregory B, Kirchem A, Rankin S et al. Exposure of human eosinophils to IL-5 down-regulates IL-5R and IL-5 responsiveness: a possible explanation for relative resistance of airway eosinophils to anti-IL-5 therapy [abstract]. Am J Respir Crit Care Med 2002; 165: B50

    Google Scholar 

  35. Flood-Page, O, Menzies-Gow, A, Phipps, S et al Reduction of tissue eosinophils in mild atopic asthmatics by an anti-IL-5 monoclonal antibody (mepolizumab) is associated with inhibition of tenascin deposition within the bronchial epithelial basement membrane [abstract]. Am J Respir Crit Care Med 2002; 165: B42.

    Google Scholar 

  36. Farooqi IS, Hopkin JM. Early childhood infection and atopic disorder. Thorax 1998; 53: 927–932.

    Article  PubMed  CAS  Google Scholar 

  37. Wang Li-Chieh, Lee Jyh-Hong, Yang Yao-Hsu, Lin Yu-Tsan, Chiang Bor-Luen New Biological Approaches in Asthma: DNA-Based Therapy. Current Medicinal Chemistry 2007; 14: 1607–1618.

    Article  PubMed  CAS  Google Scholar 

  38. Gauvreau GM, Hessel EM, Boulet LP, Coffman RL, O’Byrne PM. Immunostimulatory sequences regulate interferoninducible genes but not allergic airway responses. Am J Respir Crit Care Med 2006 174: 15–20.

    Article  PubMed  CAS  Google Scholar 

  39. Chang TW. The pharmacological basis of anti-IgE therapy. Nat Biotechnol 2000; 18: 157–162

    Article  PubMed  CAS  Google Scholar 

  40. Soler M, Matz J, Townley R et al. The anti-IgE antibody omalizumab reduces exacerbations and steroid requirement in allergic asthmatics. Eur Respir J 2001; 18: 254–261.

    Article  PubMed  CAS  Google Scholar 

  41. Milgrom H, Berger W, Nayak A, Gupta Niroo, Pollard Stephen et al. Treatment of childhood asthma with antiimmunoglobulin E antibody (omalizumab). Pediatrics 2001; 108: e36

    Article  PubMed  CAS  Google Scholar 

  42. XOLair FDA alert as downloaded June 2008 from their website http://www.fda.gov/cder/drug/InfoSheets/HCP/omalizumabHCP.pdf

  43. Holgate S. Adenosine provocation: a new test for allergic type airway inflammation. Am J Respir Crit Care Med 2002; 165: 317–318.

    PubMed  Google Scholar 

  44. Ali, S, Leonard SA, Kukoly CA, Metzger WJ, Wooles WR, McGinty JF et al. Absorption, Distribution, Metabolism, and Excretion of a Respirable Antisense Oligonucleotide for Asthma. Am J Respir. Crit Care Med 2001; 163: 989–993.

    PubMed  CAS  Google Scholar 

  45. Nyce, J. Respirable antisense oligonucleotides: a new, third drug class targeting respiratory disease. Immunotherapy Current Opinion Allergy & Clinical Immunology 2002; 2: 533–536.

    Article  Google Scholar 

  46. Nyce JW, Metzger WJ. DNA antisense therapy for asthma in an animal model. Nature 1997; 385: 721–725.

    Article  PubMed  CAS  Google Scholar 

  47. Lechin F, van der Dijs Bertha, Lechin A E,. Boushey H A Tianeptine: A New exploratory Therapy for Asthma. Chest 2004; 125: 348–349.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Lady Hardinge Medical College and Assoc Kalawati Saran Children’s Hospital, New Delhi, India

    Varinder Singh

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  1. Varinder Singh
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Correspondence to Varinder Singh.

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Singh, V. What is new in the management of childhood asthma?. Indian J Pediatr 75, 845–853 (2008). https://doi.org/10.1007/s12098-008-0157-8

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  • DOI: https://doi.org/10.1007/s12098-008-0157-8

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