Present and future treatment of asthma in infants and young children

Asthma is a chronic inflammatory disease of the airways characterized by th e local production of inflammatory mediators and an increase in recruitment of inflammatory cells (predominantly eosinophils and mast cells), It has b een proposed that the chronic nature of this inflammatory response may be r esponsible for long-term pulmonary changes including bronchial hyperrespons iveness, airway remodeling, and irreversible airflow obstruction. Much of t he information available on the pathogenesis of asthma is based on studies performed in young adults. Because of numerous complications, studies in in fants and young children are often difficult to conduct; therefore informat ion on this age group is lacking, Although studies are limited, data sugges t that an asthma-like inflammation is present at a very early age, with inc reases in inflammatory cells and thickening of the lung basement membrane d etected in infants and young children, In addition, lung function of childr en with persistent wheezing was significantly lower by 6 years of age compa red with children who had no wheezing episodes during the same period; diff erences between groups were not apparent at 6 months of age. These data sug gest that airway inflammation in young children with asthma is associated w ith nonreversible impairment of lung function. Recent National Asthma Educa tion and Prevention Guidelines stress the importance of anti-inflammatory a gents, particularly inhaled corticosteroids, in the treatment of young chil dren with persistent asthma, Given data supporting the presence of an infla mmatory response early in the disease course, early intervention with anti- inflammatory agents may be indicated at the onset of symptoms to prevent lo ng-term, irreversible, impairment of lung function. Although several studie s have shown that inhaled corticosteroids may be effective in the treatment of recurrent wheezing in infancy, tools need to be developed to distinguis h infants with early-onset asthma from those with transient wheezing.