Leonard B Bacharier

..Therefore, clinicians will need to balance the benefits and risks associated with these therapies on an individual patient basis as they consider which patients should undergo step-down and which approach would be most appropriate...

..Finally, regular monitoring of symptom control and medication side effects is important along with titrating controllers to the minimally effective dose...

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..Acute wheezing illnesses in preschoolers require better management strategies to reduce morbidity...

..However, determination of baseline features associated with ICS responsiveness may identify children most likely to benefit from ICS treatment...

..To determine the safety of long-term (36 months) administration of an inhaled corticosteroid (budesonide) on hypothalamic-pituitary-adrenal (HPA) axis function in children with mild to moderate asthma...

..FEV(1) is generally normal, even in severe persistent childhood asthma, whereas FEV(1)/FVC declines as asthma severity increases...

..The aim of this article is to review the recently published studies addressing various treatment approaches for asthma in preschool children...

..The high prevalence of wheezing illnesses in the preschool age group and the heterogeneity of wheezing phenotypes early in life combine to present significant challenges in the clinical management of this problem...

..Sensitization and exposure to inhalant allergens have been identified as risk factors for asthma hospitalization...

..Responses to inhaled corticosteroids (ICSs) and leukotriene receptor antagonists (LTRAs) vary among asthmatic patients...

..Clinical trials in children with moderate-to-severe persistent asthma are limited...

..To examine parent-reported signs and symptoms as antecedents of wheezing in preschool children with previous moderate to severe wheezing episodes, and to determine the predictive capacity of these symptom patterns for wheezing events...

..Outcome data are needed to base recommendations for controller asthma medication use in school-aged children...

..The development of asthma after respiratory syncytial virus (RSV) bronchiolitis has been demonstrated in case-control studies, although the determinants of post-RSV asthma remain undefined...

..A subset of children with asthma respond better to leukotriene receptor antagonists than to inhaled corticosteroids. Information is needed to identify children with these preferential responses...

..Although nocturnal awakenings help categorize asthma severity and control, their clinical significance has not been thoroughly studied...

..Determination of the benefits and limitations of specific physiologic tests has not been well studied in long-term clinical pediatric trials...

..The effect on linear growth of daily long-term inhaled corticosteroid therapy in preschool-aged children with recurrent wheezing is controversial...

..Immune response after viral infection usually involves T(H)1-mediated response; however, severe respiratory syncytial virus (RSV) infection appears to be associated with the development of asthma, a T(H)2-predominant phenotype...

..Children who are diagnosed with asthma after severe RSV bronchiolitis appear to have a relative deficiency of plasmacytoid DC in peripheral blood...

..The fractional concentration of exhaled nitric oxide (FeNO) is a noninvasive marker for airway inflammation but requires further study in preschool-aged children to determine its clinical relevance...

..CONCLUSION: The severity of RSV bronchiolitis early in life seems modified by postnatal maternal cigarette smoke exposure and atopy and age of the infant, not by levels of allergens in the home environment...

..This review examines the changes in the revised National Asthma Education and Prevention Program (NAEPP) Guidelines for the diagnosis and management of asthma pertaining to children and highlights areas that may benefit from further study...

..Children with different chronic asthma severities had comparable severities of acute exacerbation. In conclusion, acute asthma exacerbations dissociate in severity from chronic asthma and are under-treated with systemic corticosteroids...

..01). CONCLUSIONS: Nocturnal awakening occurred in one third of the children with mild-to-moderate asthma during a month of relative stability and appears to be an indicator of asthma that is becoming increasingly severe...

..Although unsupervised cluster analysis is a useful tool for identifying phenotypes, it has not been applied to school-age children with persistent asthma across a wide range of severities...

..Our findings also suggest that psychological stress and control beliefs may provide one explanation for links between SES and immune responses in childhood asthma...

..Once validated in a different population, these factors might be used for selection of patients who are most likely to show negative OFCs...

..This article discusses the populations at risk for the development of atopic conditions and the interventions that have been explored in attempts to modify the progression of allergic disease...

..This article examines the evidence for interaction between specific infectious agents and exacerbations of asthma, including the immunopathology of infection-triggered asthma, and the current therapeutic options for management...

..To review the recently published studies addressing various treatment approaches for episodic wheezing in young children...

..Whether the association between bronchiolitis and subsequent asthma is due to causality or a reflection of predisposition may be dependent on host factors and virus-specific effects...

..This review will discuss phenotypic and pathogenic aspects of severe asthma in childhood, as well as remaining knowledge gaps...

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..It is unknown whether inhaled corticosteroids can modify the subsequent development of asthma in preschool children at high risk for asthma...

..These measures were chosen to reflect the progression of the disease from intermittent wheezing to persistent asthma and measurement of the extent of airflow limitation and airway reactivity...

..More evidence is needed on which to base recommendations for treatment of mild-moderate persistent asthma in school-aged children...

..Furthermore, C4BP colocalized with B cells in the germinal centers of human tonsils. These observations suggest that C4BP is an activating ligand for CD40 and establish a novel interface between complement and B cell activation...