Inflammatory mechanisms in childhood asthma

There is now a reasonable body of data that would suggest that the immunopa thology of asthma is similar, if not identical, in childhood asthmatics com pared with adult asthmatics. Indeed, we now have evidence that much of the immunopathology is established within the airways of asthmatics very early after the onset of symptoms and, given the lack of correlation with duratio n of symptoms, may even antedate the first manifestations. There are, howev er, some differences with neutrophil recruitment being somewhat more promin ent than has been recorded from adult observations. The utility of any infl ammation parameter in identifying the real future asthmatics has yet to be studied in sufficient detail to define sensitivity, specificity and predict ive value. Such studies will be an essential prerequisite to establishing v ery early intervention strategies, particularly if these involve the use of inhaled and/or oral corticosteroid.