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Clinicians should recognize potential of childhood asthma as a lifelong burden

BOSTON — There’s a growing sense of a better appreciation of the implications of childhood asthma on adverse respiratory outcomes in adults among allergists, Stanley Szefler, MD, director of pediatric asthma research at the Breathing Institute at Children’s Hospital Colorado and professor of pediatrics at the University of Colorado School of Medicine, said at the ACAAI Annual Scientific Meeting.

“It's becoming apparent that we need to take a closer look at the level of severity and how to monitor childhood asthma and shift our focus a little bit in the direction of risk management,” Szefler said in an interview.

“I think what we have to do is look at asthma as a disease of the lifespan and begin to prompt our medical records to accumulate the information in a better way,” he said. “Look at when exacerbations occur – how frequently, what the pulmonary function is, where it's going, and what biomarkers may be useful in assessing the level of severity and making choices in treatment.”

Szefler spoke exclusively with Healio Internal Medicine about how allergists need to view asthma as a lifelong disease, and continue to place emphasis on the emergence of asthma in young children.

However, as Szefler said, although there is a growing sense of the importance of pediatric asthma, practice has been slow to adopt that emphasis.

“I think [physicians] really need to be on the lookout for indicators that are there,” he said. “It's just that, they've not been formalized like the way things have been done in the past in terms of having updates in the asthma guidelines. Even the global initiative for asthma, the attention has been more toward adults and more toward the primary care physicians. I think the asthma specialist has to step out and look at the way they practice and not be timid about applying new techniques and new ways of monitoring in order to lead the direction in terms of better care.”

However, Szefler said he sees the transition being smooth, but that it will depend on updates to the asthma guidelines that are expected over the next several years, with several controversial areas likely to be addressed, including the use of combination therapy bronchial thermoplasty, allergen immunotherapy and tiotropium and the role of intermittent inhaled steroid use.

“But, we really need to direct our attention at some of the new treatments that have come out and some of the studies that have been out there – we've spent a lot of money doing [these studies], we need to take some of those key lessons and integrate them into practice as well.” – by Ryan McDonald

Disclosure: Szefler reports receiving research funding through his institution.