MODERN APPROACHES TO THE TREATMENT OF BRONCHIAL ASTHMA IN CHILDREN

Bronchial asthma in children remains one of the most prevalent chronic non-infectious diseases of the respiratory system and is characterized by pronounced clinical and biological heterogeneity. Current concepts of disease pathogenesis are associated with the predominance of type 2 (T2)–mediated inflammation, the involvement of genetic and molecular mechanisms, as well as the influence of social and environmental factors. Despite significant advances in pharmacotherapy, achieving sustained asthma control in the pediatric population remains a challenge, which drives interest in pathogenetically oriented therapeutic approaches.Objective. To summarize and analyze current scientific evidence on the molecular mechanisms underlying bronchial asthma in children and to evaluate pathogenetic treatment approaches, with a particular focus on biological therapy.Material and Methods. A narrative systematic review of the literature was conducted using the PubMed, Europe PMC, Cochrane Library, and Google Scholar databases. Publications from 2015 to 2025, as well as classical review articles addressing immunological, genetic, and molecular aspects of bronchial asthma in children, particularly in severe or uncontrolled disease, were analyzed.Results. The reviewed literature indicates that T2-mediated inflammation plays a central role in the pathogenesis of pediatric bronchial asthma. This process is driven by activation of Th2 lymphocytes and the production of cytokines IL-4, IL-5, and IL-13, which contribute to eosinophilic inflammation, IgE overproduction, and airway remodeling. Genetic factors were also shown to be significant, including increased expression of the TRPV1 gene. Biological agents (omalizumab, mepolizumab, dupilumab, and tezepelumab) demonstrate clinical efficacy in children with severe or uncontrolled bronchial asthma when therapy is individually tailored. However, even with effective blockade of T2-mediated pathways, alternative inflammatory mechanisms may be activated limiting treatment effectiveness. Disease course and therapeutic response are also substantially influenced by social, economic, and environmental factors.Conclusions. Pathogenetically oriented therapy represents a key component in the management of severe and uncontrolled bronchial asthma in children. Promising directions include further investigation of the long-term safety of biological agents, integration of omics technologies to predict treatment response, and refinement of personalized therapeutic strategies.