Asthma is the most common chronic respiratory disorder of children.

It is a pleomorphic disorder characterized by hypersensitivity induced bronchospasm,airway inflammation and variable airway obstruction.

More than 100 genes have been recognised which predispose a child to develop asthma,the most important is 17Q21

Most of the asthmatic children respond very well to inhaled corticosteroid(ICS) alone or in combination with long acting beta agonist(LABA) for the control of asthma symptoms and disabilities.Some children require LTRA in the form of monteleukast as an add on therapy to ICS and LABA for the control of asthma.

Rarely some children do not respond in spite of correct technique of inhalational medications , good compliance,allergen avoidance and comorbidities well addressed.

There is practically no drug available for these children below 12 years of age.

It has been well established that interleukin-4(IL-4) and interleukin-13(IL-13) are responsible for intiation of airway inflammation in asthmatic airways.So,some biological agents are being tried to block these inflammatory initiators.

A new biologic agent DUPILUMAB which blocks IL-4 and 1L-13 has shown promosing results to control severe  asthma in adults.

A study in this regard has been done by Jonathan Corren MD,David Geffen School of medicine,university of California,Los Angeles.According to him, the severity of asthma is best assessed by number of exacerbations in a span of time.He has studied on465,227,122,62 patients with asthma  with 1 0r more,2 or more,3 or more and 4 or more exacerbations respectively in one year.He had given 200mg to 300mg DUPILUMAB at an interval of 2 weeks in addition to ICS and LABA for 24 weeks.

The additioon of Dupilumab has improved the quality of life as assessed by Asthma quality of life questionnaire (AQLQ) and Asthma control questionnaire(ACQ 5,5items)..The impact was seen regardless of eosinophil counts.There was no difference in events of adverse effects among subgroups.Patients with greater number of exacerbations benefitted more.

This study warrants a multicentre study in children so that the children with very poorly controlled asthma even on appropriate therapy may benefit.

Lancet. 2016;388:31-44