Preface

Bronchial asthma is a chronic respiratory disease that poses a significant threat to the physical and mental well-being of children, placing a heavy burden on both families and society. The global prevalence of asthma is on the rise, making it crucial for pediatric healthcare professionals to prioritize the prevention and treatment of this condition. In recent years, experts in pediatric medicine have dedicated extensive research to understanding the causes, pathogenesis, clinical prevention, treatment, health education, and awareness of asthma. The objective is to ensure that healthcare personnel, children, and their families have accurate knowledge and can effectively prevent asthma.

While this research has yielded positive results, challenges persist due to the unequal distribution of medical resources, varying levels of disease prevention and treatment, and disparities in social development and disease knowledge. Consequently, healthcare professionals often lack comprehensive knowledge about asthma and require ongoing education regarding its diagnosis, treatment, and underlying mechanisms. Thus, there is an urgent need to enhance and broaden the understanding of asthmatic disease.

This book summarizes recent perspectives on the pathogenesis of asthma, advancements in its diagnosis and treatment, epigenetic and biomarker studies pertaining to asthma, the correlation between environmental factors, occupational hazards, and asthma development, as well as family education and asthma management. We firmly believe that this book will contribute to the promotion of asthma prevention, treatment, and research into its underlying mechanisms. Our sincere wish is for children with asthma worldwide to achieve a better quality of life.

**Xiaoyan Dong, M.D., Ph.D.**

Chair, Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

**Dr. Nanbert Zhong** 

New York State Institute for Basic Research in Developmental Disabilities, New York, United States of America

**1**

**Chapter 1**

**1. Introduction**

**and treatments**

develops rapidly.

Introductory Chapter: New

Understandings of Asthma

Asthma is a heterogeneous disease characterized by chronic airway inflammation and airway hyperresponsiveness, and the main lesion site is bronchi. It is a threat to public health worldwide and affects people of all ages. According to relevant data, it is conservatively estimated that there are at least 300 million asthma patients in the world, and 380,000 people die of asthma every year. Asthma has become a serious public health problem, bringing great pressure to individuals, families and the society. At the same time, the incidence of asthma is also one of the fastest rising diseases in the world. Data show that the overall prevalence of asthma in both adults and children has been increasing worldwide for the past 20 years. At present, the prevalence of asthma varies greatly among countries in the world, ranging from 0.3–17%, and the incidence of asthma varies in different regions and genders within the same country. Generally speaking, the incidence of asthma is higher in developed countries than in

developing countries and higher in urban areas than in rural areas [1, 2].

**2. New understandings of asthma in definitions, phenotypes** 

The mechanism of asthma is complicated, and its pathogenesis has not been fully understood. Currently, asthma is considered to be a heterogeneous disease with the combined effects of gene and environment [3]. Asthma is a polygenic disease, and hundreds of asthma susceptibility gene loci have been found, which are related to the molecular mechanism and pathophysiological manifestations. Epigenetics regulate asthma between environmental and genetic factors through DNA methylation, histone modification, and regulation of non-coding RNA [4]. At the same time, the complex role of airway and gut microbiome in the development and severity of asthma has also been recognized [3].

In recent years, thanks to the continuous explorations and understandings of the pathogenesis of asthma, as well as high-quality clinical trials and real-world data, the recommended treatment strategies of various countries are updated frequently, and new drugs for asthma treatment keep emerging. The field of asthma treatment

First, the definition of asthma is constantly being updated. The 2021 update of GINA no longer distinguishes between intermittent and mild persistent asthma and refers to both as mild asthma. The preferred treatment for mild asthma is updated to low-dose ICS/formoterol on demand [5]. However, the Spanish Asthma Management

*Ran Zhao and Xiaoyan Dong*
