Long term management for severe asthma in children

Abstract

 Long term management for pediatric asthma centered on inhaled corticosteroid and leukotriene receptor antagonist has spread along with the dissemination of the Japanese pediatric guideline for the treatment and management a of asthma. As a result, the number of asthma-related death and hospitalized patients due to asthma attacks has decreased, and the quality of life of many children with asthma has been improved. Despite high-dose inhaled corticosteroid and combined therapy of multiple asthma medications, there are also children with severe asthma that cannot be adequately controlled. Recently, a humanized anti-IgE monoclonal antibody (omalizumab) and a humanized anti-IL-5 monoclonal antibody (mepolizumab) have been approved for use in pediatric severe asthma, and the effectiveness of these biological agents has been reported. On the other hand, some cases show persistent asthmatic symptoms even after the initiation of biological agents, and their pulmonary function or airway inflammatory markers cannot be improved. In addition, there is not enough evidence regarding the methods for tapering or discontinuation of the biological agents. Therefore, development of biomarkers to predict effectiveness as well as guidelines to select biological agents according to the endotypes are desirable for a proper treatment of pediatric severe asthma in the future.