Improving patient care for children with asthma: PeARL’s first steps

Improving patient care for children with asthma: PeARL’s first steps

Mathioudakis AG, Custovic A, Deschildre A, Price D et al. Research priorities in pediatric asthma: Results of a global survey of multiple stakeholder groups by the Pediatric Asthma in Real Life (PeARL) Think Tank. J Allergy Clin Immunol: In Pract 2020; In press.

Pediatric Asthma in Real Life (PeARL) is a think-tank led by international clinical researchers in Pediatric Asthma and initiated by the Respiratory Effectiveness Group (REG). This think-tank, of which Professor David Price is a member, was developed to address the unmet clinical needs in pediatric asthma. Professor Price is also the founder of the Observational Pragmatic Research Institute (OPRI) and Optimum Patient Care (OPC) and is heavily involved in asthma research, including that of pediatric asthma.

Currently, pediatric asthma is viewed as an extension of adult asthma, despite the two being very different in terms of disease mechanisms, triggers, diagnostic challenges, outcomes and response to treatments. This is largely due to the fact that not much data exists on pediatric asthma specifically, likely due to the ethical constraints of conducting research on children. Additionally, the criteria to extend adult asthma drug licences to children is rather lax, which only further contributes to this data shortage.

The PeARL think-tank was therefore developed to address these issues and thereby improve the quality of care for children with asthma.

By surveying the members of the PeARL think-tank, the current unmet clinical needs in pediatric asthma were identified in a large, international multi-stakeholder survey1. These results were then prioritized via a second survey sent to over 400 stakeholders from the following responder groups: leading experts, researchers, clinicians, patients, policymakers and the pharmaceutical industry. The differences across responder groups were also compared.

A total of 57 issues relating to the definition, natural history, classification, diagnosis, assessment, drug therapy, non-drug management and the management of exacerbations were identified and prioritized. The high-priority issues highlighted a clear need for stratified care based on biomarkers and clinical characteristics such as disease phenotype. Also, more data needs to be collected on disease progression and the future risk of severe asthma. Specifically, the persistence of disease severity, the progression of of pediatric asthma into adulthood and the development of fixed airway obstruction were highlighted as key concerns.

OPRI is taking steps to address this data shortage in pediatric asthma, as well as improve patient care for children with this disease. Currently, a pediatric registry for children with severe asthma, as well as urticaria and atopic dermatitis, is in the process of being established. “This will provide a valuable source of data for future observational real-life research,” said Professor Price, “so that pediatric asthma can be better understood and appropriately treated.”

In conclusion, although pediatric asthma remains largely uncharacterized and treatment options are mostly an extension of those for adult asthma, great strides are being taken to identify the gaps in knowledge, with the ultimate goal of improving patient care and outcome.