Imperial College London
Alternate

ProfessorSejalSaglani

Faculty of Medicine, National Heart & Lung Institute

Professor of Paediatric Respiratory Medicine
 
 
 
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Contact

 

+44 (0)20 7594 3167s.saglani

 
 
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Location

 

112Sir Alexander Fleming BuildingSouth Kensington Campus

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Summary

 

Publications

Citation

BibTex format

@article{Selby:2019:10.1097/ACI.0000000000000521,
author = {Selby, L and Saglani, S},
doi = {10.1097/ACI.0000000000000521},
journal = {Current Opinion in Allergy and Clinical Immunology},
pages = {132--140},
title = {Severe asthma in children: therapeutic considerations},
url = {http://dx.doi.org/10.1097/ACI.0000000000000521},
volume = {19},
year = {2019}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Purpose of review Children with poor asthma control despite maximal maintenance therapy have problematic severe asthma(PSA). A step-wise approach including objective adherence monitoring and a detailed multidisciplinaryteam assessment to identify modifiable factors contributing to poor control is needed prior to consideringtherapy escalation. Pathophysiological phenotyping in those with true severe therapy-resistant asthma(STRA) and the current array of add-on therapies will be discussed.Recent findingsAdherence monitoring using electronic devices has shown that only 20–30% of children with PSA haveSTRA and need additional therapies. Omalizumab and mepolizumab are licensed for children with STRAaged 6 years and older. Although robust safety and efficacy data, with reduced exacerbations, areavailable for omalizumab, biomarkers predicting response to treatment are lacking. Paediatric safety dataare available for mepolizumab, but efficacy data are unknown for those aged 6–11 years and minimal forthose 12 years and older. A sub-group of children with STRA have neutrophilia, but the clinicalsignificance and contribution to disease severity remains uncertain.SummaryMost children with PSA have steroid sensitive disease which improves with adherence to maintenanceinhaled corticosteroids. Add-on therapies are only needed for the minority with STRA. Paediatric efficacydata of novel biologics and biomarkers that identify the optimal add-on for each child are lacking. If weare to progress toward individualized therapy for STRA, pragmatic clinical trials of biologics in accuratelyphenotyped children are needed.
AU  - Selby,L
AU  - Saglani,S
DO  - 10.1097/ACI.0000000000000521
EP  - 140
PY  - 2019///
SN  - 1473-6322
SP  - 132
TI  - Severe asthma in children: therapeutic considerations
T2  - Current Opinion in Allergy and Clinical Immunology
UR  - http://dx.doi.org/10.1097/ACI.0000000000000521
UR  - https://journals.lww.com/co-allergy/fulltext/2019/04000/Severe_asthma_in_children__therapeutic.10.aspx
UR  - http://hdl.handle.net/10044/1/67203
VL  - 19
ER  -
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