CHICAGO,Aug. 3, 2025
asthma Attacks in Kids linked to New Inflammatory Pathways
Table of Contents
Even with targeted therapies, some children continue to suffer from asthma flare-ups, suggesting more complex triggers are at play.
- New research identifies three distinct inflammatory “engines” driving asthma exacerbations in children.
- These pathways are active even when allergic inflammation is suppressed by medication.
- Findings point to a need for more personalized asthma treatments.
Why do some children still have asthma attacks even when treated for allergic inflammation? A recent multicenter clinical trial published in Jama Pediatrics has uncovered new inflammatory pathways that contribute to asthma flare-ups in children,even when they receive targeted treatment.
Eosinophilic asthma, a common type, is marked by an overabundance of eosinophils, a type of white blood cell.While normally helpful against infections, in this condition, they gather in the airways, causing chronic inflammation and damage. Therapies targeting type 2 inflammation (T2), which drives eosinophil production, are standard treatments to curb these attacks.
However, the existence of persistent asthma attacks despite these therapies indicates that other inflammatory processes are also at work. “This suggests that other inflammatory pathways also play a role in exacerbations,” saeid Rajesh Kumar, MD, acting chief of allergies and immunology at Ann & Robert H. Lurie Children’s Hospital of Chicago, who co-authored the study.
Unraveling the Triggers
The study analyzed data from a prior trial involving children with eosinophilic asthma in low-income urban areas across nine American cities. Researchers compared the effectiveness of a T2-targeting biological therapy against a placebo over 52 weeks. While the biological therapy significantly reduced T2 inflammation, asthma attacks still occurred.
“The previous trial raised questions about what happens when you remove part of the allergic inflammation using a biological medication,” Dr. Kumar explained. “Why do some children experience exacerbations and others don’t? Different types of inflammation-allergic and non-allergic-interact with exacerbations, whether they’re viral or non-viral. We wanted a more precise way to understand what motivates some of the exacerbations in children.”
Dr. Rajesh Kumar, MD
by examining nasal samples from 176 episodes of acute respiratory illness, scientists pinpointed three distinct inflammatory drivers of asthma exacerbations. One involved epithelial inflammatory pathways, present in children receiving treatment regardless of viral infection. Another was macrophage-driven inflammation, specifically linked to viral respiratory illnesses. The third pathway involved excessive mucus production and cell stress responses, which were elevated in both treatment and placebo groups during flare-ups.
“We found that children who were still experiencing exacerbations on the drug had less of this allergic type of inflammation,” Dr. Kumar stated.”But they had other residual epithelial pathways that contributed to this inflammatory response involved in exacerbation.”
Personalized care Ahead
This research underscores the intricate nature of childhood asthma and the crucial need for tailored treatment plans. “There are several types of inflammatory responses involved in exacerbations, and they drive exacerbations differently depending on whether patients have a virus or are taking medication to block different parts of the inflammatory response,” Dr. Kumar noted.
Given that asthma disproportionately affects children in urban communities, these findings could pave the way for precise interventions. Tailoring treatments to the specific type of inflammation driving a child’s asthma could significantly improve their quality of life.
“This study gives us a better understanding of what leads to persistent exacerbations and opens the potential for new therapies or combinations of therapies based on this,” Dr. Kumar concluded.
The research received support from a grant from the National Institutes of Health (UM1AI11427).
