Utility of biomarkers in the diagnosis and monitoring of asthmatic children

Paraskevi Xepapadaki; Yuichi Adachi; César Fireth Pozo Beltrán; Zeinab A El-Sayed; René Maximiliano Gómez; Elham Hossny; Ivana Filipovic; Peter Le Souef; Mário Morais-Almeida; Michael Miligkos; Antonio Nieto; Wanda Phipatanakul; Paulo M Pitrez; Jiu-Yao Wang; Gary W K Wong; Nikolaos G Papadopoulos

doi:10.1016/j.waojou.2022.100727

Utility of biomarkers in the diagnosis and monitoring of asthmatic children

World Allergy Organ J. 2022 Dec 15;16(1):100727. doi: 10.1016/j.waojou.2022.100727. eCollection 2023 Jan.

Authors

Paraskevi Xepapadaki¹, Yuichi Adachi², César Fireth Pozo Beltrán³, Zeinab A El-Sayed⁴, René Maximiliano Gómez⁵, Elham Hossny⁴, Ivana Filipovic⁶, Peter Le Souef⁷, Mário Morais-Almeida⁸, Michael Miligkos¹, Antonio Nieto⁹, Wanda Phipatanakul¹⁰, Paulo M Pitrez¹¹, Jiu-Yao Wang¹², Gary W K Wong¹³, Nikolaos G Papadopoulos¹

Affiliations

¹ Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
² Department of Pediatrics, Faculty of Medicine, University of Toyam, Japan.
³ Pediatric Allergy and Immunology, Hospital Infantil de México Federico Gómez, Mexico City, USA.
⁴ Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt.
⁵ School of Health Sciences, Catholic University of Salta, Argentina.
⁶ University Hospital Center Dr Dragiša Mišović Hospital Pediatric Department, Serbia.
⁷ Faculty of Health and Medical Sciences, Dept of Respiratory Medicine, Child and Adolescent Health Service, University of Western Australia, Perth, Australia.
⁸ Centro de Alergia dos Hospitais CUF, Lisbon, Portugal.
⁹ Pediatric Pulmonology & Allergy Unit Children's. Health Research Institute. Hospital La Fe, 46026, Valencia, Spain.
¹⁰ Pediatric Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA.
¹¹ School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
¹² Center for Allergy and Clinical Immunology Research, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
¹³ Department of Paediatrics, The Chinese University of Hong Kong, China.

Abstract

Asthma imposes a heavy morbidity burden during childhood; it affects over 10% of children in Europe and North America and it is estimated to exceed 400 million people worldwide by the year 2025. In clinical practice, diagnosis of asthma in children is mostly based on clinical criteria; nevertheless, assessment of both physiological and pathological processes through biomarkers, support asthma diagnosis, aid monitoring, and further lead to better treatment outcomes and reduced morbidity. Recently, identification and validation of biomarkers in pediatric asthma has emerged as a top priority across leading experts, researchers, and clinicians. Moreover, the implementation of non-invasive biomarkers for the assessment and monitoring of paediatric patients with asthma, has been prioritized; however, only a proportion of them are currently included in the clinical practise. Although, the use of non-invasive biomarkers is highly supported in recent asthma guidelines for documenting diagnosis and supporting monitoring of asthmatic patients, data on the Pediatric population are limited. In the present report, the Pediatric Asthma Committee of the World Allergy Organization (WAO), aims to summarize and discuss available data for the implementation of non-invasive biomarkers in the diagnosis and monitoring in children with asthma. Information on the most studied biomarkers, including spirometry, oscillometry, markers of allergic sensitization, fractional exhaled nitric oxide, and the most recent exhaled breath markers and "omic" approaches, will be reviewed. Practical limitations and considerations based on both experts' opinion and critical review of the literature, on the utility of all "well-known" and newly introduced non-invasive biomarkers will be presented. A critical commentary on biomarkers' use in diagnosing and monitoring asthma during the COVID-19 pandemic, cost and availability of biomarkers in different settings and in developing countries, the differences on the biomarkers use between Primary Practitioners, Pediatricians, and Specialists and their role on the longitudinal aspect of asthma is provided.

Keywords: Asthma; Children; Non-invasive biomarkers; Pediatric asthma.

Publication types

Review