The future in paediatric respirology

H. Joel Schmidt, Vineet Bhandari, Anita Bhandari, Jane Davies, Bruce Marshall, Jean Paul Praud, Heather J. Zar, Bruce K. Rubin

Research output: Contribution to journalReview article

Abstract

The authors were given the charge of providing a vision of the future in paediatric respirology. Themes selected for being ripe for this visionary analysis include bronchopulmonary dysplasia (BPD), asthma, cystic fibrosis (CF), lung infections, obstructive sleep disordered breathing (OSDB) and pulmonary diagnostics and monitoring. A profound reduction or elimination of BPD is seen. Given the strong genetic component of this disease, genetic biomarkers will likely be identified that will permit much earlier recognition of BPD susceptibility and potentially the ability to modify disease course by altering gene expression. The ultimate prevention of BPD will be to prevent prematurity, but recognition of both the genetic basis of BPD and the inflammatory background should lead to improved prevention and therapy. A clear understanding and definition of asthma phenotypes will lead to more specific and targeted therapy, earlier detection and prevention, better monitoring of severity and adherence to therapy, lower mortality and decreased inappropriate diagnosis of asthma. The greatest opportunities in asthma care will likely come through tools to improve adherence to effective therapy. Also, areas are identified where better therapies are needed such as in patients with severe mucus hypersecretion (secretory hyperresponsiveness) especially in those with life-threatening asthma. The future of CF is easier to foresee with early successes seen in clinical trials. After the expected ability to correct the CF transmembrane regulator, care will need to change and additional research will be needed. Additionally, the face of CF is changing with more adults than children presently having the disease. This will necessitate changes to our approach to treating this disease in a fortunately aging population. If we are going to affect the worldwide lung health of children, we will need to address respiratory infections particularly pneumonia, tuberculosis and HIV-associated infections. Preventive, diagnostic and treatment strategies will shape the future face of these problems. The availability of inexpensive, readily available, and rapid molecular techniques to identify true infection (including HIV and tuberculosis) may permit earlier use of effective therapy while preventing the inappropriate use of antibiotics for common viral diseases. Sleep medicine will continue to be an important aspect of paediatric pulmonology. The evaluation of OSDB cannot rely on full-night attended polysomnography due to limited access. Identifying reliable markers of end organ dysfunction in children with OSDB may permit more rapid identification of patients in need of intervention like CPAP and assisted breathing. In addition, management options, as an alternative to adenotonsilectomy, are listed with a call for further research. Pulmonary diagnostics and monitoring will see the development and refinement of tools like the lung clearance index and the analysis of exhaled gasses, volatiles and dissolved biomarkers of inflammation as techniques that might help clinicians identify both the initiation of inflammation while it is more amenable to therapy, and to identify more readily the early changes associated with chronic lung diseases in children. The authors hope that these visionary articles will generate comments, arguments, inspiration, and perhaps even motivate funding agencies.

Original languageEnglish (US)
Pages (from-to)733-741
Number of pages9
JournalRespirology
Volume15
Issue number5
DOIs
StatePublished - Jul 2010
Externally publishedYes

Fingerprint

Bronchopulmonary Dysplasia
Pediatrics
Asthma
Cystic Fibrosis
Sleep Apnea Syndromes
Lung
Therapeutics
HIV Infections
Tuberculosis
Biomarkers
Inflammation
Pulmonary Medicine
Inborn Genetic Diseases
Aptitude
Polysomnography
Virus Diseases
Mucus
Research
Respiratory Tract Infections
Lung Diseases

Keywords

  • cystic fibrosis
  • paediatric asthma
  • paediatric lung disease
  • pneumonia
  • sleep apnoea

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Schmidt, H. J., Bhandari, V., Bhandari, A., Davies, J., Marshall, B., Praud, J. P., ... Rubin, B. K. (2010). The future in paediatric respirology. Respirology, 15(5), 733-741. https://doi.org/10.1111/j.1440-1843.2010.01745.x

The future in paediatric respirology. / Schmidt, H. Joel; Bhandari, Vineet; Bhandari, Anita; Davies, Jane; Marshall, Bruce; Praud, Jean Paul; Zar, Heather J.; Rubin, Bruce K.

In: Respirology, Vol. 15, No. 5, 07.2010, p. 733-741.

Research output: Contribution to journalReview article

Schmidt, HJ, Bhandari, V, Bhandari, A, Davies, J, Marshall, B, Praud, JP, Zar, HJ & Rubin, BK 2010, 'The future in paediatric respirology', Respirology, vol. 15, no. 5, pp. 733-741. https://doi.org/10.1111/j.1440-1843.2010.01745.x
Schmidt HJ, Bhandari V, Bhandari A, Davies J, Marshall B, Praud JP et al. The future in paediatric respirology. Respirology. 2010 Jul;15(5):733-741. https://doi.org/10.1111/j.1440-1843.2010.01745.x
Schmidt, H. Joel ; Bhandari, Vineet ; Bhandari, Anita ; Davies, Jane ; Marshall, Bruce ; Praud, Jean Paul ; Zar, Heather J. ; Rubin, Bruce K. / The future in paediatric respirology. In: Respirology. 2010 ; Vol. 15, No. 5. pp. 733-741.
@article{0153d0b7a7b24b7f81de56bf6bcde7fd,
title = "The future in paediatric respirology",
abstract = "The authors were given the charge of providing a vision of the future in paediatric respirology. Themes selected for being ripe for this visionary analysis include bronchopulmonary dysplasia (BPD), asthma, cystic fibrosis (CF), lung infections, obstructive sleep disordered breathing (OSDB) and pulmonary diagnostics and monitoring. A profound reduction or elimination of BPD is seen. Given the strong genetic component of this disease, genetic biomarkers will likely be identified that will permit much earlier recognition of BPD susceptibility and potentially the ability to modify disease course by altering gene expression. The ultimate prevention of BPD will be to prevent prematurity, but recognition of both the genetic basis of BPD and the inflammatory background should lead to improved prevention and therapy. A clear understanding and definition of asthma phenotypes will lead to more specific and targeted therapy, earlier detection and prevention, better monitoring of severity and adherence to therapy, lower mortality and decreased inappropriate diagnosis of asthma. The greatest opportunities in asthma care will likely come through tools to improve adherence to effective therapy. Also, areas are identified where better therapies are needed such as in patients with severe mucus hypersecretion (secretory hyperresponsiveness) especially in those with life-threatening asthma. The future of CF is easier to foresee with early successes seen in clinical trials. After the expected ability to correct the CF transmembrane regulator, care will need to change and additional research will be needed. Additionally, the face of CF is changing with more adults than children presently having the disease. This will necessitate changes to our approach to treating this disease in a fortunately aging population. If we are going to affect the worldwide lung health of children, we will need to address respiratory infections particularly pneumonia, tuberculosis and HIV-associated infections. Preventive, diagnostic and treatment strategies will shape the future face of these problems. The availability of inexpensive, readily available, and rapid molecular techniques to identify true infection (including HIV and tuberculosis) may permit earlier use of effective therapy while preventing the inappropriate use of antibiotics for common viral diseases. Sleep medicine will continue to be an important aspect of paediatric pulmonology. The evaluation of OSDB cannot rely on full-night attended polysomnography due to limited access. Identifying reliable markers of end organ dysfunction in children with OSDB may permit more rapid identification of patients in need of intervention like CPAP and assisted breathing. In addition, management options, as an alternative to adenotonsilectomy, are listed with a call for further research. Pulmonary diagnostics and monitoring will see the development and refinement of tools like the lung clearance index and the analysis of exhaled gasses, volatiles and dissolved biomarkers of inflammation as techniques that might help clinicians identify both the initiation of inflammation while it is more amenable to therapy, and to identify more readily the early changes associated with chronic lung diseases in children. The authors hope that these visionary articles will generate comments, arguments, inspiration, and perhaps even motivate funding agencies.",
keywords = "cystic fibrosis, paediatric asthma, paediatric lung disease, pneumonia, sleep apnoea",
author = "Schmidt, {H. Joel} and Vineet Bhandari and Anita Bhandari and Jane Davies and Bruce Marshall and Praud, {Jean Paul} and Zar, {Heather J.} and Rubin, {Bruce K.}",
year = "2010",
month = "7",
doi = "10.1111/j.1440-1843.2010.01745.x",
language = "English (US)",
volume = "15",
pages = "733--741",
journal = "Respirology",
issn = "1323-7799",
publisher = "Wiley-Blackwell",
number = "5",

}

TY - JOUR

T1 - The future in paediatric respirology

AU - Schmidt, H. Joel

AU - Bhandari, Vineet

AU - Bhandari, Anita

AU - Davies, Jane

AU - Marshall, Bruce

AU - Praud, Jean Paul

AU - Zar, Heather J.

AU - Rubin, Bruce K.

PY - 2010/7

Y1 - 2010/7

N2 - The authors were given the charge of providing a vision of the future in paediatric respirology. Themes selected for being ripe for this visionary analysis include bronchopulmonary dysplasia (BPD), asthma, cystic fibrosis (CF), lung infections, obstructive sleep disordered breathing (OSDB) and pulmonary diagnostics and monitoring. A profound reduction or elimination of BPD is seen. Given the strong genetic component of this disease, genetic biomarkers will likely be identified that will permit much earlier recognition of BPD susceptibility and potentially the ability to modify disease course by altering gene expression. The ultimate prevention of BPD will be to prevent prematurity, but recognition of both the genetic basis of BPD and the inflammatory background should lead to improved prevention and therapy. A clear understanding and definition of asthma phenotypes will lead to more specific and targeted therapy, earlier detection and prevention, better monitoring of severity and adherence to therapy, lower mortality and decreased inappropriate diagnosis of asthma. The greatest opportunities in asthma care will likely come through tools to improve adherence to effective therapy. Also, areas are identified where better therapies are needed such as in patients with severe mucus hypersecretion (secretory hyperresponsiveness) especially in those with life-threatening asthma. The future of CF is easier to foresee with early successes seen in clinical trials. After the expected ability to correct the CF transmembrane regulator, care will need to change and additional research will be needed. Additionally, the face of CF is changing with more adults than children presently having the disease. This will necessitate changes to our approach to treating this disease in a fortunately aging population. If we are going to affect the worldwide lung health of children, we will need to address respiratory infections particularly pneumonia, tuberculosis and HIV-associated infections. Preventive, diagnostic and treatment strategies will shape the future face of these problems. The availability of inexpensive, readily available, and rapid molecular techniques to identify true infection (including HIV and tuberculosis) may permit earlier use of effective therapy while preventing the inappropriate use of antibiotics for common viral diseases. Sleep medicine will continue to be an important aspect of paediatric pulmonology. The evaluation of OSDB cannot rely on full-night attended polysomnography due to limited access. Identifying reliable markers of end organ dysfunction in children with OSDB may permit more rapid identification of patients in need of intervention like CPAP and assisted breathing. In addition, management options, as an alternative to adenotonsilectomy, are listed with a call for further research. Pulmonary diagnostics and monitoring will see the development and refinement of tools like the lung clearance index and the analysis of exhaled gasses, volatiles and dissolved biomarkers of inflammation as techniques that might help clinicians identify both the initiation of inflammation while it is more amenable to therapy, and to identify more readily the early changes associated with chronic lung diseases in children. The authors hope that these visionary articles will generate comments, arguments, inspiration, and perhaps even motivate funding agencies.

AB - The authors were given the charge of providing a vision of the future in paediatric respirology. Themes selected for being ripe for this visionary analysis include bronchopulmonary dysplasia (BPD), asthma, cystic fibrosis (CF), lung infections, obstructive sleep disordered breathing (OSDB) and pulmonary diagnostics and monitoring. A profound reduction or elimination of BPD is seen. Given the strong genetic component of this disease, genetic biomarkers will likely be identified that will permit much earlier recognition of BPD susceptibility and potentially the ability to modify disease course by altering gene expression. The ultimate prevention of BPD will be to prevent prematurity, but recognition of both the genetic basis of BPD and the inflammatory background should lead to improved prevention and therapy. A clear understanding and definition of asthma phenotypes will lead to more specific and targeted therapy, earlier detection and prevention, better monitoring of severity and adherence to therapy, lower mortality and decreased inappropriate diagnosis of asthma. The greatest opportunities in asthma care will likely come through tools to improve adherence to effective therapy. Also, areas are identified where better therapies are needed such as in patients with severe mucus hypersecretion (secretory hyperresponsiveness) especially in those with life-threatening asthma. The future of CF is easier to foresee with early successes seen in clinical trials. After the expected ability to correct the CF transmembrane regulator, care will need to change and additional research will be needed. Additionally, the face of CF is changing with more adults than children presently having the disease. This will necessitate changes to our approach to treating this disease in a fortunately aging population. If we are going to affect the worldwide lung health of children, we will need to address respiratory infections particularly pneumonia, tuberculosis and HIV-associated infections. Preventive, diagnostic and treatment strategies will shape the future face of these problems. The availability of inexpensive, readily available, and rapid molecular techniques to identify true infection (including HIV and tuberculosis) may permit earlier use of effective therapy while preventing the inappropriate use of antibiotics for common viral diseases. Sleep medicine will continue to be an important aspect of paediatric pulmonology. The evaluation of OSDB cannot rely on full-night attended polysomnography due to limited access. Identifying reliable markers of end organ dysfunction in children with OSDB may permit more rapid identification of patients in need of intervention like CPAP and assisted breathing. In addition, management options, as an alternative to adenotonsilectomy, are listed with a call for further research. Pulmonary diagnostics and monitoring will see the development and refinement of tools like the lung clearance index and the analysis of exhaled gasses, volatiles and dissolved biomarkers of inflammation as techniques that might help clinicians identify both the initiation of inflammation while it is more amenable to therapy, and to identify more readily the early changes associated with chronic lung diseases in children. The authors hope that these visionary articles will generate comments, arguments, inspiration, and perhaps even motivate funding agencies.

KW - cystic fibrosis

KW - paediatric asthma

KW - paediatric lung disease

KW - pneumonia

KW - sleep apnoea

UR - http://www.scopus.com/inward/record.url?scp=77953849819&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77953849819&partnerID=8YFLogxK

U2 - 10.1111/j.1440-1843.2010.01745.x

DO - 10.1111/j.1440-1843.2010.01745.x

M3 - Review article

VL - 15

SP - 733

EP - 741

JO - Respirology

JF - Respirology

SN - 1323-7799

IS - 5

ER -