Consider the child: how early should we treat?

Abstract

Epidemiologic and natural history studies of asthma have found that, for most people who develop asthma, clinical manifestations of the disease occur in the early childhood years. Both asthma persistence and severity during early childhood predict disease persistence into later childhood and adulthood, at which point asthma remission is uncommon. Current pathogenesis paradigms suggest that early intervention, before serious pathologic changes occur, may lead to optimal outcomes. Early intervention might optimize lung growth and immune development, and mitigate asthma persistence and severity. In this overview, categories for early intervention strategies for asthma will be based on the level of disruption of asthma pathogenesis. "Early interventions" target asthma shortly after its onset, "secondary preventions" aim to prevent lung targeting of disease processes in the vulnerable host, and "primary preventions" strive to promote healthful immune development and lung growth by keeping pro-asthmatic immune responses from occurring. This review will discuss recent clinical studies that exemplify early intervention and prevention strategies.