Clinical phenotypes: Children

Teague, W. Gerald and Roberts, Graham (2019) Clinical phenotypes: Children. In, Chung, K Fan, Israel, Elliot, Gibson, Peter G. and Hurst, John R. (eds.) Severe Asthma. (ERS Monograph) Sheffield. European Respiratory Society, pp. 64-81. (doi:10.1183/2312508X.10023018).

Abstract

Severe asthma is a complex syndrome with heterogeneous clinical features that change with development. Pre-school children manifest a phenotype characterised by repeated episodes of multitrigger wheeze and sensitisation to environmental allergens. School-age children may manifest a phenotype of severe wheeze and airflow limitation that can persist and potentially culminate in COPD. School-age children with severe asthma can be sorted by cluster analysis into phenotypes differentiated by young age of onset, sensitisation to multiple allergens and by the presence or absence of airflow limitation. Pre-school children are more likely to transition from one phenotype to another compared to school-age children. Unlike “neutrophilic” asthma in adults, lung neutrophilia in childhood asthma is highly informed by microbial pathogens and has fewer morbid features. Future phenotypic classification methods will evolve to recognition of endotypes, defined by common molecular patterns of inflammation, and will guide specific therapies.

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Contributors

Author: Graham Roberts

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