Asthma in Kids: Look for these Red Flags

Increasingly, healthcare providers, and policy makers are looking at effective interventions in school age children. Children in that age group often experience asthma attacks, and some of those attacks are quite serious. Kids may have to skip school, be admitted to the hospital, and occasionally, children die from asthma attacks. That's a clear call for better intervention on the part of healthcare providers.

The journalCurrent Opinion in Allergy and Clinical Immunologyhas published a review article that discusses things healthcare providers might monitor to prevent asthma exacerbations. Researchers from the National Heart and Lung Institute in the UK assembled this review, and indicate that vigilance can prevent asthma attacks.

Healthcare providers can monitor patient behaviors and characteristics, physiological factors, environmental data, and biomarkers to prevent asthma attacks. All of these factors have been associated with asthma exacerbation predictions.

The authors indicate that several factors increase risk of a childhood asthma attack. These include the following:

• A severe exacerbation elevates risk of another attack for approximately 12 months.
• Poor adherence, and current poor control is an obvious predictor of exacerbation.
• Biomarkers that are outside of normal limits should sound the alarm.
• Alerts sent by digital monitoring technology are convenient and good predictors.
• Salbutamol overuse signals high risk for attack, and has been associated with some deaths.

These factors and their impact vary considerably among individuals. When healthcare professionals identify any of these risk factors in specific patients, they need to take remedial action immediately.

The authors expand on the topic of biomarkers, including exhaled volatile organic compounds. They emphasize the need to measure biomarkers frequently, and to rely not only on the biomarker results, but also other measures.

The authors indicate that organizations that sponsor clinical guidelines are beginning to incorporate some of these factors, including the use of biomarkers. Clinical guidelines are slowly moving from recommending stepwise escalation of drug therapy to recommending personalized approaches for each individual who has asthma. The next few years should be extremely exciting as biomarkers are developed, refined, and validated in clinical trials.

Reference

Fleming L. Asthma exacerbation prediction: recent insights.Curr Opin Allergy Clin Immunol. 2018;18(2):117-123.