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An InsightAsthma phenotypesinyoung childrenAsthma Timelines1970sBronchospasm1990sBronchospasm+ Inflammation+ RemodelingpresentT cellEosinophil Th-2IL-5 / IL-13Th17Dendritic cellsCHEST 2013; 144(3):10261032.2014 MFMER | slide-4Our understanding of asthma continues to increase overtimeBronchoconstrictionPhenotypes and geneticsInflammation and remodelingAirway HyperesponsivenessWhat Is a Phenotype?Henderson J et al. Arch Dis Child. 2009Phenotype:Any observable characteristic of an individual that is influenced by genetic and environmental factorsClinical relevance:May reflect causal pathways specific to subgroups of patients with asthma, may lead to improved management andHelp to predict prognosis

Natural history and PathophysiologyInceptionGeneticsAllergensInfectionsProgressionInflammationBronchospasmRemodelingExacerbationsLung functionsStanley J. Szefler. J Allergy Clin Immunol 2014;133:3-13.)Clinical relevanceAsthma, which typically begins in childhood and occurs throughout lifeMajor burden from asthmathat persists into adult lifeMany different phenotypes that are associated with variable disease courses.Presentation of asthmaStanley J. Szefler. J Allergy Clin Immunol 2014;133:3-13.)Presentation of asthmaKey symptom indicatorsMiddleton ed 8th .Not all wheeze is asthmaNewborn infants between May 1980 and October 1984A total of 1246 children were initially enrolled11 years follow up

Renato T Stein. Thorax 1997;52:946-52.Tucson studyNo wheezing in first 6 years of birth 51.5%CONTDRenato T Stein. Thorax 1997;52:946-52.Wheezing phenotypes- AVON StudyJ Henderson. Thorax 2008;63:974980Wheezing phenotypesAAIAT Annual Meeting 2014Common clinical elements that definephenotypes in pediatric asthmaBasic of classificationExamples of clinical featuresSymptomsAge at onsetNatural history/disease courseSeverityTriggersVirusesExerciseAllergensTrigger-Based Pediatric PhenotypesVirus-induced asthma

Exercise-induced asthma

Allergen-induced asthmaStanley J. Szefler. J Allergy Clin Immunol 2014;133:3-13.)Virus-induced asthmaMost common presentation of asthma in early life 90% of children