Asthma Across the Lifespan: Time for a Paradigm Shift

Publication date: Available online 5 April 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Stanley J. Szefler
We have a unique opportunity to significantly reduce the worldwide burden of asthma in children and impact respiratory outcomes in adults. However, this will require a paradigm shift that is directed at altering the natural history of asthma, reducing asthma exacerbations and preventing long-term adverse outcomes of childhood asthma. Attention should continue to be directed toward minimizing risk as well as impairment with a goal to achieve optimal control. Based on several NIH studies conducted over the last 10 years we now have the tools necessary to accomplish this goal. The tools include: assessment of lung function over time or defining trajectories of lung growth, the Composite Asthma Severity Score (CASI), a panel of useful biomarkers, the Seasonal Asthma Exacerbation Prediction Index (SAEPI), and rapidly advancing technology that includes adherence monitoring. Future guidelines revisions should consider incorporating recommendations to follow spirometry over time and defining trajectories of lung growth to assess risk for reduced lung growth and early decline, asthma burden, using biomarkers to select and monitor therapy, assessing social determinants of health, evaluating risk for seasonal exacerbations, and consideration of electronic adherence monitoring for asthma that is difficult to manage. Guidelines should continue to include a core dedicated to the diagnosis and treatment of intermittent and mild and moderate persistent asthma and include additional sections dedicated to the management of severe asthma.



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