pediatrics

2. Heterogeneity and the Origins of Asthma
Rebecca Scherzer, MD
Mitchell H. Grayson, MD
Ann Allergy Asthma Immunol. October 2018;121(4):385-514

3. Heterogeneity and the Origins of Asthma
Key Messages
Scherzer R, Grayson MH. Ann Allergy Asthma Immunol. October 2018;121(4):400-405
• Asthma is a frequently diagnosed heterogeneous disease with many origins
that all lead to the key finding of airway inflammation.
• Both genetics and environment, nature and nurture, likely play a role in the
pathogenesis and course of the disease.
• Origins of asthma in childhood often have an atopic root and frequently are
associated with other atopic diagnoses.
• The microbiome in very young children likely influences susceptibility of the
host to developing atopic disease.
• In adults, asthma is often comorbid with other diseases, such as obesity or
aspirin-exacerbated respiratory disease, and these comorbidities play a
significant role in the course of the disease and response to treatment.

4. Phenotypic Origins of Asthma in Children and Adults
Scherzer R, Grayson MH. Ann Allergy Asthma Immunol. October 2018;121(4):400-405

5. Selecting the Right Biologic for your Patients
with Severe Asthma
Laurie A. Manka, MD
Michael E. Wechsler, MD, MMSc
Ann Allergy Asthma Immunol. October 2018;121(4):406-413

6. Selecting the Right Biologic for your Patients
with Severe Asthma
Key Messages
Ann Allergy Asthma Immunol. October 2018;121(4):406-413
• Severe asthma is associated with increased morbidity, mortality, and increased consumption
of health care resources when compared with the entire asthma population.
• Asthma endotypes include type 2-high and type 2-low. Type 2-high asthma is characterized by
inflammatory pathways involving IL-4, IL-5, IL-13, and IgE, which result in clinical eosinophilia,
high fractional exhaled nitric oxide (FeNO), and/or atopy.
• Several biologic medications are available for type 2-high severe asthma.
• Clinical biomarkers, such as blood or sputum eosinophils, IgE levels, and FeNO, are clinically
available and can help in choosing the best biologic medication. Other biomarkers are
currently under investigation and may provider further guidance in the future.
• Other patient-centered factors including cost of the medication, administration route, weight of
the patient, and medical comorbidities, can also assist in selecting the
best biologic for an individual patient.

7. Activation Type 2-high and Type 2-low
Inflammatory Pathways
Ann Allergy Asthma Immunol. October 2018;121(4):406-413

8. Endotypes is Asthma and Biologic Targets
Currently in Use or Under Investigation
Ann Allergy Asthma Immunol. October 2018;121(4):406-413

9. Use of Biomarkers to Identify Phenotypes
and Endotypes of Severe Asthma
Tara F. Carr, MD
Monica Kraft, MD
Ann Allergy Asthma Immunol. October 2018;121(4):414-420

10. Use of Biomarkers to Identify Phenotypes
and Endotypes of Severe Asthma
Key Messages
Carr TF, Kraft M. Ann Allergy Asthma Immunol. October 2018;121(4):414-420
• A number of different biomarkers can be applied to identify severe asthma
phenotypes and endotypes.
• Biomarkers are not yet pathognomonic for severe asthma phenotypes or
endotypes and therefore need to be used thoughtfully and in combinations.
• Biomarkers, although useful to identify severe asthma phenotypes and
endotypes, may have even greater impact when used to predict response to
targeted biologic therapies.
• Novel biomarkers in development, which assess specific inflammatory
pathways or identify activated inflammatory cells, may prove to more
accurately identify severe asthma phenotypes or endotypes.

11. Biomarker-based Approach to Identifying Phenotypes
and Endotypes of Severe Asthma
Carr TF, Kraft M. Ann Allergy Asthma Immunol. October 2018;121(4):414-420

12. The Effects of Caregiver Depression on Childhood
Asthma: Pathways and Mechanisms
Beatrice L. Wood, PhD
E. Sherwood Brown, MD, PhD
Heather K. Lehman, MD
David A. Khan, MD
Min Jung Lee, MD
Bruce D. Miller, MD
Ann Allergy Asthma Immunol. October 2018;121(4):421-427

13. The Effects of Caregiver Depression on Childhood
Asthma: Pathways and Mechanisms
Key Messages
Wood BL, et al. Ann Allergy Asthma Immunol. October 2018;121(4):421-427
• More complex and complete heuristic models of the cascade of
socioeconomic, familial, psychological, and biological influences on
childhood asthma should be developed.
• Such knowledge is necessary to identify appropriate pathways for
multilevel evidence-based intervention programs to reduce childhood
asthma morbidity and mortality.
• Caregiver depression plays a key role in the cascade of socioeconomic,
familial, psychological, and biological influences on childhood asthma.
• Caregiver depression should be treated as a partial means of improving
morbidity and mortality in child asthma.

14. Pathways (A-P) and Mechanisms by which
Socioeconomic Stress
Wood BL, et al. Ann Allergy Asthma Immunol. October 2018;121(4):421-427