Current knowledge of bronchial asthma with low T2-inflammation in school-aged children (review)

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Abstract

Bronchial asthma in children is a heterogeneous disease; therefore, determination of the disease endotype is important for personalized therapy, overcoming refractoriness to bronchial asthma treatment, and selecting a targeted biologic drug. The endotype of the disease, which is not associated with eosinophilia and, therefore, characterized by an insufficient response to inhaled corticosteroids, may begin at school age. The prevalence of low T2-inflammatory bronchial asthma in school-aged children is poorly understood, but the evidence presented in this article supports the presence of this endotype. This endotype of bronchial asthma in children is characterized by clinical and pathogenetic features, including low degree of allergic sensitization, reduced level of total IgE, limited number of positive allergy tests, decreased concentration of nitric oxide in exhaled air and eosinophil content in blood. The role of neutrophils in the development and prognosis of bronchial asthma in children is currently insufficiently studied and defined, nevertheless, it is known that the neutrophilic type of inflammation is associated with a more severe course of the disease and inadequate control. It is important to emphasize the need for further research into the endotypes of bronchial asthma in children with the identification of novel biomarkers and molecular mechanisms underlying asthma with low T2-inflammation. This may further enable the achievement of control of bronchial asthma with different inflammatory endotypes.

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About the authors

Evgeny G. Furman

Academician Ye.A. Wagner Perm State Medical University

Author for correspondence.
Email: furman1@yandex.ru
ORCID iD: 0000-0002-1751-5532
SPIN-code: 7373-9210

MD, PhD, Dr. Sci. (Medicine), Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Faculty Pediatrics and Hospital Pediatrics

Russian Federation, 26 Petropavlovskaya st., Perm, 614990

Yulia S. Alieva

Academician Ye.A. Wagner Perm State Medical University

Email: dolgomirovay@mail.ru
ORCID iD: 0000-0002-0283-088X

Assistant Professor at the Department of Faculty Pediatrics and Hospital Pediatrics

Russian Federation, 26 Petropavlovskaya st., Perm, 614990

Ekaterina A. Khuzina

Academician Ye.A. Wagner Perm State Medical University

Email: eka-khuzina@yandex.ru
ORCID iD: 0000-0003-0901-7944
SPIN-code: 6816-0587

MD, PhD, Cand. Sci. (Medicine), Associate Professor, Department of Faculty Pediatrics and Hospital Pediatrics

Russian Federation, 26 Petropavlovskaya st., Perm, 614990

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2. Figure. Hypothetical mechanism of asthma development with low-level type 2 inflammation [27]. IL — interleukin, IFN — interferon, Th — T-helper, TSLP — thymic stromal lymphopoietin, TNF — tumor necrosis factor, CXCL8 — interleukin 8, CXCR2 — interleukin 8 beta receptor, MHC — major histocompatibility complex, GM-CSF — granulocyte-macrophage colony-stimulating factor

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