Expert review of respiratory medicine · 2025
Advances in the management of severe therapy-resistant pediatric asthma.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Corsello Antonio, Senatore Antonio Andrea, Bajeli Marta, Marseglia Gian Luigi, Licari Amelia, Brambilla Ilaria
Аннотация
INTRODUCTION: Severe therapy-resistant pediatric asthma (STRA) is an uncommon but high-impact form of childhood asthma, affecting 2-5% of patients yet causing disproportionate morbidity, healthcare use, and corticosteroid exposure. It is defined by uncontrolled disease despite optimized high-dose inhaled corticosteroids plus additional controllers, after exclusion and correction of modifiable factors. Accurate distinction from difficult-to-treat asthma is essential to avoid unnecessary treatment escalation and enable timely advanced interventions.
AREAS COVERED: This narrative review summarizes current knowledge on STRA pathophysiology, diagnosis, and management in children, with a focus on precision medicine. Mechanistic insights include epithelial barrier dysfunction, distinct inflammatory endotypes, early airway remodeling, and microbial - immune interactions. Biomarker-guided endotyping supports individualized care. The article evaluates the efficacy, safety, and positioning of approved biologics, while noting gaps in treating non-T2 phenotypes and in predicting biologic response.
EXPERT OPINION: STRA management is shifting from empirical escalation to endotype-driven strategies. Biologics benefit biomarker-selected patients by reducing exacerbations, improving lung function, and lowering steroid dependence, sometimes addressing comorbid allergies. Future priorities include expanding options for non-T2 and mixed phenotypes, validating predictive biomarkers, integrating digital monitoring, and reducing global inequities in access to advanced therapy.
AREAS COVERED: This narrative review summarizes current knowledge on STRA pathophysiology, diagnosis, and management in children, with a focus on precision medicine. Mechanistic insights include epithelial barrier dysfunction, distinct inflammatory endotypes, early airway remodeling, and microbial - immune interactions. Biomarker-guided endotyping supports individualized care. The article evaluates the efficacy, safety, and positioning of approved biologics, while noting gaps in treating non-T2 phenotypes and in predicting biologic response.
EXPERT OPINION: STRA management is shifting from empirical escalation to endotype-driven strategies. Biologics benefit biomarker-selected patients by reducing exacerbations, improving lung function, and lowering steroid dependence, sometimes addressing comorbid allergies. Future priorities include expanding options for non-T2 and mixed phenotypes, validating predictive biomarkers, integrating digital monitoring, and reducing global inequities in access to advanced therapy.